TY - JOUR
T1 - Long-term effects of premenopausal risk-reducing salpingo-oophorectomy on bone mineral density
AU - Beekman, Maarten J
AU - Terra, Lara
AU - Stuursma, Anniek
AU - Heemskerk-Gerritsen, Bernadette A M
AU - van Lennep, Jeanine E Roeters
AU - van Beurden, Marc
AU - van Doorn, Lena C
AU - de Hullu, Joanne A
AU - van Dorst, Eleonora B L
AU - Mom, Constantijne H
AU - Slangen, Brigitte F M
AU - Mitea, Christina
AU - Slart, Riemer H J A
AU - Snoeren, Miranda M
AU - Stokkel, Marcel P
AU - Verberne, Hein J
AU - de Keizer, Bart
AU - Korse, Catharina M
AU - Gaarenstroom, Katja N
AU - van Engelen, Klaartje
AU - van der Kolk, Lizet E
AU - Collée, J Margriet
AU - Wevers, Marijke R
AU - Ausems, Margreet G E M
AU - Berger, Lieke P V
AU - Garcia, Encarna B Gomez
AU - van Asperen, Christi J
AU - Hooning, Maartje J
AU - Maas, Angela H E M
AU - Mourits, Marian J E
AU - van Leeuwen, Flora E
AU - Zillikens, M Carola
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025/11
Y1 - 2025/11
N2 - Summary: Women at high familial risk for ovarian cancer are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO), leading to surgical menopause and short-term bone loss. However, long-term studies and osteoporosis screening recommendations are lacking. Eighteen years after premenopausal RRSO, women had lower bone mineral density compared with women who underwent a postmenopausal RRSO. Purpose: To prevent ovarian cancer, BRCA1/2 germline pathogenic variant carriers are recommended to undergo premenopausal risk-reducing salpingo-oophorectomy (RRSO). Premenopausal RRSO leads to immediate menopause, which has been associated with an acute phase of rapid bone loss. However, data on long-term bone mineral density (BMD) is scarce and inconclusive. We aimed to investigate long-term BMD after premenopausal RRSO. Methods: We conducted a cross-sectional study nested in a nationwide cohort of women at high familial risk of ovarian cancer. We compared 493 women who underwent premenopausal RRSO (≤ 45 years) with 228 women who underwent postmenopausal RRSO (≥ 54 years). BMD was assessed by Dual-Energy X-ray absorptiometry of the lumbar spine (LS) and femoral neck (FN). Age differences between the pre- and postmenopausal RRSO groups were accounted for using Z-scores. Results: Median age at study visit was 59.2 years in the premenopausal RRSO group and 69.7 years in the postmenopausal RRSO group (P < 0.001), median time since premenopausal RRSO was 18.1 years (IQR 15.3–21.3). In multivariable regression analyses the BMD Z-scores of the LS and FN were significantly lower for the premenopausal compared with the postmenopausal RRSO group (β -0.88, 95% CI, -1.10,-0.66 for LS; β -0.51, 95% CI, -0.71,-0.31 for FN). Relative risks (RRs) of having a Z-score ≤ -1.0 were also higher in the premenopausal compared with the postmenopausal RRSO group (RR 2.35, 95% CI, 1.26–4.40 and RR 1.84, 95% CI, 1.08–3.13, respectively). Conclusion: Premenopausal RRSO appears to be associated with long-term lowering of BMD Z-scores, emphasizing the importance of counseling women about bone health after premenopausal RRSO.
AB - Summary: Women at high familial risk for ovarian cancer are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO), leading to surgical menopause and short-term bone loss. However, long-term studies and osteoporosis screening recommendations are lacking. Eighteen years after premenopausal RRSO, women had lower bone mineral density compared with women who underwent a postmenopausal RRSO. Purpose: To prevent ovarian cancer, BRCA1/2 germline pathogenic variant carriers are recommended to undergo premenopausal risk-reducing salpingo-oophorectomy (RRSO). Premenopausal RRSO leads to immediate menopause, which has been associated with an acute phase of rapid bone loss. However, data on long-term bone mineral density (BMD) is scarce and inconclusive. We aimed to investigate long-term BMD after premenopausal RRSO. Methods: We conducted a cross-sectional study nested in a nationwide cohort of women at high familial risk of ovarian cancer. We compared 493 women who underwent premenopausal RRSO (≤ 45 years) with 228 women who underwent postmenopausal RRSO (≥ 54 years). BMD was assessed by Dual-Energy X-ray absorptiometry of the lumbar spine (LS) and femoral neck (FN). Age differences between the pre- and postmenopausal RRSO groups were accounted for using Z-scores. Results: Median age at study visit was 59.2 years in the premenopausal RRSO group and 69.7 years in the postmenopausal RRSO group (P < 0.001), median time since premenopausal RRSO was 18.1 years (IQR 15.3–21.3). In multivariable regression analyses the BMD Z-scores of the LS and FN were significantly lower for the premenopausal compared with the postmenopausal RRSO group (β -0.88, 95% CI, -1.10,-0.66 for LS; β -0.51, 95% CI, -0.71,-0.31 for FN). Relative risks (RRs) of having a Z-score ≤ -1.0 were also higher in the premenopausal compared with the postmenopausal RRSO group (RR 2.35, 95% CI, 1.26–4.40 and RR 1.84, 95% CI, 1.08–3.13, respectively). Conclusion: Premenopausal RRSO appears to be associated with long-term lowering of BMD Z-scores, emphasizing the importance of counseling women about bone health after premenopausal RRSO.
KW - Bone Mineral Density
KW - DXA
KW - Early Menopause
KW - Epidemiology
KW - Estrogen
UR - https://www.scopus.com/pages/publications/105017880356
U2 - 10.1007/s00198-025-07679-8
DO - 10.1007/s00198-025-07679-8
M3 - Article
C2 - 41045325
SN - 0937-941X
VL - 36
SP - 2307
EP - 2317
JO - Osteoporosis International
JF - Osteoporosis International
IS - 11
ER -