Article Text

Download PDFPDF
Opportunistic osteoporosis screening using routine computed tomography images to identify bone loss in gynecologic cancer survivors
  1. Janelle Sobecki1,
  2. Benjamin Weigman2,
  3. India Anderson-Carter2,
  4. Lisa Barroilhet1,
  5. Thevaa Chandereng3,
  6. Mark Kliewer4 and
  7. Ellen Hartenbach1
  1. 1Department of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  2. 2University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  3. 3Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  4. 4Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  1. Correspondence to Dr Janelle Sobecki, Department of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, USA; janelle.sobecki{at}wisc.edu

Abstract

Objective Cancer treatment-induced bone loss is a known side effect of cancer therapy. Computed tomography (CT) bone mineral density screening is a novel tool for identifying bone loss. This study aims to use routine CT images to determine long-term bone mineral density changes and osteoporosis risk among women with gynecologic cancers.

Methods Bone loss was evaluated in a retrospective cohort of women ≤65 years old with gynecologic cancer who underwent oophorectomy from January 2010 to December 2014. Opportunistic CT-based bone mineral density measurements (Hounsfield units, HU) were performed at baseline and intervals up to 5 years after cancer diagnosis. Osteoporosis risk was categorized by HU. Bivariate and multivariate analyses were performed to compare baseline to follow-up bone mineral density at 1, 3, and 5 years and to identify predictors of bone loss following diagnosis.

Results A total of 185 patients (median age 53 years, range 23–65 years, 78.1% ovarian cancer) were included. Bone mineral density significantly decreased between baseline and 1 year (p<0.001), 3 years (p<0.001), and 5 years (p<0.001). Half with normal bone mineral density at baseline had risk for osteopenia or osteoporosis at 5 years. Four percent had osteoporosis risk at baseline compared with 1 year (7.4%), 3 years (15.7%), and 5 years (18.0%). Pre-treatment bone mineral density was a significant predictor at 1 and 5 years (1 year: p<0.01; 5 years: p<0.01). History of chemotherapy predicted bone loss at 1 year (p=0.03). More lifetime chemotherapy cycles were associated with increased risk of osteoporosis at 1 year (p=0.03) and 5 years (p=0.01).

Conclusions Women with gynecologic cancers may experience accelerated cancer treatment-induced bone loss. Routine CT imaging is a convenient screening modality to identify those at highest risk for osteoporosis who warrant further evaluation with dual-energy X-ray absorptiometry. Routine bone mineral density assessments 1 year following oophorectomy for cancer treatment may be warranted in this population.

  • quality of Life (PRO)/palliative care
  • uterine cancer
  • ovarian cancer

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

Statistics from Altmetric.com

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

View Full Text

Footnotes

  • Contributors JS and EH participated in conceptualization, data curation, roles/writing – original draft, writing – review and editing. BW participated in data curation and writing – review and editing. IA-C participated in data curation and writing – review and editing. LB participated in writing – review and editing. TC participated in data curation and analysis. MK participated in conceptualization, data curation, and writing – review and editing. JS is responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.