[Effect of aromatase inhibitors on bone metabolism]

Aromatase inhibitors (AI) increase the disease-free survival of patients with receptor-positive breast cancer. They inhibit the endogenous production of estrogen by 50-90% and, in contrast to tamoxifen, reduce bone mineral density. Placebo-controlled studies have lacked statistical power to detect changes in fracture incidence; however, AI increases the incidence of fractures in comparison with tamoxifen. Therefore, we suggest that post-menopausal women starting on AI should be offered a DXA scan and that antiresorptive therapy should be considered for those with osteoporosis.