Background/Purpose: A well-known adverse effect of aromatase inhibitors (AI) in the bone is the loss of mineral density with the consequent increased risk of fracture (fx).

A widely used algorithm for the management of bone agent treatment in patients taking AI is that of Hadji from 2011. Depending on the risk factors and densitometric values, patients would or would not be subsidiaries of receiving such treatment.

Methods: Retrospective cross-sectional study of 200 patients collected in the period between 2014 and 2019 on the monographic consultation of osteoporosis, referred by Medical Oncology to assess the risk of fracture at the start of AI treatment after being diagnosed with breast cancer. BMD and clinical risk factors for fractures are included, based on the 2011 Hadji algorithm, what percentage of patients required treatment with bone agents during follow-up.

Results: The average age of our sample is 64.8 years with a SD of 9.5 and a median of 64.5 (Q1 58
and Q3 72). Regarding the treatment, 56 patients (28%) took Anastrozole, 122 (61%) Letrozole and 22 (11%) Exemestane. The risk factors are: 28 patients (14%) were active smokers and 35 (17.5%) ex-smokers; 11 (5.5%) recognized daily alcohol intake at significant doses. 42 women (21%) had previous fx, of which 15 (35.71%) were on the wrist, 8 (19.05%) vertebral, 2 (4.76%) on the shoulder and 1 (2.38%) on the hip. 44 women (22%) recognized habitual falls and 15 (7.5%) had familiar history of hip fx. There were no patients on chronic steroid treatment and 9 (4.5%) had osteoporosis secondary to a chronic disease. The DXA at the baseline visit showed OP in 64 patients (32%), osteopenia in 108 (54%) and normality in the other 28 (14%). In the blood tests, all women except 1 had normal phospho-calcium levels. Regarding VitD, 13 patients (6.67%) had values < 10 ng/mL, 50 (25.64%) from 10 to 20, 68 (34.87%) from 20 to 30, and the remaining 64 (32.82%) over 30 ng/mL. PTHi levels were high in 15 women (7.69%) and the CTX was elevated in 34 (17.53%). Monitoring data is collected with the following interest: 12 patients (6%) suffer a new fx during AI treatment, 58% vertebral, 25% wrist, and 16% in other locations. 121 women in our sample (60.5%) received treatment for OP according to Hadji's protocol, 92 (76.03%) of them alendronate, 7 (5.79%) risedronate, 18 (14.88%) denosumab, and the remaining 4 (3.3% ) zoledronate and ibandronate in equal proportion (1.65%).

Conclusion: 60.5% of the patients in our series required a bone agent based on the Hadji combining risk factors and BMD values. Highlight that only 30% of patients presented osteoporosis values in DXA at the initial assessment and that 21% had previous fractures, the most on the wrist. We consider the systematic assessment of the risk of fracture presented by patients with breast cancer who begin treatment with AI, assessing the need to prescribe bone agents using an algorithm as practical as that of Hadji.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/description-of-risk-factors-at-baseline-and-need-of-bone-agent-according-to-hadji-recommendations-in-patients-taking-aromatase-inhibitors-as-breast-cancer-therapy/