Third of Older Women on AIs Not Getting Bone Density Testing
Older women starting treatment with aromatase inhibitors (AIs) for breast cancer may not be getting recommended bone minteral density (BMD) assessment, even though their age and these therapies put them at the risk for fractures.
In a group of 19,585 older women with breast cancer who started adjuvant AI therapy, approximately one third did not undergo recommended baseline BMD testing. The findingswere published in the July issue of the Journal of the National Comprehensive Cancer Network
John Charlson, MD, associate professor of medicine, Division of Hematology and Oncology at the Medical College of Wisconsin, Milwaukee, and colleagues found that testing rates decreased substantially with increasing age.
Testing rates were 73% for women aged 67 to 70 years, but that number dropped to 51% for those 85 years of age and older.
The proportion of women who had neither BMD testing nor bisphosphonate therapy also increased with age, the researchers found.
NCCN Recommends Testing
The National Comprehensive Cancer Network (NCCN) recommends that patients undergo assessment before beginning AI treatment and that women at increased risk for osteoporosis consider antiresorptive therapy, such as bisphosphonates.
Thus, these results highlight suboptimal US compliance with guideline recommendations for baseline BMD testing when starting AI therapy.
“These findings may be even more important in light of recent data from additional studies suggesting bone fracture rates may be even higher than previously recognized for women using adjuvant aromatase inhibitors,” Steven J. Isakoff, MD, PhD, Massachusetts General Hospital Cancer Center, Boston, and member of the NCCN Guidelines Panel for Breast Cancer, commented in a statement.
“In addition, many women may now be using aromatase inhibitors beyond 5 years, which may further increase the risk of fractures,” he said. “This study highlights that, as a breast cancer community, we need to do a better job screening for bone health because with proper screening and treatment, many of these fractures can be prevented, particularly in the older patients at highest risk for fractures but who have the lowest rates of bone health screening.”
Lowest Rates Among the Oldest
In this study, Dr Charlson and colleagues investigated whether older women who were being treated with AIs as adjuvant breast cancer therapy were receiving appropriate bone risk assessments, as recommended in guidelines.
They used Medicare Parts A, B, and D claims to identify women aged 67 years or older who underwent initial breast cancer surgery in 2006 or 2007 and then received AI therapy within 1 year after undergoing surgery.
Roughly two thirds of the women initiating adjuvant AI therapy (67.7%) underwent baseline BMD testing.
When the researchers looked at BMD testing rates that were unadjusted for socioeconomic or health variables, the lowest were found in the oldest age group.
Conversely, the use of bisphosphonates without BMD testing were slightly higher among women in the oldest age group (10% for those 86 years and older vs 4% to 7% in younger age groups).
But even so, the percentage of women who began AI therapy without undergoing BMD testing or using bisphosphonates increased from 24% in the 67- to 70-year-old age group to 40% in the oldest group (aged 86 years or older).
“While a larger number of older patients did receive bisphosphonates, this does not explain the disparities in bone density findings, or even substantially change our finding that attending to BMD was higher in lower risk younger women,” said Dr. Charlson in a statement.
In addition to older age, the authors also found that comorbidity, low income, and black race were associated with a higher likelihood of starting an AI without baseline BMD testing.
J Natl Compr Canc Netw. 2016;14:875-880.