Bone Test May Predict Infertility in Breast Cancer Patients

Armen Hareyan's picture

Breast Cancer and Infertility

A simple bone test may be the best predictor yet of who is, and who is not, most likely to go through early menopause following chemotherapy treatment for breast cancer.

Young women with localized breast cancer who receive chemotherapy sometimes lose their ability to have children because the toxic effects of the drugs destroy normal ovarian function. For women who are hoping to have children, the resulting early menopause and loss of fertility can be devastating.

Clinicians have traditionally relied upon two broad measures, age and the total amount of the chemotherapeutic drug cyclophosphamide (Cytoxan) the patient receives, to help them predict who is likely to go through early menopause or develop problems with fertility. Generally, the closer a woman is to menopause and the greater the amount of Cytoxan in her treatment plan, the more likely she is to undergo early menopause.

But now, after researching multiple biological and behavioral factors among several dozen young breast cancer patients, Ohio State cancer researchers have discovered that baseline bone mineral density of the spine (BMD) may be an even more precise way to calculate the risk of infertility.

The findings appear in a recent issue of the journal Breast Cancer Research and Treatment.

"Not every breast cancer patient needs chemotherapy, but for those who do, this discovery may be helpful in more accurately predicting who will go into early menopause. We think it may be able to help women better weigh the value and consequences of chemotherapy," says Dr. Charles Shapiro, director of breast medical oncology at The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and senior author of the study.

Shapiro studied 49 premenopausal women with stage I or stage II breast cancer who went through chemotherapy. After treatment, 35 of the women became infertile; 14 did not.

Collaborating with colleagues at Memorial Sloan-Kettering Cancer Center and Brigham and Women's Hospital, Shapiro studied a number of factors that may have played a role in affecting fertility, including the patients' use of tobacco, alcohol, vitamin supplements, level of physical exercise and family history of osteoporosis. Measures were taken before the patients started treatment and six months later.


Within a month of starting chemotherapy, scientists also began tracking the patients' levels of two reproductive hormones, estradiol and follicle stimulating hormone, along with weight, body mass index and bone mineral density of their hips and spines. They also noted the study participants' levels of ionized calcium, osteocalcin and bone-specific alkaline phosphatases, all markers of bone growth.

In analyzing the data, researchers discovered that higher total spine BMD before treatment predicted who would go through early menopause and become infertile after chemotherapy.

"We feel this finding may be very useful in a clinical setting," says Shapiro. "The decision to undergo chemotherapy is often not clear-cut. For young women with breast cancer who still hope to have children, the possibility of infertility makes that decision even harder. Now, it appears we have a way to help predict the outcome of therapy with more precision, which we hope will make decision-making a bit easier."

Shapiro adds that more studies need to be done before BMD measures become a routine part of clinical care.

Additional collaborators on the study from Ohio State include Drs. Rebecca Jackson and Stanley Lemeshow.

A grant from the National Cancer Institute supported the study.


The Ohio State University Comprehensive Cancer Center is a network of interdisciplinary research programs with over 200 investigators in 13 colleges across the OSU campus, the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Children's Hospital, in Columbus. OSUCCC members conduct research on the prevention, detection, diagnosis and treatment of cancer, generating over $95 million annually in external funding. COLUMBUS, Ohio -