Abstract 219P
Background
Aromatase inhibitors (AI) are standard of care for postmenopausal women with hormone receptor (HR)-positive early breast cancer (EBC). As a result of treatment they lose bone mineral density (BMD) with or without ovarian function suppression. They require baseline BMD with DEXA scan. Individualised therapy should be aimed at mitigating fracture risk. Strategies like weight-bearing exercise, calcium, vitamin D and bisphosphonates are recommended to prevent bone loss. Evidence is growing how to screen, monitor and manage bone health. In spite of expanding evidence this aspect of care is not always fully integrated into daily practice. We evaluated baseline BMD to look at incidence of osteopenia and osteoporosis and its impact on treatment.
Methods
Retrospective study for 289 EBC patients from Jan 2015 to June 2015 at University Hospital of North Midlands UK. Demographics and DEXA scan results studied to evaluate BMD in those taking AI. Univariate, multivariate and Kaplan-Meier survival analysis done.
Results
Among those studied 219 were ER positive, 15 triple negative and 40 were HER2 positive. Among ER positive patients 140 were postmenopausal. All of them were started on anastrozole as adjuvant treatment. DEXA scan was done in 75%. Among them 21 (15%) were in the range of osteoporosis with T score reading of lower than -2.5, 57 (40%) were having reading between -1 to -2.5 showing osteopenia and 27 (20%) of them had T score reading above -1 which was considered normal. The T score analysis was as per WHO guidelines. 55% of those receiving AI were either osteopenic or osteoporotic at the start. 2nd DEXA scan was done in half of them (52%) during therapy. 60% of them were having risk factors for osteoporosis. Age and co-morbidities were independent risk factors for osteprosis. 40% of them were treated with bisphosphonates but this had no impact on progression free survival.
Conclusions
In this study 55% patients had either osteopenia or osteoporosis and 15% had osteoporosis at the start. We recommend all patients undergoing EBC treatment should have DEXA scan at the start of treatment to screen those in need of bisphosphonates therapy. In fact larger studies are needed to focus on biomarkers to select those who would benefit from adjuvant bisphosphones.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.