Clin Osteol 2026; 31(1): 16-24 | DOI: 10.36290/clo.2026.003

Management of osteoporosis and fracture risk in women with hormone-sensitive breast cancer treated with aromatase inhibitors: a working draft of updated clinical practice recommendationsMain theme

Dana Michalská¹, Martina Zimovjanová², Jana Přibylová², Dominika Svobodová², Vít Zikán¹

¹ 3. interní klinika 1. LF UK a VFN v Praze

² Onkologická klinika 1. LF UK a VFN v Praze

Adjuvant therapy with aromatase inhibitors (AIs) is a standard component of treatment for hormone-sensitive breast cancer; however, it is associated with accelerated bone mineral density loss and an increased risk of osteoporosis and fractures. Current international recommendations emphasize the need for systematic fracture risk assessment both at the initiation of AI therapy and throughout its course, as well as for the timely implementation of preventive and therapeutic measures. In all patients, lifestyle and nutritional interventions are recommended, including regular physical activity, adequate calcium intake, and vitamin D supplementation. Antiresorptive therapy is indicated in women at increased risk according to T-score values and other clinical fracture risk factors and should be continued throughout the duration of AI therapy. The recommendations also take into account the beneficial effect of adjuvant bisphosphonates in reducing the incidence of bone metastases and mortality in postmenopausal women at increased risk of recurrence. The present document summarizes current knowledge on fracture risk assessment and the management of AI-induced bone loss (AIBL), proposes an algorithm for clinical practice, and is also intended to serve as a basis for further expert discussion aimed at formulating a joint position statement of the relevant professional societies.

Keywords: aromatase inhibitors, breast cancer, osteoporosis, fractures, bisphosphonates.

Accepted: March 25, 2026; Published: March 30, 2026  Show citation