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 wellknow. It is commonly, but not exclusively, related to aromataseinhibitors. The “Nota 79” by AIFA contemplatesthe primary prevention of fracture risk in BC women inadjuvant hormonal treatment with bisphosphonates or denosumab,at osteoporosis dosage. At the Modena CancerCenter we started a collaboration with oncologists hematologistsand bone specialists in order to offer thebest tailored treatment in high risk fracture patients.Patients and Methods: patients newly diagnosed with BCin hormonal treatment fill-out a form, in order to evaluatethe risk factors for osteoporosis, and based on the resultsand the bone density they are referred to the osteoncologyunit along with serological and urinary markers of boneturn-over.Results: in over 18 months of activity, more than 600patients have been screened by self-completed questionnaire.From the analysis of the first 400 questionnairesemerged that 61% had one or more risk factors, 20%received supplement of vitamin D, and approximately 5%were on bisphosphonates. At baseline, the measurement ofthe height, the evaluation of the spine at the chest X ray orby morphometry highlighted asymptomatic vertebral fracturesin few patients. Several patients presented with secondaryhyperparathyroidism, that required correctionbefore to start any treatment with antiresorptive agents.Cases with hypercalciuria were also corrected along withantiresorptive therapy. Few cases demonstrated high boneturn-over with CTX levels above the limits. The treatmenthas been individualized based on the medical history andcomorbidities, oncological treatment and the bone turnover.All the patients have been informed of the possiblerisk of osteonecrosis of the jaw; dental medical history wascollected for each patient, but orthopanthomography andodontoiatric evaluation was prescribed in selected patients.Vitamin D level was corrected before any therapy andimprovement of the dietary habits and physical activitywas highly recommended. Data analysis is still ongoing.Conclusions: all the patients receiving AIs require the preventionof CTIBL, but the limited resources pushed us toselect, at this time, the patients with special needs to beevaluated in multidisciplinary group. The complexity of thebone health requires attentive evaluation by bone specialistsin selected cases before to start antiresorptive agents.Supplemental data will be presented at the meeting.