Ovarian suppression as a result of surgical ablation
Oophorectomy before the menopause
In premenopausal individuals, the effect of oophorectomy on bone has been examined in two retrospective studies. In the first of these, a case-control study of 146 patients with a mean
age at oophorectomy of 25 years,35 there was a greater than two-fold increase in the risk of developing any subsequent fracture when compared with age-matched controls. More specifically, there was an increased risk of developing a hip or radial forearm fracture (2-fold and 3.7-fold, respectively).
In the second study,36 describing a cohort of 463 patients with a median age of 43.8 years, there was a significantly increased risk of developing either a vertebral fracture (standardized morbidity ratio [SMR] 1.9; 95% CI 1.3–2.8) or a forearm fracture (SMR 1.4; 95% CI 1.0–2.0). There was no increased risk of hip fracture. However, confounding factors were that 60% of women had taken HRT at some time, with 80% doing so within the first year after oophorectomy. Younger women were more likely to develop fractures and were more likely to be taking HRT.
Effects of HRT on bone in individuals who have undergone oophorectomy
One hundred women who had taken part in a prospective controlled trial of oestrogen therapy for the prevention of postoophorectomy bone loss were reviewed after a median follow-up period of 9 years. A significant reduction in height occurred among the placebo-treated group, but not in the group treated with mestranol (mean 23 x 3 μg/day). The placebo-treated group had a higher spine score, lower central vertebral height, and larger wedge-angle than the oestrogen group.
Within each group, none of these spinal morphometric changes correlated with changes in mineral content of metacarpal or radial bones as measured by photon absorptiometry or X-ray densitometry, although both peripheral and central measurements showed highly significant differences between the two groups.
Oestrogen treatment, therefore, prevents against central, as well as peripheral, bone loss, and reduces the incidence of vertebral compression. Three case-control and two case series have attempted to evaluate what effect the provision of HRT has on bone density following oophorectomy. Interpretation of the studies is difficult as they are small studies of less than 88 patients. The mean ages of patients studied have ranged from 40 to 50 years, with one case series reporting two patients of 12 years of age.
These studies have indicated that, following oophorectomy, there is a reduction in bone density of up to 10% in the 3 years afterwards. However, in the setting of breast cancer, HRT is not recommended for bone protection due to the adverse effects of HRT on breast cancer recurrence and the availability of alternative therapies.
Oophorectomy before the menopause
In premenopausal individuals, the effect of oophorectomy on bone has been examined in two retrospective studies. In the first of these, a case-control study of 146 patients with a mean
age at oophorectomy of 25 years,35 there was a greater than two-fold increase in the risk of developing any subsequent fracture when compared with age-matched controls. More specifically, there was an increased risk of developing a hip or radial forearm fracture (2-fold and 3.7-fold, respectively).
In the second study,36 describing a cohort of 463 patients with a median age of 43.8 years, there was a significantly increased risk of developing either a vertebral fracture (standardized morbidity ratio [SMR] 1.9; 95% CI 1.3–2.8) or a forearm fracture (SMR 1.4; 95% CI 1.0–2.0). There was no increased risk of hip fracture. However, confounding factors were that 60% of women had taken HRT at some time, with 80% doing so within the first year after oophorectomy. Younger women were more likely to develop fractures and were more likely to be taking HRT.
Effects of HRT on bone in individuals who have undergone oophorectomy
One hundred women who had taken part in a prospective controlled trial of oestrogen therapy for the prevention of postoophorectomy bone loss were reviewed after a median follow-up period of 9 years. A significant reduction in height occurred among the placebo-treated group, but not in the group treated with mestranol (mean 23 x 3 μg/day). The placebo-treated group had a higher spine score, lower central vertebral height, and larger wedge-angle than the oestrogen group.
Within each group, none of these spinal morphometric changes correlated with changes in mineral content of metacarpal or radial bones as measured by photon absorptiometry or X-ray densitometry, although both peripheral and central measurements showed highly significant differences between the two groups.
Oestrogen treatment, therefore, prevents against central, as well as peripheral, bone loss, and reduces the incidence of vertebral compression. Three case-control and two case series have attempted to evaluate what effect the provision of HRT has on bone density following oophorectomy. Interpretation of the studies is difficult as they are small studies of less than 88 patients. The mean ages of patients studied have ranged from 40 to 50 years, with one case series reporting two patients of 12 years of age.
These studies have indicated that, following oophorectomy, there is a reduction in bone density of up to 10% in the 3 years afterwards. However, in the setting of breast cancer, HRT is not recommended for bone protection due to the adverse effects of HRT on breast cancer recurrence and the availability of alternative therapies.
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