BoneKEy-Osteovision | Perspective

Aromatase inhibitors and bone health

Eugene V McCloskey

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DOI:10.1138/20060216

Abstract

The third-generation aromatase inhibitors (anastrozole, letrozole, and exemestane) are increasingly used in the treatment of early and advanced breast cancer and act by substantially reducing estrogen synthesis in postmenopausal women. Low estradiol levels in women are associated with decreased bone mineral density (BMD) and increased fracture risk. Current data suggest that both the steroidal (exemestane) and nonsteroidal (anastrozole and letrozole) aromatase inhibitors increase bone turnover. Conclusions regarding any clinically relevant differences between these agents are difficult to make, and further data are awaited from use of these three agents as long-term adjuvants in ongoing clinical studies and head-to-head studies. Postmenopausal women are at increased risk of osteoporosis and fracture, and the increasing use of aromatase inhibitors in the adjuvant treatment of postmenopausal breast cancer patients will require appropriate consideration of fracture risk, with the use of anti-osteoporotic therapies, if necessary.

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