PSAT160 The Dangers of Long-term Aromatase Inhibitor use in an Elderly Hispanic Population

The most common endocrine therapies for breast cancer are Aromatase Inhibitors (AIs), which can help reduce the recurrence of the disease and its mortality rate. However, because aromatase inhibitors prevent the aromatization of androgens into estrogen, they can have serious effects on bone health. This can lead to accelerated bone loss and an increased risk for fractures, especially among postmenopausal women. In 2017, the Journal of Bone Oncology (JBO) released a joint position statement advising that all patients with breast cancer on endocrine treatment, such as AIs which are known to accelerate bone loss, be placed on bisphosphonate therapy should they present 2 or more risk factors for fracture (1). The purpose of this study was to evaluate patients on AIs at a 5-star Medicare Advantage plan facility and document any discrepancies with regards to whether appropriate treatment is being given to prevent fractures. We hypothesized that we may have a large percentage of patients on AI that have 2 or more risk factors and are not on treatment. An electronic chart review was conducted of 398 patients on AIs between 6/9/2020 and 8/25/2020. Patients were evaluated for the following risk factors: current smoking, personal history of hip/vertebral fracture, current use of glucocorticoids, age > 65, BMD T-score < -1.5, and BMI < 20. Surprisingly, 1 out of every 2 patients treated with an AI was not being treated in accordance with the JBO's recommendations. Of the 398 patients evaluated, 191 presented 2 or more risk factors and were not on antiresorptive treatment. There are a few steps that can be taken to better manage these at-risk patients. First is raising awareness to providers about the dangers of long-term AI use. Additional changes to the EMR system may help as well, such as prompting the ordering provider to consider bisphosphonate therapy if risk factors are present. Lastly, the addition of a fracture reduction clinic can help streamline the referral process to an endocrinologist upon the prescribing of AI therapy. This would allow patients to be fully evaluated for fracture risks and prescribed treatment should they qualify. With the low costs of generic bisphosphonate therapy, if a fracture is prevented, providers can hope to save a significant amount in indirect costs. Through improved awareness of providers of the risks, a more intuitive EMR system, and the creation of a new automatic referral process, we believe that we can vastly improve patient morbidity and quality of life by reducing the chances of fracture in patients on long-term AIs.Reference: (1) Hadji et al., J Bone Oncol. 2017 Mar 23;7: 1-12. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.