131. MANAGMENT OF BREAST CANCER TREATMENT–INDUCED BONE LOSS

Abstract

Background: Breast cancer treatment therapies are associated with early menopause and adverse effect on bone density. Identifying highrisk patients and managing them appropriately will help reduce their fracture risk. We wanted to ascertain whether our management of breast cancer patients referred to the osteoporosis clinic was as per the national and international guidelines. A consensus position statement from a UK Expert group regarding breast cancer treatment induced bone loss was published with the support of the National Osteoporosis Society, the National Cancer Research Institute, Breast Cancer Study Group and the International Osteoporosis Foundation. Method(s): Data were collected from 1 June 2014 to 31 August 2016 for all patients referred to the osteoporosis clinic that had a history of or were presently being treated for Breast cancer. All patients underwent a DEXA scan prior to consultation in clinic. Patients were placed into two algorithms; algorithm 1: women who had experienced premature menopause due to chemotherapy or ovarian suppression, ablation or removal. Algorithm 2: Postmenopausal women receiving treatment with an aromatase inhibitor. T-scores were used to stratify patients in algorithm 1 into high (T score =-1) and algorithm 2 into high (T score =-1). Result(s): A total of 54, all female patients with ages ranging from 45 to 96 years, and a median age of 77 years. Thirty (56%) were secondary referrals following a fracture. Twenty-three (43%) patients were osteopenic and thirty-one (57%) were osteoporotic. Patients stratified to algorithm 1; 18 were high-risk and 5 were medium risk, none were low risk. In algorithm 2 all 31 patients were deemed high-risk. 9 patients were given lifestyle advice and calcium/vitamin D supplementation while 45 underwent drug therapy. 4 of the 9 patients given lifestyle advice were patients that were deemed fit for a drug holiday following previous treatment and had stable or improved bone density. The first line drug used in all patients was bisphosphonates. The second line was either denosumab or teraperatide. In our cohort 21 patients were on bisphosphonates, 23 were on denosumab and 1 on teraperatide. Conclusion(s): All standards were being met with regards to treatment of breast cancer patients as per the guidelines during the time period of the audit. The audit did not identify the interval between start of treatment for breast cancer and referral to osteoporosis clinic. A majority of patients were secondary referrals following a fragility fracture and Breast cancer risk factor was elicited through the history. We feel the importance of identifying breast cancer treatment therapies as independent risk factors, consenting patients to the risk of osteoporosis when starting on therapy, and ensuring appropriate bone protection.