Reducing the risk of bone loss associated with breast cancer treatment

Women with breast cancer experience more fractures than their healthy peers. Fracture risk factors that are frequently observed in healthy postmenopausal women may already be present when breast cancer is diagnosed. Although low bone mineral density (BMD) significantly increases fracture risk, additional clinical risk factors that are independent of BMD, including age, previous fragility fracture, premature menopause, family history of hip fracture, use of corticosteroids, and low body mass index, also increase fracture risk. Additionally, cancer therapies can further increase fracture risk. Most notably, gonadotropin-releasing hormone analogues and aromatase inhibitor (AI) therapy increase bone loss and fracture incidence. Therefore, patients receiving AIs require a comprehensive fracture risk assessment including all risk factors and BMD when available. Zoledronic acid is an effective therapy for the prevention of AI-associated bone loss and, when combined with AI therapy, may provide the greatest clinical benefit without increasing fracture risk.