Matthew Wallis

Background: Approximately 500,000 fragility fractures occur annually in the UK. ER positive breast cancer (BC) treated with Aromatase Inhibitors (AI) reduces BC recurrence by 30% but increases bone loss by 1-3% per annum. 

Local audit showed the incidence of a femoral neck T score of <-2 requiring active treatment was 8% in the 40-49 year olds rising to 32% in the over 70s. Guidelines mandate monitoring of bone health with DXA. Additional visits add burden to patients, carers and family. We have piloted a new intervention, IBEX BH, which can predict fracture risk from wrist X-rays undertaken on mammography equipment. The study investigated practical feasibility and the acceptability of the intervention with patients.

Method: Women with breast cancer awaiting DXA were recruited to undertake an additional wrist X-ray as part of their mammography follow-up. They and the administering radiographer were surveyed on their experience. 

Results: Fifteen women were recruited to the study. Only 1-2 mins additional time was required, radiographers ranked the additional exposure as ‘1- easy’ on a 1-5 Likert scale of difficulty. Participants reported the additional wrist X-ray to be of little impact, most feeling it was beneficial to combine mammography and bone health appointments. All wrist images were analysable with a wrist X-ray dose 6% of the DXA dose. The correlations for the first 12 women between IBEX BH aBMD and DXA femoral neck aBMD are 0.514 95% CI [-0.228, 0.878] and 0.36 95% CI [-0.40, 0.83] for the ultra-distal and distal third regions respectively, indicating technical feasibility.

Conclusion: This successful pilot study indicates the need for a larger clinical to ensure the clinical validity of the IBEX BH mammography method, and the suitability of the adapted clinical pathway to improve the care of women with breast cancer and reduce burden on the patient and healthcare service.