Trabecular bone score and quantitative ultrasound measurements in the assessment of bone health in breast cancer survivors assuming aromatase inhibitors

PurposeAromatase inhibitors (AIs) represent the first-line adjuvant therapy for hormone receptor-positive breast cancer (BC) women. AIs have been associated with an increased rate of fractures. The aim of our study was to investigate trabecular bone score (TBS) and bone quantitative ultrasound (QUS) measurements as bone quality surrogates in AIs users.MethodsSixty postmenopausal BC women starting AIs and forty-two controls (mean age 61.648.33 years) were considered. Bone mineral density (BMD) at lumbar spine and femoral neck and TBS were measured by DXA; QUS-derived Amplitude-Dependent Speed of Sound (AD-SoS), Bone Transmission Time (BTT), and Ultrasound Bone Profile Index (UBPI) were assessed at phalangeal site; morphometric vertebral fractures (Vfx) by X-ray, serum bone-specific alkaline phosphatase (BSAP), and C-telopeptide of type 1 collagen (CTX) were also evaluated.ResultsAfter 18 months, changes of TBS vs baseline were significantly different between AIs group and controls [Delta TBS -2.2% vs -0.4%, respectively, p=0.001]. AD-SoS, BTT and UBPI values decreased only in AIs' group (-3.7%, -6.45%, -8.5%, vs baseline, respectively, p(all)<0.001). 3 Vfx occurred in AIs users and were associated with the greater TBS and AD-SoS modifications. In the AIs' group, TBS was associated with Delta AD-SoS (r=0.58, p<0.001) and UBPI (r=0.415, p=0.001), but not with Delta BMD. Moreover, Delta TBS was independently predicted by Delta AD-SoS, after correcting for BMD, CTX and BSAP level changes (beta =0.37, SE=2.44, p<0.001).Conclusions p id=Par TBS and phalangeal QUS provide useful information related to bone quality in AI-treated BC survivors and could be considered for fracture risk evaluation.