Endocrine Abstracts

JOINT470

Introduction: Bone loss in younger gynecologic cancer survivors occurs prematurely, sometimes decades before routine age-based osteoporosis screening in the general population. Data regarding bone loss management in this group of patients are generally lacking, especially in ovarian cancer survivors.

Case: A 31-year-old female was referred to an endocrinologist regarding the treatment strategy for osteoporosis. The medical history was clarified: in 2014, she was diagnosed with stage 3 ovarian cancer (G1 serous carcinoma). Laparotomy, total hysterectomy with adnexectomy, omentectomy, peritonectomy in the minor pelvic region and diaphragm, and paraaortic lymphadenectomy were performed, followed by six cycles of Paclitaxel/Carboplatin chemotherapy in the same year. Due to a BRCA2 gene mutation revealed by genetic testing, the usual choice of hormone replacement therapy (HRT) was not applied. She was monitored for oncologic recurrence and osteoporosis development. The patient was regularly followed up by the endocrinologist, with observation of Ca-P metabolism tests, bone markers (BAP, CTX), and DXA changes. DXA results presented progression from osteopenia in 2015 (spine: T-1,22; 1,033 g/cm²) to osteoporosis in 2023 (T-3,6; 0,741 g/cm²). The patient was discussed in the Reproductive Health MDT: there are no clear contraindications for prescribing HRT in the presence of a previous oncological disease and the BRCA2 gene mutation. The BRCA2 gene mutation increases the risk of breast cancer in postmenopausal women; however, there is no data indicating an increased risk at a younger age. At this stage, was recommended to prescribe HRT for at least one year, and if osteoporosis continues to progress or osteoporotic fractures occur earlier, bisphosphonates should be prescribed.

Conclusion: This case highlights the challenging management of osteoporosis in young cancer survivor and the necessity of MDT when facing a clinical situation with no strong clinical evidence and treatment guidelines.