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Poster Display session

71P - Aromatase inhibitors and fracture prevention- is our current approach correct?


04 May 2022


Poster Display session


Breast Cancer


Anem Mirza


Annals of Oncology (2022) 33 (suppl_3): S148-S164. 10.1016/annonc/annonc889


A. Mirza, Z.W. Naing, P. Khonsari, H. Khan, P. Rezai, A.K. Abbas, M. Nisar

Author affiliations

  • Luton and Dunstable Hospital NHS Foundation Trust, Luton/GB

Abstract 71P


Breast cancer remains a common diagnosis. Aromatase inhibitors (AI) are recommended for their mortality benefit in postmenopausal women with hormone sensitive disease. AI bone loss is a recognised adverse event with resultant increase in fracture risk. In 2017, a consensus statement of international bone and cancer societies published an algorithm based on risk factors and bone mineral densities (BMD) threshold for bone active therapeutic intervention.


Over 7 years, 1001 women were prescribed AI at a university teaching hospital. The new guidelines were adopted in 2017. 361 women had commenced AI prior to the adoption of guidelines and were offered bone active treatment based on NOS 2009 guidelines. 640 women were in the post implementation group and offered treatment based on the 2017 consensus guidelines. Women with osteoporosis were all offered treatment, the difference in guideline is pertinent to osteopenia and we analysed that group.


Mean age was 64 years. 929 (93%) women were Caucasian, 723 (72%) had invasive ductal carcinoma and 863 (86%) were postmenopausal. At diagnosis, 428 (43%) had node-positive disease and 35 (4%) metastases. 91 (9%) had fractures prior to their cancer. First group (n=361): baseline DEXA mean left neck of femur (LNOF) BMD of 0.888 g/cm2 (range 0.552-1.222). 143 (40%) women were normal, 174 (48%) osteopenic and 44 (12%) osteoporotic. Osteopenia- 44 women (25%) were treated and 33 had a repeat DEXA after 4 years (mean). Treatment group- LNOF mean BMD remained unchanged from 0.814 g/cm2 to 0.812 g/cm2 at the repeat (p= 0.94). 22 (13%) women had a fracture. Second group (n=640): baseline DEXA mean LNOF BMD of 0.888 g/cm2 (range 0.512-1.390). 216 (33%) women were normal, 322 (50%) osteopenic and 107 (17%) osteoporotic. Osteopenia- 127 women (39%) were treated and 56 had a repeat DEXA after 3 years (mean). Treatment group- LNOF mean BMD remained relatively unchanged from 0.822 g/cm2 to 0.829 g/cm2 at the repeat (p= 0.6169). 8 (2.5%) women had a fracture.


This shows the success of 2017 consensus statement in lowering fracture risk amongst women with breast cancer. A significant reduction in fractures pre (13%) and post (2.5%) guidelines change has implications for healthcare systems worldwide with a chance to reduce morbidity.

Legal entity responsible for the study

The authors.


Has not received any funding.


All authors have declared no conflicts of interest.

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