An updated joint statement on the treatment of bone loss associated with aromatase inhibitors (AIBL) addresses the increased risk of fractures in women undergoing endocrine therapy for estrogen-sensitive breast cancer and provides practical guidance for both osteoporosis specialists and oncologists.

Aromatase inhibitors are a cornerstone of adjuvant treatment for hormone-sensitive breast cancer, as they significantly reduce the risk of recurrence. However, they also accelerate bone resorption, leading to a higher incidence of osteoporosis and fractures.

This new publication, which updates the 2017 recommendations, is a joint statement by experts from the IOF, CABS, ECTS, IEG, ESCEO, IMS and SIOG*.

The statement incorporates information from recent clinical trials, systematic reviews and meta-analyses. It provides clinicians with an evidence-based treatment algorithm to assess fracture risk and guide bone treatment in women receiving aromatase inhibitors.

The most important updates include:

Improved risk stratification for fracture assessment.

Expanded data on the impact of prolonged use of aromatase inhibitors (>5 years).

Updated guidelines on pharmacological interventions to mitigate bone loss.

New insights into how bone-protecting therapies may influence breast cancer outcomes, including bone metastasis and overall survival.

Lead author Professor Peyman Hadji, from the Centre for Bone Health and Endocrinology, Frankfurt, and Philipps University of Marburg, Marburg, Germany, said: "The significant negative impact that aromatase inhibitors and other breast cancer therapies can have on the bone health of postmenopausal women reinforces the need for clear strategies to routinely assess and appropriately treat this patient group, alongside the treatment of their primary disease.

This updated position statement reflects the latest combined insights on fracture and risk assessment in postmenopausal women with breast cancer receiving adjuvant aromatase inhibitor therapy and summarises the most appropriate treatment modalities and an ideal treatment algorithm for the management of AIBL." Professor Nicholas Harvey, President of the IOF, added:

‘All women undergoing aromatase inhibitor therapy deserve to understand their increased risk of fracture and its consequences. This updated guidance brings together the latest knowledge on fracture prevention and treatment, and calls on osteoporosis specialists and oncologists to integrate it into their daily practice.’

‘By working together, doctors and patients can promote a personalised, evidence-based strategy that protects bone health and optimises cancer care.’

Source: International Osteoporosis Foundation