Cancer Treatment Induced Bone Loss (CTIBL) in breast cancer women: a multidisciplinary approach at the Modena Cancer Center screening over 600 patients.

Background: CTIBL in breast cancer (BC) women is well know. It is commonly, but not exclusively, related to aromatase inhibitors. The “Nota 79” by AIFA contemplates the primary prevention of fracture risk in BC women in adjuvant hormonal treatment with bisphosphonates or denosumab, at osteoporosis dosage. At the Modena Cancer Center we started a collaboration with oncologists hematologists and bone specialists in order to offer the best tailored treatment in high risk fracture patients. Patients and Methods: patients newly diagnosed with BC in hormonal treatment fill-out a form, in order to evaluate the risk factors for osteoporosis, and based on the results and the bone density they are referred to the osteoncology unit along with serological and urinary markers of bone turn-over. Results: in over 18 months of activity, more than 600 patients have been screened by self-completed questionnaire. From the analysis of the first 400 questionnaires emerged that 61% had one or more risk factors, 20% received supplement of vitamin D, and approximately 5% were on bisphosphonates. At baseline, the measurement of the height, the evaluation of the spine at the chest X ray or by morphometry highlighted asymptomatic vertebral fractures in few patients. Several patients presented with secondary hyperparathyroidism, that required correction before to start any treatment with antiresorptive agents. Cases with hypercalciuria were also corrected along with antiresorptive therapy. Few cases demonstrated high bone turn-over with CTX levels above the limits. The treatment has been individualized based on the medical history and comorbidities, oncological treatment and the bone turnover. All the patients have been informed of the possible risk of osteonecrosis of the jaw; dental medical history was collected for each patient, but orthopanthomography and odontoiatric evaluation was prescribed in selected patients. Vitamin D level was corrected before any therapy and improvement of the dietary habits and physical activity was highly recommended. Data analysis is still ongoing. Conclusions: all the patients receiving AIs require the prevention of CTIBL, but the limited resources pushed us to select, at this time, the patients with special needs to be evaluated in multidisciplinary group. The complexity of the bone health requires attentive evaluation by bone specialists in selected cases before to start antiresorptive agents. Supplemental data will be presented at the meeting.