Abstract
Summary
Bone mineral density screening prior to initiating aromatase inhibitor therapy was associated with lower incident bone fractures and healthcare resource utilization among postmenopausal breast cancer survivors.
Introduction
Postmenopausal women with hormone receptor–positive breast cancer (BC) often receive aromatase inhibitor (AI) therapy. However, AIs induce bone loss and BC survivors are at an increased risk of bone fractures. This study determined whether receipt of baseline dual-energy x-ray absorptiometry (DXA) screening is associated with decreased incident fractures and lower healthcare resource utilization.
Methods
We retrospectively analyzed 22,713 stage 0–III primary BC survivors who received AI therapy ≤ 1 year prior to BC diagnosis from the Medicare-Linked Surveillance, Epidemiology, and End-Results database. We categorized DXA screening for those who had a procedural claim within 12 months prior through 6 months after first AI claim. We used propensity score methods to assess the association of DXA screening with bone fractures and health resource utilization.
Results
Of the study cohort, 62% received a DXA screening. Women with comorbid dementia, renal disease, and congestive heart failure were less likely to receive a DXA. After adjusting for confounders, BC survivors who received a DXA had a 32% decreased risk of any bone fracture compared to those who did not (hazard ratio (HR): 0.68, 95% confidence interval (CI): 0.60–0.76, p < 0.001). Similarly, those who received a DXA were less likely to be hospitalized (HR 0.73 (0.62–0.86)) or use outpatient services (HR 0.85 (0.74–0.97)).
Conclusions
Bone density screening is associated with decreased incident bone fractures and a lower likelihood of utilizing healthcare resource for fracture-related events. Postmenopausal BC survivors treated with AIs should undergo appropriate bone density screening to reduce morbidity, mortality, and health care expenses.
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Data availability
The data that support the findings of this study are available from NCI SEER-Medicare, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of NCI SEER-Medicare.
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Acknowledgements
This work was supported by the National Cancer Institute of the National Institutes of Health (T32CA225617 to SB). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Bailey, S., Mhango, G. & Lin, J.J. The impact of bone mineral density screening on incident fractures and healthcare resource utilization among postmenopausal breast cancer survivors treated with aromatase inhibitors. Osteoporos Int 33, 1989–1997 (2022). https://doi.org/10.1007/s00198-022-06458-z
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DOI: https://doi.org/10.1007/s00198-022-06458-z