Kaiser Permanente Northern California Gynecologic Cancer Program, San Francisco, CA, USA; Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA.
Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA.
Gynecol Oncol. 2018 Mar;148(3):535-539. doi: 10.1016/j.ygyno.2018.01.013.
Estimate the prevalence and identify risk factors for bone loss in women with BRCA mutations.
Women, age 40 and older, with BRCA mutations identified from the Breast Cancer Surveillance database at Kaiser Permanente Northern California were invited to participate and undergo a dual-energy x-ray absorptiometry scan to assess for bone loss (osteopenia or osteoporosis). Multivariable logistic regression analysis was performed to assess clinical factors associated with bone loss.
Of the 238 women in the final cohort, 20 women had intact ovaries (median age 54.5years) and 218 had undergone risk reducing salpingo-oophorectomy (RRSO) (median age 57). The prevalence of bone loss was 55% in the no RRSO group and 72.5% in the RRSO group (P=0.10). In multivariable analysis, only higher body mass index (OR 0.6 per 5kg/m, 95% CI: 0.4-0.7) and nonwhite race compared to white (OR 0.5, 95% CI: 0.2-0.9) were protective for bone loss while older age (OR 1.5 per 10years, 95% CI: 1.1-2.1) and selective estrogen receptor modulator use (3.1, 95% CI: 1.2-10.1) were associated with increased odds of bone loss. Among women with RRSO, bone loss was more frequent in women who had postmenopausal (n=106) compared to women who had premenopausal RRSO (n=112), (82.1% and 63.4% respectively, P=0.002). In multivariable analysis, only BMI was protective of bone loss (OR 0.5, 95%, CI: 0.4-0.7) but neither age nor menopausal status at RRSO were associated with bone loss.
Bone loss is common in women with BRCA mutations who undergo RRSO.
估计携带 BRCA 突变的女性发生骨质流失的患病率，并确定其相关风险因素。
从 Kaiser Permanente 北加州的乳腺癌监测数据库中招募年龄在 40 岁及以上且携带 BRCA 突变的女性，并邀请她们参加双能 X 线吸收法扫描以评估骨质流失（骨质疏松或骨质减少）情况。采用多变量逻辑回归分析来评估与骨质流失相关的临床因素。
在最终队列的 238 名女性中，20 名女性卵巢功能完整（中位年龄 54.5 岁），218 名女性接受了预防性输卵管卵巢切除术（RRSO）（中位年龄 57 岁）。未行 RRSO 组的骨质流失患病率为 55%，而行 RRSO 组为 72.5%（P=0.10）。多变量分析显示，仅较高的体重指数（每增加 5kg/m，OR 0.6，95%CI：0.4-0.7）和非白种人（与白种人相比，OR 0.5，95%CI：0.2-0.9）种族对骨质流失有保护作用，而年龄较大（每增加 10 岁，OR 1.5，95%CI：1.1-2.1）和选择性雌激素受体调节剂的使用（OR 3.1，95%CI：1.2-10.1）与骨质流失的风险增加相关。在 RRSO 后的女性中，绝经后（n=106）的骨质流失发生率高于 RRSO 前绝经（n=112）的女性（分别为 82.1%和 63.4%，P=0.002）。多变量分析显示，只有 BMI 对骨质流失有保护作用（OR 0.5，95%CI：0.4-0.7），但 RRSO 时的年龄或绝经状态与骨质流失无关。
行 RRSO 的携带 BRCA 突变的女性骨质流失较为常见。
