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Guidance for the prevention of bone loss and fractures in postmenopausal women treated with aromatase inhibitors for breast cancer: an ESCEO position paper

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An Erratum to this article was published on 03 March 2012

Abstract

Summary

Aromatase inhibitors (AIs) are widely used in women with breast cancer, but they are known to increase bone loss and risk of fractures. Based on available evidence and recommendations, an ESCEO working group proposes specific guidance for the prevention of AIs-induced bone loss and fragility fractures.

Introduction

Aromatase inhibitors (AIs) are now the standard treatment for hormone receptor-positive breast cancer. However, deleterious effects of AIs on bone health have been reported. An ESCEO working group proposes guidance for the prevention of bone loss and fragility fractures in post-menopausal women with breast cancer receiving AIs.

Methods

A panel of experts addressed the issue of skeletal effects of AIs and effectiveness of antifracture therapies for the prevention of AI-induced bone loss and fractures. Recommendations by national and international organizations, and experts’ opinions on this topic were evaluated.

Results

All aromatase inhibitors are associated with negative effects on the skeleton, resulting in bone loss and increased risk of fragility fractures. Current guidelines suggest approaches that differ both in terms of drugs proposed for fracture prevention and duration of treatment.

Conclusion

The ESCEO working group recommends that all AI-treated women should be evaluated for fracture risk. Besides general recommendations, zoledronic acid 4 mg i.v. every 6 months, denosumab s.c., or possibly oral bisphosphonates should be administered for the entire period of AI treatment to all osteoporotic women (T-score hip/spine <−2.5 or ≥1 prevalent fragility fracture), to women aged ≥75 irrespective of BMD, and to patients with T-score <−1.5 + ≥1 clinical risk factor or T-score <−1.0 + ≥2 clinical risk factors. Alternatively, therapy could be considered in patients with a FRAX-determined 10-year hip fracture probability ≥3%.

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Acknowledgments

This work has been promoted and supported by the European Society of Clinical and Economic aspects of Osteoporosis and Osteoarthritis (ESCEO).

Conflicts of interest

RR: speaker or scientific board for Amgen, Danone, Nestlè, Novartis, Nycomed, Roche, Servier; JJB: speaker for or consulting fees from Amgen and Novartis; ADC: No-one. JYR: speaker or paid advisory boards for and consulting fees or research grants from Servier, Novartis, Negma, Eli-Lilly, Wyeth, Amgen, GlaxoSmithKline, Roche, Merckle, Nycomed, NPS, Theramex, UCB Rottapharm, IBSA, Teijin, Teva, Ebewee Pharma, Zodiac, Analis, Novo-Nordisk, Nolver, Bristol Myers Squibb, Merck Sharp and Dohme; PP: consulting fees from Amgen, Novartis, Eli-Lilly, Servier. MLB: consulting fees or research grants from Servier, Merck Sharp and Dohme, Novartis, Amgen, Eli-Lilly, Roche.

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Authors and Affiliations

  1. Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

    R. Rizzoli

  2. Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    J. J. Body

  3. Division of Medical Oncology, Galliera Hospital, Genoa, Italy

    A. De Censi

  4. Division of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy

    A. De Censi

  5. Department of Public Health Science, University of Liège, Liège, Belgium

    J. Y. Reginster

  6. Department of Internal Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy

    P. Piscitelli & M. L. Brandi

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Rizzoli, R., Body, J.J., De Censi, A. et al. Guidance for the prevention of bone loss and fractures in postmenopausal women treated with aromatase inhibitors for breast cancer: an ESCEO position paper. Osteoporos Int 23, 2567–2576 (2012). https://doi.org/10.1007/s00198-011-1870-0

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