104 Fracture risk assessment of patients on aromatase inhibitors: is fracture risk being addressed appropriately for patients taking aromatase inhibitors?

Abstract

Background: Aromatase inhibitors (AI) have now become the standard of care in the management of post-menopausal hormone receptor positive breast cancer. One of the main side effects is accelerated bone loss and consequently increased risk of fragility fractures Fracture risk maybe easily overlooked unless a specific assessment is carried out.The objectives were to assess whether screening for fracture risk was done by the oncologists in a secondary care setting. The latest ESCEO guidelines were used as standard of care. Methods: 80 consecutive patients started on an AI in the year 2016 were identified. Data was collected from medical notes consisted of age at diagnosis, type of AI, previous diagnosis of osteopenia/ osteoporosis and anti-resorptive treatment. Documentation of risk factors for fragility fractures were assessed as well as the availability of follow-up DEXA scans after starting AI. Results: The mean age was 65 years (SD 9.8). 36% were on anastrazole, 26% on exemestane and 38% on letrozole. Age at menopause was documented in only one patient. 14% had osteopenia/ osteoporosis at baseline prior to starting AI treatment. Of these 10% were on calcium/vitamin D supplementation. Out of the 80 patients only 11% had a follow-up DEXA scan after starting the AI. Calcium and vitamin D levels were checked in 41% and 6% respectively. After initiation of AI 10 patients were given anti-resorptive therapy (eight patients received zolendronic acid, two patients received strontium ranelate). Rheumatology input was requested for only three patients. Documentation of risk factors for fragility fractures such as BMI, smoking and alcohol status was absent in the majority of cases. Conclusion: The majority of patients treated with aromatase inhibitors did not have a proper fracture risk assessment. This cannot be underestimated since it can potentially lead to serious complications for breast cancer patients. Rheumatologists need to work with oncologists to establish care pathways to ensure that all patients on aromatase inhibitors are screened and treated to reduce fracture risk. This audit highlights the need to develop a clear care pathway to guide oncologists prescribing AI.