Clin Osteol 2026; 31(2): 91-96 | DOI: 10.36290/clo.2026.014
Gynecologists in caring for bone health in women with breast cancerMain theme
- 1 Gymuno, s. r. o., Praha
- 2 Katedra zdravotnických studií VŠPJ, Jihlava
- 3 Gynekologicko-porodnická klinika 2. LF UK a FNMH, Praha
Breast cancer is the most common malignancy in women. Therapeutically induced hypoestrogenism may lead to significant bone loss and a consequent increase in fracture risk. Antiresorptive treatment of osteoporosis (bisphosphonates and denosumab) plays an important role in mitigating bone loss induced by anticancer therapy. Currently, evidence supports the use of bisphosphonates as adjuvant therapy to prevent metastasis and recurrence of the disease. Unfortunately, bone health care in women with breast cancer is often not prioritized, leaving this group of patients vulnerable to significant bone loss and subsequent fractures.
Keywords: breast cancer, cancer therapy-induced bone loss, clodronate, zoledronic acid, denosumab.
Accepted: June 12, 2026; Published: July 1, 2026 Show citation
References
- Fait T. Steroidní kontraceptiva - vliv na kostní metabolismus. Clin Osteol. 2024;29(4):8-13.
Go to original source... - Fait T, Vrablik M. Hormone replacement therapy (HRT) shortages for treating menopause: what can clinicians do to relieve symptoms and concerns? Sci. 2024;6:46.
Go to original source... - Trémolieres FA, Ceausu I, Depypere H, et al. Osteoporosis management in patients with breast cancer: EMAS position statement. Maturitas. 2017;95:65-71.
Go to original source...
Go to PubMed... - Sung J, Song YM, Stone J, et al. The relationship between bone mineral density and mammographic density in Korean women: the Healthy Twin study. Breast Cancer Res Treat. 2011;129:583-591.
Go to original source... - Mann GB, Kang YC, Brand C, et al. Secondary causes of low bone mass in patients with breast cancer: a need for greater vigilance. J Clin Oncol. 2009;27:3605-3610.
Go to original source...
Go to PubMed... - Van der Klift M, de Laet EDH, Coebergh JWW, et al. Bone mineral density and the risk of cancer: the Rotterdam study. Bone. 2003;32:211-216.
Go to original source...
Go to PubMed... - Chen Z, Arendell L, Aickin M, et al. Hip bone density predicts breast cancer risk independently of Gail score: results from the Women's Health Initiative. Cancer. 2008;113:907-915.
Go to original source... - Gradishar W, Salerno KE, NCCN, et al. Guidelines update: breast cancer. J Natl Compr Canc Netw. 2016;14(Suppl 5):641-644.
Go to original source... - Kristensen B, Eljertsen B, Dalgaard P, et al. Tamoxifen and bone metabolism in postmenopausal low-risk breast cancer patients: a randomized study. J Clin Oncol. 1994;12:992-997.
Go to original source...
Go to PubMed... - Lee SJ, Cha CD, Hong H, et al. Adverse effects of tamoxifen treatment on bone mineral density in premenopausal patients with breast cancer: a systematic review and meta-analysis. Breast Cancer. 2024;31:717-725.
Go to original source... - Henze M, Stuckey BGA. Endocrine consequences of breast cancer therapy and survivorship. Climacteric. 2024;27(4):333-339.
Go to original source...
Go to PubMed... - Goss PE, Ingle JN, Alés-Martínez JE, et al. Exemestane for breast-cancer prevention in postmenopausal women. N Engl J Med. 2011;364(25):2381-2391.
Go to original source...
Go to PubMed... - Cuzick J, Sestak I, Forbes JF, et al. Use of anastrozole for breast cancer prevention (IBIS-II): long-term results of a randomised controlled trial. Lancet. 2020;395(10218):117-122.
Go to original source... - Hadji P, Apro MS, Body JJ, et al. Management of aromatase inhibitor-associated bone loss (AIBL) in postmenopausal women with hormone-sensitive breast cancer: joint position of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG. J Bone Oncol. 2017;7:1-12.
Go to original source...
Go to PubMed... - Hyder T, Marino CC, Ahmad S, et al. Aromatase inhibitor-associated musculoskeletal syndrome: understanding mechanisms and management. Front Endocrinol. 2021;12:713700.
Go to original source...
Go to PubMed... - Saarto T, Vehmanen L, Elomaa I, et al. The effect of clodronate and antioestrogens on bone loss associated with oestrogen withdrawal in postmenopausal women with breast cancer. Br J Cancer. 2001;84:1047-1051.
Go to original source...
Go to PubMed... - Confavreux CB, Fontana A, Guastalla JP, et al. Estrogen-dependent increase in bone turnover and bone loss in postmenopausal women with breast cancer treated with anastrozole: prevention with bisphosphonates. Bone. 2007;41:346-352.
Go to original source...
