Introduction: Aromatase inhibitors (AIs) are suppressors of aromatase enzyme activity like non-steroids as anastrozole or letrozole and steroids as exemestane. They are useful for breast cancer as an adjuvant line. Screening of bone mineral density (BMD) is needed because the loss of estrogens will dramatically increase the risk of osteoporosis. We aim to introduce insights of bone- related AIs aspects. This is a mini-review (PubMed research).
General data: A multidisciplinary team is required. DXA, FRAX evaluation, and Trabecular Bone Score (TBS) are useful before starting therapy. As options, intravenous zolendronic acid 4 mg every 6 months, subcutaneous denosumab 60 μg every 6 months or even oral alendronate, risendronate, ibandronate are considered. The therapy is continued at least during treatment with AI. Physical exercise, vitamin D and calcium supplements are required. Patients with adequate DXA and no fracture risk should be followed up; if they loss BMD at 1 or 2 years, anti-osteoporotic therapy should be started. If a patient decreases BMD after 1 or 2 years of oral bisphosphonates, injectable drugs are preferred. Particular thresholds of intervention based on general recommendations do not display individual decision. Despite all this aspects of management, a large number of women with breast cancer are still not tested; neither treated for cancer-drugs induced osteoporosis.
Conclusion: A high index of awareness is need in the endocrine field of osteoporosis that follows oncologic field of breast cancer diagnosed on women who are treated with aromatase inhibitors.
Full text sources
