April 8, 2021

New Review Recommends Earlier Osteoporosis Screenings for Gynecologic Cancer Survivors

People diagnosed with cancer often have health concerns related to the ongoing management of both their cancer and the effects of their treatment regimen. That can include bone health.  

To the end, researchers in UW-Madison’s Department of Obstetrics and Gynecology and members of the UW Carbone Cancer Center recently authored a review published in Gynecologic Oncology that put forward recommendations on osteoporosis screenings specific to gynecologic cancer survivors.

“We are concerned our patients are at least as at risk for bone loss, if not at increased risk, compared to patients with other cancer types,” said lead author and gynecologic oncology fellow Janelle Sobecki, MD.

From research in breast and prostate cancers, scientists know that chemotherapy and radiation therapy can lead to decreases in bone mineral density. However, people diagnosed with gynecologic cancer undergo other treatments that increase their risk for bone loss through their effect on the ovaries.

For example, the radiation therapy often used to treat cervical cancer can stop ovarian function. Additionally, some people with gynecologic cancer have their ovaries removed in a procedure called an oophorectomy.

“From what we know about the effects of oophorectomy alone on bone health, we recognize bone loss is likely an important aspect of survivor care in our patient population,” Sobecki said.

Since estrogen — a hormone produced and secreted by the ovaries — has a positive and protective effect on bone health in women, treatments that remove the primary source of it can have a detrimental effect on bone mineral density. This means bone loss could start happening in gynecologic cancer survivors years before they might start receiving regular osteoporosis screenings at age 65.

In looking the current scientific data for this population, the researchers discovered that surprisingly few studies had ever specifically looked at bone density in gynecologic cancer survivors. 

“There have been some survivorship papers and there's been lots written about osteoporosis, but what we found out was bone health in gynecologic cancer survivors is a little bit of an understudied area,” said Ellen Hartenbach, MD, a UW Carbone member and senior author on the study.

Based on the data they reviewed, Sobecki, Hartenbach, and gynecologic oncologist Laurel Rice, MD, recommended that any woman with gynecologic cancer should have bone density screenings within one to two years after treatment. They also specifically identified premenopausal women who have had an oophorectomy or pelvic radiotherapy as people at higher risk for bone loss.

Sobecki also said that prioritizing screenings for gynecologic cancer survivors with other well-known risk factors for bone loss — like previous history of nontraumatic fracture, rheumatoid arthritis, low body weight, or parents’ history of hip fracture — would also be important.  

“There are incredibly safe and effective treatments for osteoporosis, so this really is an issue of timely identification of women at risk and getting those women to screening,” Sobecki said.

In collaboration with radiologist Mark Kliewer, MD, Sobecki and Hartenbach are now studying if CT scans — which are already routine procedures for gynecologic cancer survivors — could be used to monitor their bone health following cancer treatment.

“It would be great to identify people who have bone loss with a CT scan and that could then trigger bone mineral density or more investigation,” Hartenbach said.

The researchers hope that awareness of the risk of bone loss in gynecologic cancer survivors will soon routinely be incorporated into survivorship care plans. These documents serve as a summary of someone’s cancer diagnosis and treatment, helping oncologists communicate with both the cancer survivor and their primary care physician.

“Survivorship care is widely recognized as an important aspect of gynecologic cancer care, but there are many components to survivor care,” Sobecki said. “The first step is recognition that bone health is important for gynecologic cancer survivors.”

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