Bone density screening in postmenopausal women with early-stage breast cancer treated with aromatase inhibitors

Abstract

Purpose In postmenopausal women with breast cancer treated with aromatase inhibitors (AIs), most expert panels advise baseline bone mineral density testing with a dual-energy x-ray absorptiometry (DXA) scan repeated every 1to 2years.Howoften this recommendation is followed is unclear. Methods We performed a retrospective analysis of women with stage I to III breast cancer who started AI therapy from January 1, 2008, to December 31, 2010, with follow-up through December 31, 2012, by using the SEER-Medicare database. Selection criteria included AI use for$6 months and no recent osteoporosis diagnosis or bisphosphonate use.Weused multivariable logistic regression to investigate associations between patient characteristics and receipt of a baselineDXAscan. In patientswhocontinued AI treatment, we assessed rates of follow-up scans. Results In the sample of 2,409 patients (median age,74years), 51.0% received a baselineDXAscan. Demographic characteristics associated with the absence of a baseline DXA scan were older age (85 to 94 years v 67 to 69 years; odds ratio [OR], 0.62; 95% CI, 0.42 to 0.92) and black v white race (OR, 0.68; 95% CI, 0.47 to 0.97). Among patients who underwent a baseline DXA scan and continued AI for 3 years, 28.0% had a repeat DXA scan within 2years and 65.9% within3years. In aggregate, of the 1,164 patientswhocontinued with AI treatment for 3 years, only 34.5% had both a baseline and at least oneDXAscan during the 3-year follow-up period. Conclusion The majority of older Medicare beneficiaries with breast cancer treated with AIs do not undergo appropriate bone mineral density evaluation.