Evaluation and management of aromatase inhibitor-induced bone loss in women with breast cancer

Women with a history of breast cancer may be at increased risk of osteoporosis secondary to the adjuvant systemic therapies administered. Osteoporosis is associated with an increased risk of fracture and can be associated with significant morbidity, mortality, disfigurement and loss of self esteem, and health care expenditure. As more women are exposed to AIs, it is important to understand their adverse effects on the skeleton. Search Method: In this review article, electronic searches were undertaken in PubMed, Scholar google and up to date since 2012. Results: Aromatase inhibitors (AIs) are an important component of adjuvant endocrine therapy in women with estrogen receptor positive breast cancer. Although the primary source of estrogen in premenopausal women is the ovaries, the primary source in postmenopausal women is the adrenal gland, where aromatase converts adrenal androgens to estrogens. Aromatase inhibitors prevent conversion of androgens to estrogens. In postmenopausal women, AIs cause relatively rapid decreases in circulating estrogen . Treatment with AIs, therefore, results in bone loss due to estrogen deficiency. BMD of the LS and total hip (TH) were significantly reduced in postmenopausal women receiving AIs. CONCLUSION: Nurses may play a crucial role in screening this high-risk group for low bone density and ineducating patients on the importance of healthy lifestyle changes. These include increasing physical activity, reducing or stopping smoking, and taking calcium and vitamin D supplements . Because AIs are associated with bone loss and fracture, women who will be initiating AIs require fracture risk assessment. The pharmacologic agents available for the prevention of aromatase inhibitor-induced bone loss in postmenopausal women are bisphosphonate and denosumab.

Keywords:

Evaluation , management , aromatase inhibitor , bone loss , breast cancer