Bone health after RRBSO among BRCA1/2 mutation carriers: a population-based study

Area of Science:

• Oncology
• Gynecology
• Endocrinology
• Orthopedics

Background:

• Women with BRCA1/2 mutations often undergo risk-reducing bilateral salpingo-oophorectomy (RRBSO) to prevent cancer.
• The long-term effects of RRBSO on bone health, specifically osteoporosis and fracture risk, require thorough investigation.

Purpose of the Study:

• To assess the risks of fractures and osteoporosis in women with BRCA1/2 mutations following RRBSO.
• To compare these risks against age-matched controls who underwent different gynecological procedures.

Main Methods:

• Retrospective population-based study in British Columbia (1996-2017).
• Compared 329 women with BRCA1/2 mutations undergoing RRBSO before age 50 to 3,290 women who had bilateral oophorectomy and 3,290 women with intact ovaries.
• Secondary outcomes included DEXA scan and bisphosphonate use.

Main Results:

• No increased fracture hazard was observed in BRCA1/2 mutation carriers post-RRBSO compared to controls.
• However, women with BRCA1/2 mutations showed a significantly higher risk of osteoporosis (aHR=1.60 vs. BO, aHR=2.49 vs. intact ovaries).
• Despite higher DEXA scan rates, only 46% of mutation carriers were screened, and 36% of those diagnosed with osteoporosis received bisphosphonates.

Conclusions:

• RRBSO in BRCA1/2 mutation carriers is associated with an elevated risk of osteoporosis, not fractures.
• Current rates of bone density screening (DEXA) and bisphosphonate use are suboptimal, indicating a need for improved bone loss prevention strategies.