From the Guidelines
Yes, you can get an early DEXA scan if you've had an oophorectomy and total hysterectomy, as these procedures increase the risk of osteoporosis and fractures due to the sudden drop in estrogen production. These procedures cause surgical menopause, which can lead to rapid bone loss, with bone density decreasing by 2-3% per year in the first few years after surgery, compared to about 1% per year with natural menopause 1. The standard recommendation is to get a baseline DEXA scan within the first year after surgery, rather than waiting until age 65 as typically recommended for women with natural menopause.
Key Considerations
- Early detection of bone loss allows for timely intervention with medications like bisphosphonates, hormone replacement therapy, or calcium and vitamin D supplementation to prevent osteoporosis and reduce fracture risk 1.
- Dual-energy x-ray absorptiometry (DXA) is the current gold standard test for diagnosing osteoporosis in people without an osteoporotic fracture, and results are scored as T scores, with a T score of –2 indicating a BMD that is 2 SDs below the comparative norm 1.
- Risk scores that combine clinical risk factors with BMD testing results, such as FRAX, can be used to predict fracture risk among people with low bone density 1.
Recommendations
- Discuss with your healthcare provider about scheduling a baseline DEXA scan within the first year after surgery, and follow-up scans every 1-2 years to monitor bone density changes.
- Consider pharmacologic treatments for osteoporosis, such as bisphosphonates, peptide hormones, estrogen, or selective estrogen receptor modulators (SERMs), as well as dietary and supplemental calcium and vitamin D, to prevent bone resorption and reduce fracture risk 1.
From the Research
Oophorectomy and Hysterectomy
- Patients who have undergone an oophorectomy and total hysterectomy may be at increased risk of osteoporosis due to the resulting decrease in estrogen levels 2.
- Estrogen deficiency is a significant risk factor for osteoporosis, and patients who have undergone hysterectomy and oophorectomy may experience accelerated bone loss 3, 2.
Bone Density Scans
- There is no specific evidence to suggest that patients who have undergone an oophorectomy and total hysterectomy should receive an early DEXA scan.
- However, given the increased risk of osteoporosis in these patients, it may be reasonable to consider earlier screening for osteoporosis, including DEXA scans, to assess bone density and guide treatment decisions 2, 4.
Treatment Options
- Treatment options for osteoporosis in patients who have undergone an oophorectomy and total hysterectomy may include hormone replacement therapy (HRT), bisphosphonates, selective estrogen receptor modulators, and calcitonin 3, 5, 6, 4.
- The choice of treatment will depend on individual patient factors, including age, medical history, and bone density results 3, 6, 4.