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

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.