Elevated bone turnover markers after risk-reducing salpingo-oophorectomy in women at increased risk for breast and ovarian cancer

Ingrid E. Fakkert*, Eveline Van Der Veer, Elske Marije Abma, Joop D. Lefrandt, Bruce H.R. Wolffenbuttel, Jan C. Oosterwijk, Riemer H.J.A. Slart, Iris G. Westrik, Geertruida H. De Bock, Marian J.E. Mourits

*Corresponding author for this work

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Abstract

Background: Risk-reducing salpingo-oophorectomy (RRSO) reduces ovarian cancer risk in BRCA1/2 mutation carriers. Premenopausal RRSO is hypothesized to increase fracture risk more than natural menopause. Elevated bone turnover markers (BTMs) might predict fracture risk. We investigated BTM levels after RRSO and aimed to identify clinical characteristics associated with elevated BTMs.

Methods: Osteocalcin (OC), procollagen type I N-terminal peptide (PINP) and serum C-telopeptide of type I collagen (sCTx) were measured in 210 women ≥ 2 years after RRSO before age 53. BTM Z-scores were calculated using an existing reference cohort of age-matched women. Clinical characteristics were assessed by questionnaire.

Results: BTMs after RRSO were higher than age-matched reference values: median Z-scores OC 0.11, p = 0.003; PINP 0.84, p < 0.001; sCTx 0.53, p < 0.001 (compared to Z = 0). After excluding women with recent fractures or BTM interfering medication, Z-scores increased to 0.34, 1.14 and 0.88, respectively. Z-scores for OC and PINP were inversely correlated to age at RRSO. No correlation was found with fracture incidence or history of breast cancer.

Conclusions: Five years after RRSO, BTMs were higher than age-matched reference values. Since elevated BTMs might predict higher fracture risk, prospective studies are required to evaluate the clinical implications of this finding.

Original languageEnglish
Article numbere0169673
JournalPLoS ONE
Volume12
Issue number1
DOIs
Publication statusPublished - 1 Jan 2017

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    Fakkert, I. E., Van Der Veer, E., Abma, E. M., Lefrandt, J. D., Wolffenbuttel, B. H. R., Oosterwijk, J. C., ... Mourits, M. J. E. (2017). Elevated bone turnover markers after risk-reducing salpingo-oophorectomy in women at increased risk for breast and ovarian cancer. PLoS ONE, 12(1), [e0169673]. https://doi.org/10.1371/journal.pone.0169673