Fracture Risk in Women with Breast Cancer
An expert analysis of recent studies looking at the impact that breast cancer treatments may have on bone health, and the recommended managed to reduce risk of fracture.
July 2021
Volume 7, Issue 1


Welcome from Azeez Farooki, MD

Women with nonmetastatic breast cancer appear at increased risk for bone loss and eventually for osteoporotic (fragility) fractures as a result of factors such as surgical or chemotherapy-induced (premature) menopause, as well as adjuvant aromatase inhibitor use with or without gonadotropin-releasing hormone agonists (GnRH agonists).

Nonmetastatic breast cancer patients are at increased risk for bone loss and fractures.There are protective treatments that increase bone health in breast cancer patients.

Bone health in breast cancer is an important topic given the large number of breast cancer survivors. Adjuvant aromatase inhibitors (AI) are a standard of care for many breast cancer patients with data pending as to the optimal duration (minimum of 5 years). The duration of aromatase inhibitor therapy is relevant given data suggesting some recovery of bone mineral density (BMD) after stopping AI therapy and, also given rare but serious adverse effects related to "long term" use of potent antiresorptive agents, such as bisphosphonates and densoumab.

A final consideration to weigh in the equation of whether a given patient should be treated with bone-protective therapy is the recent meta analysis data of randomized bisphosphonate trials showing a decrease in bone recurrence and an improvement in cancer-specific mortality in postmenopausal women with breast cancer.

Here I present and comment on recent informative studies on this topic.

  • The study by Tsa et al investigated the risk of bone fracture in Asian women, for whom the risk of breast cancer peaks much earlier than in Caucasian women.
  • Eastell et al evaluated the effects of 5 years of anastrozole on bone mineral density, as well as the subsequent effects of discontinuing this agent for 2 years.
  • Gnant and co-authors studied the effects of the anti-RANK ligand antibody densosmab on fracture risk, bone health, and safety outcomes in postmenopausal women undergoing adjuvant endocrine therapy with aromatase inhibitors for the treatment of breast cancer.


First Article:
Asian Women with Breast Cancer May Be at Increased Risk for Bone Fracture
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