Aromatase inhibitors and bone health

Current Opinion in Obstetrics & Gynecology
Nigel J Bundred

Abstract

Aromatase inhibitors improve survival in breast cancer patients but adversely affect bone health. Hormone receptor positive breast cancer is increasingly targeted with chemotherapy, ovarian suppression and the use of aromatase inhibitors. Aromatase inhibitors block oestrogen production in peripheral tissues and the three third generation aromatase inhibitors (anastrozole, letrozole and exemestane) reduce circulating oestrogen levels, leading to accelerated bone loss and an increased risk of fracture.The majority of fractures occur in osteopaenic women prescribed aromatase inhibitors. Current guidelines advocate bone mineral density (BMD) measurement in all patients on aromatase inhibitors with selective use of antiresorptive therapy in osteoporotic (T-score > -2.5) women. Risk factors for premature bone loss and fracture include a low BMI, family history or personal history of fragility fracture after the age of 50, oral corticosteroid use more than 6 months and cigarette smoking. Emerging evidence supports concomitant use of bisphosphonates in all women on aromatase inhibitors to prevent fracture and breast cancer recurrence. The increasing use of aromatase inhibitors requires selection of patients for antiresorptive therapy a...Continue Reading

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Citations

Oct 10, 2013·European Journal of Obstetrics, Gynecology, and Reproductive Biology·Nirmala DuhanJyotsna Sen
Jun 11, 2010·American Journal of Clinical Oncology·Allan Lipton
May 22, 2010·Current Opinion in Pediatrics·Alicia Diaz-Thomas, Dorothy Shulman
Feb 14, 2015·The Journal of Sexual Medicine·Ecem KayaSerap Gur
May 3, 2011·Oncology Nursing Forum·Jane BrycePeyman Hadji
Feb 13, 2018·BioImpacts : BI·Muhammad Nuh MusaRajan Rajabalaya
Aug 20, 2014·The Journal of Clinical Endocrinology and Metabolism·E Kirk NeelyDiane I Suchet
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Oct 24, 2017·Journal of Cancer Epidemiology·Chelsea AndersonHazel B Nichols
Jun 15, 2021·Scandinavian Journal of Clinical and Laboratory Investigation·Kristian Buch-LarsenPeter Schwarz

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