Bone Health in Gynecologic Oncology Patients
Özet
Osteoporosis, a prevalent metabolic bone disorder, poses a significant risk in gynecologic oncology patients due to multiple interrelated factors. Women with gynecologic malignancies are predisposed to accelerated bone loss from cancer treatments—including oophorectomy, chemotherapy, and pelvic radiotherapy—as well as iatrogenic menopause and hormonal suppression. Bilateral salpingo-oophorectomy (BSO), routinely performed for surgical staging, induces abrupt estrogen deficiency, thereby increasing the risk of osteopenia and osteoporosis. Chemotherapeutic agents and glucocorticoids exacerbate bone demineralization, while pelvic radiotherapy significantly heightens the risk of insufficiency fractures, particularly in postmenopausal women. Studies have shown that bone mineral density (BMD) in cervical and ovarian cancer patients is markedly reduced both before and after treatment, and that post-treatment bone loss is especially pronounced in endometrial cancer patients who develop treatment-induced hypogonadism.
Routine osteoporosis screening using dual-energy X-ray absorptiometry (DEXA) and risk assessment tools such as FRAX is strongly recommended in this population. Preventive measures—including adequate calcium and vitamin D supplementation, weight-bearing exercise, and pharmacologic interventions (bisphosphonates or denosumab)—are essential for long-term survivorship care. Early recognition and management of bone loss not only reduces fracture risk but also improves quality of life and functional outcomes in gynecologic cancer survivors.
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