A position statement of 7 interdisciplinary cancer and bone societies that describes risk factors related to fractures and approaches for limiting bone loss and fractures in patients with early-stage breast cancer undergoing treatment with aromatase inhibitors (AIs) was updated.

This update integrates recommendations from current guidelines that detail how to avoid fractures during AI therapy, results from recent studies describing additional risk factors for fracture, new therapies, and results from real-world studies indicating a much greater rate of fracture than randomized clinical trial results have shown.

The intent of the updated algorithm is to improve assessment of fracture risk and to direct treatment.

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Researchers conducted a systematic review of the literature to identify recent developments in bone loss associated with AI (AIBL). In the updated position statement, the researchers recommend assessing all patients undergoing AI therapy for fracture risk.

The statement also recommended 6 monthly denosumab or yearly zoledronate during AI treatment to limit AIBL in postmenopausal women. Denosumab should be recommended when fracture risk is the primary concern, and zoledronate should be recommended when disease recurrence is the primary concern.

The statement recommends regular assessment of adherence and assessment of bone mineral density every 12 to 24 months.


1. Hadji P, Aapro MS, Body JJ, et al. Management of aromatase inhibitor-associated bone loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG. J Bone Oncol. 2017;7:1-12.