Five years after RRSO, BMD and fracture incidence were not different than expected from the general population. Based on these data it appears safe not to intensively screen for osteoporosis within five years after RRSO, although prospective research on the long-term effects of RRSO on bone is warranted.

Background Oophorectomy is recommended for women at increased risk for ovarian cancer. When performed at premenopausal age oophorectomy induces acute surgical menopause, with unwanted consequences. Objective To investigate bone mineral density (BMD) and fracture prevalence after surgical menopause. Search strategy A literature search of PubMed, EMBASE and Cochrane library was performed with no date restriction. Date of last search was March 1st, 2016. Selection criteria Primary studies reporting on BMD, T‐scores or fracture prevalence in women with surgical menopause and age‐matched control groups. Data collection and analysis Data were extracted on BMD (g/cm2), T‐scores and fracture prevalence in women with surgical menopause and control groups. Quality was assessed by an adaptation of the Downs and Black checklist. Random effects models were used to meta‐analyse results of studies reporting on BMD or fracture rates. Main results Seventeen studies were included, comprising 43 386 women with surgical menopause. Ten studies provided sufficient data for meta‐analysis. BMD after surgical menopause was significantly lower than in premenopausal age‐matched women [mean difference lumbar spine, −0.15 g/cm2 (95% CI, −0.19 to −0.11 g/cm2); femoral neck, −0.17 g/cm2 (95% CI, −0.23 to −0.11 g/cm2)] but not lower than in women with natural menopause [lumbar spine, −0.02 g/cm2 (95% CI, −0.04 to 0.00 g/cm2); femoral neck, 0.04 g/cm2 (95% CI, −0.09 to 0.16 g/cm2)]. Hip fracture rate was not higher after surgical menopause compared with natural menopause [hazard ratio: 0.85 (95% CI, 0.70 to 1.04)]. Author's conclusions No evident effect of surgical menopause was observed on BMD and fracture prevalence compared with natural menopause. However, available studies are prone to bias and need to be interpreted with caution. Tweetable abstract Bone health after menopause: no evidence for additional effect of surgical menopause on BMD and fractures.

BackgroundRisk-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.MethodsOsteocalcin (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.ResultsBTMs 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.ConclusionsFive 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.