title: Systematic review of bone health in older women treated with aromatase inhibitors for early-stage breast cancer.
abstract: OBJECTIVE
  To review data from randomized controlled trials (RCTs) that evaluate adverse bone outcomes in older women using aromatase inhibitors (AIs) for early-stage hormone receptor-positive breast cancer.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  International RCTs referenced in Medline and EMBASE databases through August 1, 2011.
  
  
  METHODS
  Postmenopausal women with early-stage hormone receptor-positive breast cancer receiving adjuvant endocrine therapy.
  
  
  METHODS
  Fracture rates and changes in bone turnover markers and bone mineral density.
  
  
  RESULTS
  Eleven RCTs were identified. The majority of trials included women with a mean age in the 60s; and women aged 75 and older and 80 and older were excluded from two studies. Fracture rates ranged from 0.9% to 11%, with AIs having a 1.5 times higher risk than tamoxifen or placebo. Fracture data were not systematically collected in many of these trials. In a small subpopulation of women, AIs were associated with higher markers of bone turnover and lower bone density. The relationship between age and fracture was not described.
  
  
  CONCLUSIONS
  AIs are associated with low bone density and high fracture risk in women with a mean age in their early 60s. There is a paucity of data describing the effect of baseline fracture risk factors, particularly age, and the longer-term effects on bone health in older women. Future research is needed regarding baseline fracture risk, interventions, and long-term effects on bone in this vulnerable population to inform management decisions to optimize AI duration and ensure quality of life after breast cancer.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada. taryn.becker@wchospital.ca
authors.forename: Taryn
authors.initials: T
authors.lastname: Becker
authors.forename: Lorraine
authors.initials: L
authors.lastname: Lipscombe
authors.forename: Steven
authors.initials: S
authors.lastname: Narod
authors.forename: Christine
authors.initials: C
authors.lastname: Simmons
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Anderson
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D047072:Aromatase Inhibitors / Q000009:adverse effects*; D015519:Bone Density; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology*; D017698:Postmenopause; D016032:Randomized Controlled Trials as Topic
chemical_list: D047072:Aromatase Inhibitors