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Background: Breast cancer treatment therapies (aromatase inhibitors (AI)) are associated with early menopause and adverse effect on bone density. Identifying high-risk patients and managing them appropriately will help reduce their fracture risk.
Objectives: We wanted to ascertain whether our management of breast cancer patients on aromatase inhibitors (AI) referred to osteoporosis clinic were as per guidelines. A consensus position statement from a UK expert group regarding breast cancer treatment induced bone loss, published with the support of the National Osteoporosis Society, the National Cancer Research Institute, Breast Cancer Study Group and the International Foundation.
The guideline recommend lifestyle advice for low risk patients; calcium plus vitamin D supplementation and lifestyle advice for medium risk; bisphosphonate, calcium plus vitamin D supplementation and lifestyle advice for high risk.
Methods: This is a re-audit cycle conducted for all patients referred to the osteoporosis clinic who were treated with aromatase inhibitors for breast cancer between 2016-2020. Patients were divided into two algorithms:
Algorithm 1: women who had experienced premature menopause associated with ovarian suppression with or without AI.
Algorithm 2: Postmenopausal women receiving treatment with an AI.
T-scores were used to stratify patients in algorithm 1 into high risk (HR- T score <-2), medium risk (MR-T score -1 to -2) and low risk (LR- T score >-1).
Algorithm 2 into high risk (HR-T score <-1) medium risk (MR -T score >-1).
Showing the results of Audit 1 and Re-audit
| Audit 1 | Re-audit | |||
|---|---|---|---|---|
| Total Patients | 54 | 72 | ||
| Data collected | 2014-2016 | 2016-2020 | ||
| Gender | Female 100 (%) | Female 100 (%) | ||
| Age in years | 45-96 | 38-92 | ||
| Median age | 77 | 68 | ||
| No of Osteoporotic patients | 31 | 41 | ||
| No of Osteopenic patients | 23 | 31 | ||
| Algorithm 1: | Total patients=23 | • 18 HR• 5MR• LR nil | Total patients = 20 | • 19HR • 1 MR |
| Algorithm 2: | Total patients =31 | • 31 HR • MR-nil • LR nil | Total patients =52 | • 45HR • 5MR • 2LR |
| Drug therapy | 45 | 63 | ||
| Bisphosphonates | 21 | 49 | ||
| Denosumab | 23 | 14 | ||
| Teriparatide | 1 | 0 | ||
| Declined treatment | 0 | 1 | ||
| Lifestyle/Vit D & Cal | 9 | 6 | ||
| Lifestyle advice only | 0 | 2 | ||
Conclusion: Re-audit showed all patients were on AI and treated appropriately. As compare to audit 1, all high risk group patients were treated with drug therapy and bisphosphonate was the first line therapy as per guidelines. It was recommended that patients with risk of osteoporosis should be referred and treated according to their risk stratification. It is a collective responsibility of Breast surgeons, Geriatrician, Frailty team, Oncologist, Rheumatology and General Practitioners).All patients should have repeat bone density scan in 2 years’ time after initial bisphosphonate therapy. The next audit cycle will be conducted in five years’ time.
Disclosure of Interests: None declared