More than 70% of breast cancer patients develop endocrine-responsive disease with estrogen receptor (ER)-positive or progesterone receptor-positive tumors or both  and require endocrine treatment with either estrogen blockage or ablation. The aromatase inhibitors are highly effective well-tolerated treatment for postmenopausal endocrine-responsive breast cancer. However, their use is associated with accelerated bone loss and an increase in fracture risk(2, 3)
Post menopausal patients with early stage breast cancer( stage I and stage II) which was ER and/or PR positive and who were on AI therapy were included. Total patients 243.Stage I (101) and stage II (142).Agents used were Anastrazole, letrozole, exemestane .BMD (bone mineral density monitoring)was done by DEXA(Dual-energy X-ray absorptiometry) scan, and compared with national guidelines.
243 patients were included. At 0 years(at start of AI therapy) 150(62%) did not get a DEXA scan,40(16.4%) had normal DEXA scan, 48(19.8% )had osteopenia and 5( 2%) had osteoporosis. At 2 years from AI therapy 126(51.8%) did not get a DEXA scan, 35(14.4%) had normal DEXA scan, 73(30%) had osteopenia and 9(3.7%) had osteoporosis. At 5 years from AI therapy 180(74%) did not get a DEXA scan,21(8.6%) had normal DEXA scan, 35(14.4%) had osteopenia and 7(2.8%) had osteoporosis. Anastrazole and letrozole were equally associated with osteopenia/osteoporosis. Only 50% of patients with osteoporosis(10/21) received treatment for osteoporosis.
Although there is evidence of negative impact of the aromatase inhibitors on bone, our data still show a poor application of the recommendations in order to prevent osteoporosis related to the administration of these drugs. Part of the problem is the mixed literature on diagnosis and management of osteoporosis. Also medicare covers for a DEXA scan only once very two years.
The national compliance for managing AI induced bone loss is very low which points out tthat this is a global problem. Our suggestion is a more active implementation of the guidelines, also by means of a greater collaboration between the oncologist and the specialist in osteoporosis, and the offer of a diagnostic and therapeutic pathway.
Citation Format: Asma Taj, Sadik Khuder, Iman Mohamed. Bone mineral density(BMD) monitoring in postmenopausal women with early stage estrogen and/or progesterone receptor positive breast cancer on aromastase inhibitor(AI) therapy at University of Toledo medical center. A quality improvement project [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-10-19.