Breast Cancer Research and Treatment

, Volume 168, Issue 2, pp 523–530 | Cite as

Changes in bone mineral density in women with breast cancer receiving aromatase inhibitor therapy

  • Marilyn L. KwanEmail author
  • Song Yao
  • Cecile A. Laurent
  • Janise M. Roh
  • Charles P. QuesenberryJr.
  • Lawrence H. Kushi
  • Joan C. Lo



We assessed bone mineral density (BMD) change with aromatase inhibitor (AI) treatment in a contemporary cohort of women with breast cancer treated in Kaiser Permanente Northern California.


Percent and estimated annual percent changes in BMD at the total hip and lumbar spine were examined in 676 women receiving AI therapy who had two serial BMD reports available (at least 1 year apart) before and after AI initiation (N = 317) or during continued AI therapy (N = 359). BMD changes were examined at the total hip and lumbar spine and compared by age and clinical subgroups.


Women experienced BMD declines after AI initiation or continued therapy, with median annual percent change − 1.2% (interquartile range, IQR − 2.4 to − 0.1%) at the hip and − 1.0% (IQR − 2.3 to 0.1%) at the spine after AI initiation, and − 1.1% (IQR − 2.4 to 0.1%) at the hip and − 0.9% (IQR − 2.4 to 0.5%) at the spine during continued therapy. Higher levels of bone loss were observed among younger (< 55 years) compared with older (≥ 75 years) women at the hip (− 1.6% vs. − 0.8%) and at the spine (− 1.5% vs. − 0.5%) after AI initiation, and at the hip (− 1.4% vs. − 1.2%) and at the spine (− 2.4% vs. − 0.001%) during continued therapy.


Small but consistent declines in total hip and lumbar spine BMD were present in breast cancer patients following AI therapy initiation or continued AI therapy. Although the overall rates of osteoporosis were low, greater estimated levels of annual bone loss were evident among women < 55 years.


Breast cancer Bone mineral density Aromatase inhibitor Endocrine therapy Osteoporosis 



Aromatase inhibitor


Bone mineral density


Body mass index




Hormone receptor


Interquartile range



We thank Jean Lee for her medical record reviews. This study was funded by the National Cancer Institute R01 CA166701, R01 CA105274, and U01 CA195565.

Compliance with ethical standards

Conflict of interest

Dr. Lo or a household member has received research funding from Amgen, Sanofi, Novartis, GlaxoSmithKline, or AstraZeneca unrelated to this study. The other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Marilyn L. Kwan
    • 1
    Email author
  • Song Yao
    • 2
  • Cecile A. Laurent
    • 1
  • Janise M. Roh
    • 1
  • Charles P. QuesenberryJr.
    • 1
  • Lawrence H. Kushi
    • 1
  • Joan C. Lo
    • 1
  1. 1.Division of ResearchKaiser Permanente Northern CaliforniaOaklandUSA
  2. 2.Department of Cancer Prevention and ControlRoswell Park Cancer InstituteBuffaloUSA

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