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Bone Density Screening in Postmenopausal Women With Early-Stage Breast Cancer Treated With Aromatase Inhibitors

Posted: Wednesday, April 5, 2017

Although it is well known that treatment with aromatase inhibitors may negatively affect bone density in postmenopausal women, many patients are still not properly screened and/or monitored during therapy.  This was the conclusion of a study that explored how closely guideline recommendations were followed with respect to bone density evaluations in patients receiving aromatase inhibitors. 

Most expert panels advise baseline bone mineral density testing with a dual-energy x-ray absorptiometry (DXA) scan repeated every 1 to 2 years.  Nevertheless, in a sample of more than 2,000 women older than 65 years of age (median age, 74 years) who had been diagnosed with stage I to III breast cancer and who started treatment with an aromatase inhibitor, only about half received a baseline DXA scan. Those who were older (85 to 94 years of age) or black were less likely to receive baseline and/or follow-up scans, as recommended by guidelines.  Selection criteria included the use of an aromatase inhibitor for ≥ 6 months and no recent osteoporosis diagnosis or bisphosphonate use.

In aggregate, of the more than 1,000 patients who continued treatment with an aromatase inhibitor for 3 years, only about one third had both a baseline and at least one DXA scan during the 3-year follow-up period. The authors concluded that the majority of older Medicare beneficiaries with breast cancer who are treated with aromatase inhibitors do not undergo appropriate bone mineral density evaluation.