Abstract only e12048 Background: Aromatase inhibitors (AIs) are commonly used in treatment of ER & PR + breast cancer in postmenopausal women. It is well known that AIs can lead to bone loss. Bisphosphonates have been used to counteract bone loss due to AI use. The objective of this study was to evaluate the use of bisphosphonates in elderly females above 65 years, with ER + breast cancer on AIs, in a rural setting, and to examine the effects of oral vs. IV bisphosphonates on overall survival (OS) in geriatric patients. We also examined the effects of alcohol use on bone health in this population. Methods: An institutional database of 269 patients with histologically confirmed invasive or in-situ breast cancer with age 65 or older at the time of diagnosis was reviewed in an IRB approved fashion. 176 patients were ER+ and had DEXA diagnosed osteoporosis or osteopenia.They were treated with anastrozole n = 88 (50)% or letrozole n = 88 (50%). Type of bisphosphonate treatments used ,impact of alcohol consumption & data on OS were collected from the database. Results: 176 patients (65.4%) were ER+ and had DEXA diagnosed osteoporosis or osteopenia. Alendronate was used in 15 patients (8.5%), ibandronate was used in 3 patients (1.7%), risedronate was used in 1 patient (0.6%), and zoledronate was used in 44 patients (25%). IV bisphosphonates were used in 44 patients (69.8%) and oral were used in 19 patients (30.2%). Majority of patietns were on calcium + D supplementation.10% of non-alcohol users had osteopenia/osteoporosis compared to 15% of former alcohol users and 29% of current alcohol users. LogRank testing found no significant difference between survival based on bisphosphonate use . Similar statistical analysis found no significant difference between survival based between IV and oral bisphosphonates. Conclusions: Our study showed that geriatric patients with ER + breast cancer on AI therapy were adequately managed for osteopenia and osteoporosis with the use of bisphosphonates (oral and IV) in a rural setting. There was no significant effect on overall survival (OS) , with use of bisphosphonates during AI therapy. No significant difference in OS was identified for patients taking IV vs. oral bisphosphonates,but this was attributed to very small number of patients that experienced death as an event in this population. Bisphosphonates were also well tolerated, with only 1 patient noting ONJ and one patient with renal toxicity. Current and former alcohol use was found to be correlated with increased rates of osteopenia/osteoporosis in this population.