Bone Abstracts

Background: Aromatase inhibitors (AIs) used in treatment for postmenopausal women with hormone receptorpositive breast cancer, accelerate bone resorption and increase the risk of osteoporotic fractures. We have modified the International Guidelines on Aromatase induced bone loss locally requiring a baseline dual-energy X-ray absorptiometry (DXA) scan at initiation, a 2-year repeat scan for patients not on treatment, and a 5-year repeat scan for those prescribed bisphosphonates. Bisphosphonate therapy is indicated in patients with a T-score 2.0 or ≥2 major risk factors.

Aim: To evaluate compliance with local guidelines for bone health monitoring and bisphosphonate use in patients receiving AIs.

Methods: This retrospective audit covered 112 patients treated with AIs between January and September 2022. Data obtained from the oncology database included baseline DXA scan, bisphosphonate prescribing, and timing of repeat DXA scan.

Results: 94% (106/112) of patients underwent a DXA scan at AI initiation. Bisphosphonates were prescribed to 78 patients (70%). Among 34 patients not prescribed bisphosphonates, 27 (79.4%) underwent a repeat scan within the recommended 2-year interval. Conversely, 30 of 78 patients (38.4%) on bisphosphonates received a repeat DXA around 2 years. Risk factors included previous fractures (21%), diabetes (10.6%), current smoking (10%), and excess alcohol intake 21 units/week (3%).

Discussion: Baseline bone health monitoring is well established but repeat DXA scheduling diverges from the local protocol. Early DXA scans among bisphosphonate-treated patients may stem from incomplete therapy documentation, default 2-year scheduling patterns, or rejected referrals obscuring true compliance rates. While closer surveillance may improve patient reassurance, unnecessary early imaging imposes avoidable strain on radiology services. We have recommended educating the oncology multidisciplinary team, improved documentation of bisphosphonate in medical records and automated alerts for DXA scan on schedule.

Conclusion: This audit demonstrates strong adherence to guidelines with baseline DXA and bisphosphonate prescribing but partial adherence to repeat DXA intervals. Enhanced documentation, workflow alignment, and digital prompts could optimize follow-up accuracy and ensure consistent adherence to evidence-based guidelines to address bone health in breast cancer patients treated with Aromatase inhibitors.