BONE-MINERAL DENSITY IN WOMEN WITH CYTOTOXIC-INDUCED OVARIAN FAILURE

OBJECTIVE Premature ovarian failure is associated with a reduction in bone mineral density. As survival rates following treatment for haemat ological malignancies improve, chemotherapy-induced ovarian failure is becoming more common. However, there are few data concerning the impa ct of this on bone mineral density (BMD), We have therefore measured t he BMD in 33 women with ovarian failure following treatment with cytot oxic chemotherapy. PATIENTS AND DESIGN We studied 33 women who receive d combination chemotherapy for Hodgkin's disease (n=27), non-Hodgkin's lymphoma (n=4), sarcoma (n=1) and acute myeloid leukaemia (n=1), The mean (range) age of the subjects at the time of BMD measurement was 37 .5 (24-50) years and the mean (median: range) duration of amenorrhoea was 49 (24: 5-277) months. Eleven women had received hormone replaceme nt therapy (HRT) for a mean (range) duration of 25 (1-62) months. BMD was measured by single photon absorptiometry or single X-ray absorptio metry, and dual energy X-ray absorptiometry at the distal and proximal radius, the femoral neck and the lumbar spine, respectively. BMD was expressed as Z-scores and statistical analysis was performed using the Wilcoxon matched-pairs signed-rank test. RESULTS There was no signifi cant reduction in BMD at the hip, spine or forearm in the cohort as a whole, although there was a trend to reduce bone density at all sites. When patients who had received HRT were excluded from the analysis th ere were small reductions in mean BMD at all sites, but this was only statistically significant at the proximal forearm (Z-score=-0.65; P=0. 03). Mean BMD of the HRT-treated patients was normal at all sites. Onl y seven patients (21%) had a BMD Z-score< -2 at any site. CONCLUSION I t is inappropriate to assume that ovarian failure from different aetio logies has a similar deleterious impact on the skeleton. Untreated pre mature ovarian failure following cytotoxic chemotherapy results in som e reduction in bone mineral density, but this is of a minor degree and is less than that observed in other hypo-oestrogenic states. The reas on for this is unclear but studies of residual hormone production in t he cytotoxic-damaged ovary may provide an answer.