Go to PubMed... - Sestak I, Singh S, Cuzick J, et al. Changes in bone mineral density at 3 years in postmenopausal women receiving anastrozole and risedronate in the IBIS-II bone substudy: an international, double-blind, randomised, placebo-controlled trial. Lancet Oncol. 2014;15:1460-1468.
Go to original source... - Coleman R, de Boer R, Eidtmann H, et al. Zoledronic acid (zoledronate) for postmenopausal women with early breast cancer receiving adjuvant letrozole (ZO-FAST study): final 60-month results. Ann Oncol. 2013;24:398-405.
Go to original source...
Go to PubMed... - Wagner-Johnston ND, Sloan JA, Liu H, et al. 5-year follow-up of a randomised controlled trial of immediate versus delayed zoledronic acid for the prevention of bone loss in postmenopausal women with breast cancer starting letrozole after tamoxifen: N03CC (Alliance) trial. Cancer. 2015;121:2537-2543.
Go to original source... - Gnant M, Mlineritsch B, Luschin-Ebengreuth G, et al. Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer: 5-year follow-up of the ABCSG-12 bone-mineral density substudy. Lancet Oncol. 2008;9:840-849.
Go to original source... - Wilson C, Bell R, Hinsley S, et al. Adjuvant zoledronic acid reduced fractures in breast cancer patients: AZURE study. Eur J Cancer. 2018;94:70-78.
Go to original source...
Go to PubMed... - Kalder M, Kyvernitakis I, Albert U, et al. Effects of zoledronic acid versus placebo on bone mineral density and bone texture analysis by trabecular bone score in premenopausal women with breast cancer treatment-induced bone loss: results of the ProBONE II substudy. Osteoporos Int. 2015;26(1):353-360.
Go to original source... - Coleman R, Powles T, Paterson A, et al. Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. Lancet. 2015;386(10001):1353-1361.
Go to original source...
Go to PubMed... - Adams A, Jakob T, Huth A, et al. Bone modifying agents for reducing bone loss in women with early and locally advanced breast cancer: a network meta-analysis. Cochrane Database Syst Rev. 2024;7(7):CD013451.
Go to original source...
Go to PubMed... - Han-Sang B, Kabsoo S, Jinyoung K, et al. Efficacy of a single 5 mg zoledronic acid infusion in preventing bone loss and fracture in postmenopausal women with breast cancer. J Bone Miner Metab. 2024;42:720-727.
Go to original source... - Ellis GK, Bone HK, Chlebowski R, et al. Effect of denosumab on bone mineral density in women receiving adjuvant aromatase inhibitors for non-metastatic breast cancer: subgroup analyses of a phase 3 study. Breast Cancer Res Treat. 2009;118:81-87.
Go to original source... - Gnant M, Pfeiler G, Dubsky PC, et al. Adjuvant denosumab in breast cancer (ABCSG-18): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2015;386:433-443.
Go to original source...
Go to PubMed... - Anastasilakis AD, Makras P, Yavropoulou MP, et al. Denosumab discontinuation and the rebound phenomenon: a narrative review. J Clin Med. 2021;10(1):152.
Go to original source...
Go to PubMed... - Paterson AHG, Anderson SJ, Lembersky BC, et al. Oral clodronate for adjuvant treatment of operable breast cancer (National Surgical Adjuvant Breast and Bowel Project protocol B-34): a multicentre, placebo-controlled, randomised trial. Lancet Oncol. 2012;13:734-742.
Go to original source...
Go to PubMed... - Majithia N, Atherton PJ, Lafky JM, et al. Zoledronic acid for treatment of osteopenia and osteoporosis in women with primary breast cancer undergoing adjuvant aromatase inhibitor therapy: a 5-year follow-up. Support Care Cancer. 2016;24:1219-1226.
Go to original source... - Brufsky A, Harker WG, Beck JT, et al. Final 5-year results of Z-FAST trial: adjuvant zoledronic acid maintains bone mass in postmenopausal breast cancer patients receiving letrozole. Cancer. 2012;118:1192-1201.
Go to original source...
Go to PubMed... - Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. Lancet. 2015;386:1353-1361.
Go to original source...
Go to PubMed... - Lipton A, Fizazi K, Stopeck AT, et al. Superiority of denosumab to zoledronic acid for prevention of skeletal-related events: a combined analysis of 3 pivotal, randomised, phase 3 trials. Eur J Cancer. 2012;48:3082-3092.
Go to original source...
Go to PubMed... - Eisen A, Somerfield MR, Accordino MK, et al. Use of adjuvant bisphosphonates and other bone-modifying agents in breast cancer: ASCO-OH (CCO) guideline update. J Clin Oncol. 2022;40(7):787-800.
Go to original source... - Moretti L, Richelmi L, Cosentini D, et al. Adjuvant denosumab for early breast cancer: evidence and controversy. Breast. 2024;78:103826.
Go to original source...
