Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early-stage breast cancer

Purpose: We sought to evaluate the effects of chemotherapy-induced ovarian failure on bone loss and markers of skeletal turnover in ct prospective lon gitudinal study of young women with breast cancer receiving adjuvant chemot herapy. patients and Methods: Forty-nine premenopausal women with stage I/II breast cancers receiving adjuvant chemotherapy were evaluated within 4 weeks of s tarling chemotherapy (baseline), and 6 and 12 months after starling chemoth erapy with dual-energy absorptiometry and markers of skeletal turnover oste ocalcin and bone-specific alkaline phosphatase. Chemotherapy-induced ovaria n failure was defined as a negative pregnancy test, greater than 3 months o f amenorrhea, and a follicle-stimulating hormone greater than or equal to 3 0 MIU/mL at the la-month evaluation. Results: Among the 35 women who were defined as having ovarian failure, hig hly significant bone loss was observed in the lumbar spine by 6 months and increased further at 12 months. The median percentage decrease of bone mine ral density in the spine from 0 to 6 months and 6 to 12 months was -4.0 (ra nge, -10.4 to +1.0; P = .0001) and -3.7 (range, -10.1 to 9.2; P = .0001), r espectively In contrast, there were no significant decreases in bone minera l density in the 14 patients who retained ovarian function, Serum osteocalc in and bone specific alkaline phosphatase, markers of skeletal turnover, in creased significantly in the women who developed ovarian failure, Conclusion: Chemotherapy-induced ovarian failure causes rapid and highly si gnificant bone loss in the spine, This may have implications for long-term breast cancer survivors who may be at higher risk for osteopenia, and subse quently osteoporosis. Women with breast cancer who develop chemotherapy-ind uced ovarian failure should have their bone density monitored and treatment s to attenuate bone loss should be evaluated, (C) 2001 by American Society of Clinical Oncology.