Bridging the Age Gap: How is bone health of older women with early breast cancer managed?.

Theodoulou, E.; Martin C.; Morgan J.; Turner O.; Hartup S.; Achuthan R.; Azmy I.; Henderson J.; Reed M.; Holen I.; Brown J.; Wyld L.

Bridging the Age Gap: How is bone health of older women with early breast cancer managed?.

All Authors

Theodoulou, E.

Martin C.

Morgan J.

Turner O.

Hartup S.

Achuthan R.

Azmy I.

Henderson J.

Reed M.

Holen I.

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LTHT Author

Hartup, Sue
Achuthan, Raj

LTHT Department

Leeds Cancer Centre

Non Medic

Research Sister

Publication Date

2023

Item Type

Conference Abstract

Abstract

Introduction Age-related bone loss occurs in women from age 30 onwards and accelerates at menopause such that 50% of women at 80 years have osteoporosis. Bone loss is exacerbated in women receiving aromatase inhibitors (AIs) for early breast cancer (EBC), increasing fracture risk. This sub-study explored the management of bone health in older women (>=70 years) with EBC and factors influencing clinical decision-making. Methods This was a sub-study of a larger observational cohort study (Age Gap), which recruited women >=70 years with EBC between 2013-2018 at 56 UK hospitals. It aimed to determine factors influencing treatment selection and outcomes in this age group. Five of these centres were included in this sub-study, from which more detailed data on bone health and management were collected for women with ER+ve cancers who received adjuvant or primary endocrine therapy treatment. Results Of 565 eligible patients, 529 had received AIs (93.6%) and 26/565(4.6%) tamoxifen (1.8% unknown). A baseline DEXA scan was performed in only 354/529(67%) of the AI group. Bisphosphonates were prescribed for 226/529(43%). Baseline DEXA scans were more likely to be requested if patients were fit for surgery and were <80 years old. Of those who were scanned (N=354), 148(42%) were osteopenic and 64(18%) osteoporotic. An offer of bisphosphonates was associated with younger age (<80yrs old) (p=0.016). Fractures were diagnosed in 122/529(23%) and only 38% of these had received prior bisphosphonate. Frailty or prefrailty was present in 94% of women but there was no correlation between frailty and baseline hip (r2 = 0.0098) or spine (r2 = 0.00007) T-scores. Rates of DEXA scanning varied significantly between units from 36-76% (p<0.001). The reasons for this variation are unknown. Conclusions Patient age and general health influenced bone-health management decision-making, however there was considerable variation between centres, highlighting the need for standardised bone health care for older women with EBC.