Practical management of aromatase inhibitor-induced bone loss in breast cancer patients

摘要

Background: Aromatase inhibitors (AIs) are routinely offered to post-menopausal patients with oestrogen receptor-positive early invasive breast cancer (BC). AIs can cause significant bone loss. Several guidelines exist on the management of AI-induced bone loss (AIBL). Aim: To establish practical adherence to guidelines of the assessment and management of AIBL in BC patientsMethods: Retrospective audit in a large general practice of patients started on AIs between 2008 and 2015, against national (United Kingdom) guidance and review of the English literature using Ovid Medline and Embase databases Results: 25% (n=3) of patients in our audit did not have a baseline bone mass density (BMD) measurement when an AI was initiated. The mean interval between baseline and repeat BMD measurements was 4.1 years (national recommendation being 2 years). 7 studies assessing practical adherence to guidance were identified in the literature review. The review highlighted suboptimal rates of BMD measurements in BC patients on AIs. Patients diagnosed with osteoporosis do not appear to all be receiving treatment with antiresorptive therapy. Reasons identified for deviation from guidance in large studies include poor awareness of guidelines amongst general practitioners and lack of clarity regarding who the responsibility of bone health management lies with (hospital specialists vs. community team). Conclusion: Guidelines on AIBL have existed for years. We have summarised current evidence on its management, showing that significant gaps in adherence are still present worldwide. Institutional guidelines should be implemented to improve local compliance. Guidelines should also be updated in line with emerging evidence on AIs.