MON-760 Prevention And Treatment Of Aromatase Inhibitors Induced Bone Loss In Postmenopausal Women With Breast Cancer: A Critical Appraisal Of Guidelines And A Suggested Algorithm
Abstract
Abstract A. Bassatne: None. A. Boukhalil: None. M.T. Chakhtoura: None. G. El-Hajj Fuleihan: None. Background: Aromatase Inhibitors (AIs) are potent adjuvant therapy in postmenopausal women with non-metastatic breast cancer (NMBCa). AIs increase bone turnover and fracture risk. Methods: We conducted a systematic review to compare guidelines on bone health in postmenopausal women with NMBCa, and assess their strengths and quality. We searched 4 databases (2010-2019, update on-going). We screened titles, abstracts and full texts, abstracted data and assessed the quality of guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE) tool, independently and in duplicate. We developed an algorithm based on our review to help guide clinical practice. Results: We identified 10 guidelines. All recommend FRAX calculation and risk factors assessment, including smoking, alcohol, vitamin D deficiency, inadequate calcium intake, history of fragility fractures, family history of osteoporosis, steroid use, and low body mass index. 5/10 guidelines recommended screening with bone mineral density (BMD) upon initiation of AI. All guidelines recommend smoking cessation, activity, moderate alcohol intake, optimizing vitamin D and calcium intake. All guidelines recommend starting bone active agents based on T-score cutoffs ≤-2.5 or <-2, with higher cutoffs (<-1.5 to <-1) in presence of risk factors in 3 guidelines. Other indications include FRAX-based thresholds, annual BMD…
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