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. 2012 Nov 19;2(1):11-7.
doi: 10.1530/EC-12-0043. Print 2013 Mar 1.

Bone mineral loss induced by anticancer treatment for gynecological malignancies in premenopausal women

Keina Nishio  1 , Akiko Tanabe, Risa Maruoka, Kiyoko Nakamura, Masaaki Takai, Tatsuharu Sekijima, Satoshi Tunetoh, Yoshito Terai, Masahide Ohmichi
Affiliations

Bone mineral loss induced by anticancer treatment for gynecological malignancies in premenopausal women

Keina Nishio et al. Endocr Connect. .

Abstract

Objective: Although surgical menopause may increase the risks of osteoporosis, few studies have investigated the influence of chemotherapy and radiation therapy. The aim of this study is to evaluate the effects of treatments for gynecological malignancies on bone mineral density (BMD).

Methods: This study enrolled 35 premenopausal women (15 ovarian cancers (OCs), 9 endometrial cancers (ECs), and 11 cervical cancers (CCs)) who underwent surgical treatment that included bilateral oophorectomy with or without adjuvant platinum-based chemotherapy in OC and EC patients, or concurrent chemo-radiation therapy (CCRT) in CC patients according to the established protocols at the Osaka Medical College Hospital between 2006 and 2008. The BMD of the lumbar spine (L1-L4) was measured by dual-energy X-ray absorptiometry, and urine cross-linked telopeptides of type I collagen (NTx) and bone alkaline phosphatase (BAP) were assessed for evaluation of bone resorption and bone formation respectively. These assessments were performed at baseline and 12 months after treatment.

Results: Although the serum BAP was significantly increased only in the CC group, a rapid increase in the bone resorption marker urinary NTx was observed in all groups. The BMD, 12 months after CCRT was significantly decreased in the CC group at 91.9±5.9% (P<0.05 in comparison to the baseline).

Conclusion: This research suggests that anticancer therapies for premenopausal women with gynecological malignancies increase bone resorption and may reduce BMD, particularly in CC patients who have received CCRT. Therefore, gynecologic cancer survivors should be educated about these potential risks and complications.

Keywords: bone mineral density; cervical cancer; concurrent chemo-radiation therapy; surgical menopause.

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Figures

Figure 1
Figure 1
Study design. TC, paclitaxel plus carboplatin chemotherapy; OC, ovarian cancer; EC, endometrial cancer; CC, cervical cancer; BMD, bone mineral density; CCRT, concurrent chemo-radiation therapy.
Figure 2
Figure 2
Effect of anticancer treatment on bone turnover markers. Serum BAP (A) and urine NTx (B) were measured before surgical treatment (baseline) and at 12 months after the cancer treatment (after treatment). Vertical bars represent the mean±s.d. A value of P is shown in comparison to the baseline. Significant differences are indicated by asterisks. *P<0.05; **P<0.01.
Figure 3
Figure 3
Effect of anticancer treatment on bone mineral density. The lumbar spine BMD was measured before surgical treatment (baseline) and at 12 months after the cancer treatment (after treatment). The percentage change from baseline is shown. Vertical bars represent the mean±s.d. A value of P is shown in comparison to the baseline. Significant differences are indicated by asterisks. *P<0.05.
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