Guideline adherence in the management of aromatase inhibitor-induced bone loss in women with breast cancer.

Abstract

Osteoporosis (OP) and aromatase inhibitor (AI)-induced bone loss are major concerns among postmenopausal women with breast cancer. This study aimed to comparatively evaluate guideline-concordant bone health management for OP and AI-induced bone loss across two tertiary centers. We retrospectively analyzed medical records of 2224 postmenopausal women with breast cancer. Demographic characteristics, comorbidities, medication use, and baseline bone mineral density (BMD) and T-score values were extracted for all patients screened or followed between 2019 and 2024. Among 2224 women, AI use at the time of DXA assessment (N = 1146) was more frequent in Center 2 than Center 1 (79.4% vs. 35.6%, P < .001). Among AI users, OP prevalence was similar between centers (Center 1: 25.0%; Center 2: 26.2%); however, anti-osteoporotic treatment prescribing was higher in Center 2 (85.7% vs. 49.2%, P < .001). Among treatment-indicated non-osteoporotic AI users according to European Society of Medical Oncology guideline, prescribing rates were also higher in Center 2 (85.1% vs. 23.0%, P < .001). Among osteoporotic AI nonusers, treatment rates remained higher in Center 2 (75.9% vs. 45.8%, P < .001). Binary logistic regression confirmed center type as an independent predictor of treatment prescribing (OR: 9.414, 95% confidence interval: 6.669-13.289, P < .001). Guideline-concordant prescribing for AI-induced bone loss differed substantially between the two centers. Prospective studies evaluating longitudinal BMD changes, fracture outcomes, and treatment persistence are warranted to determine the clinical impact of these differences.