The Incidence of Premature Bone Demineralization in Breast Cancer Patients Under 65

Breast cancer patients face increased risks of low bone mineral density (BMD) and osteoporosis due to associated treatments and disease pathology. Current screening guidelines exclude patients under 65 years old, leaving younger patients vulnerable to premature bone loss and fractures.

This study utilized PET-CT scans to predict BMD at the L1 vertebra. The use of Hounsfield Units (HU) from L1 CT scans has been shown to be a reliable predictor of T-scores from DEXA scans and can be used to predict osteoporosis risk in patients.

In this study, 385 patients under 65 years old with a diagnosis of breast cancer were analyzed. The median HU score of patients was 148.6 (Mean:155.9; Min: 35.19; Max: 539.05). Approximately 65% of patients had an HU score of less than 165, indicating a high likelihood of premature bone demineralization; 17% of low BMD patients were identified as within a range of osteoporosis.

Our study reveals a high incidence of osteopenia and osteoporosis in breast cancer patients under 65, with 65% having HU scores indicative of early bone demineralization. This challenges existing osteoporosis screening guidelines, which do not include breast cancer as a risk factor for early screening. L1 vertebra PET-CT-derived HU measurements are effective for early low BMD detection and enable timely intervention. The study's significance lies in its potential to influence screening protocols, promote inclusive guidelines, and improve long-term bone health and outcomes in breast cancer patients through earlier detection and preventive care.