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Brazilian Journal of Clinical Medicine and Review

Health Review

Vol. 3 No. 1 (2025): January/December - 2025

Prevalence of Bone Fractures in Women with Breast Cancer: A Systematic Review of the Impact of the Use of Aromatase Inhibitors

DOI
https://doi.org/10.52600/2965-0968.bjcmr.2025.3.1.bjcmr33
Submitted
January 24, 2025
Published
2025-04-28

Abstract

The prevalence of bone fractures in patients with breast cancer undergoing treatment with aromatase inhibitors (AIs) is associated with a substantial increase in the risk of osteoporotic fractures and loss of bone mineral density (BMD), due to suppression of bone mineral levels, estrogen in the body, especially in postmenopausal patients. In essence, the present study aims to evaluate the prevalence and severity of bone fractures in breast cancer patients who are being treated with AIs, as well as identify the related risk factors. A systematic literary review was conducted using the scientific databases PubMed and Scielo, the keywords aromatase inhibitors, breast cancer, bone mineral density and fractures were used. Included were publications between June 2002 and February 2021. A total of 176 studies were identified (PubMed: n = 120; Scielo: n = 56), of which 126 were excluded for not meeting the eligibility criteria. Ultimately, 15 studies were included in the analysis, comprising 13 from PubMed and 2 from Scielo. The AIs has a significant impact on BMD in postmenopausal patients, especially compared to patients treated with tamoxifen, and is evident in studies that analyzed the transition from tamoxifen to AI. This negative effect on BMD is related to the increased risk of fractures in patients with hormone receptor-positive breast cancer, especially patients with BMD T-scores less than -1,5. It is relevant that different AIs have varying effects on bone health; anastrozole is associated with a more pronounced reduction in BMD than letrozole and exemestane. In addition to preserving bone health, the inclusion of biphosphonate agentes and vitamin D supplementation demonstrated efficiency in reducing the risk of BMD.

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