Bone Mineral Density Testing Disparities Among Patients With Breast Cancer Prescribed Aromatase Inhibitors

Abstract

Despite the importance of age as a risk factor for fractures, older women starting treatment with AIs for treatment of breast cancer are less likely to undergo recommended bone density assessment.

Contemporary Population-Based Analysis of Bone Mineral Density Testing in Men Initiating Androgen Deprivation Therapy for Prostate Cancer

“…Rates of baseline BMD testing among patients with breast cancer are consistently much higher compared with the PCa population: between 32% and 68% in recent studies. [43][44][45] However, it is notable that factors found to be associated with lower baseline BMD testing are similar to those identified in our study and other PCa studies, namely older patient age, higher comorbidity, and rural residence. This suggests that these factors are not specific to the PCa population treated by ADT but may in fact be generalizable to patients with cancer in general, and perhaps even the general population not experiencing cancer.…”

Bone Mineral Density at the Time of Initiating Aromatase Inhibitor Therapy Is Associated With Decreased Fractures in Women With Breast Cancer

“…Our findings are consistent with the assessment of DXA screening in the same population by Charlson and colleagues, where they demonstrated similar findings of disparity. ( 19 ) Because all women in the study were Medicare beneficiaries, and Medicare covers DXA screening, the reasons for these disparities are unclear but may include patients' lack of awareness about AI therapy's effects on bone density, poor knowledge about bone health, and logistic difficulties in attending health care visits. Health care factors could include less access to specialized care, although it is unclear whether there are differences in breast cancer treatment patterns between tertiary and community oncologists or among primary care providers.…”

“…Several studies have evaluated the utilization of baseline screening for bone health in women with breast cancer receiving AI. ( 19–23 ) To our knowledge, no studies have yet addressed whether the baseline DXA screening is associated with decreased fracture risk in women receiving AI therapy. Accordingly, this study assessed whether baseline DXA screening of women aged 66 years or older with early‐stage breast cancer who were beginning AI therapy is associated with a decreased fracture risk.…”

Bone Density Screening in Postmenopausal Women With Early-Stage Breast Cancer Treated With Aromatase Inhibitors

“…13 Studies have shown low rates of baseline BMD testing among postmenopausal women treated with AIs. [14][15][16][17] The largest of these assessed 19,585 women and found that 67.7% underwent baseline BMD testing. 17 Another study investigated data on 9,138 women with breast cancer older than 50 years (with an average age [64.6 years] younger than the enrollment age for Medicare) in a commercial payer database and found that only 41.6% underwent baseline testing.…”