ReviewTherapeutic advances in musculoskeletal disease2018
Aromatase inhibitors are associated with a higher fracture risk than tamoxifen: a systematic review and meta-analysis.
Review in Therapeutic advances in musculoskeletal disease, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 60 citations in OpenAlex.
- Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2023Pooled it
- Romosozumab for cancer treatment-induced bone loss in postmenopausal women with hormone receptor-positive breast cancer: a case series.Archives of osteoporosis · 2026Article
- Association Between Endocrine Therapy and Fracture Risk in Women with Breast Cancer in Germany-A Retrospective Cohort Study.Current oncology (Toronto, Ont.) · 2026Article
- Increased risk of fracture among breast cancer patients: a nationwide retrospective cohort study.Journal of cancer survivorship : research and practice · 2026Article
- Prevalence and risk factors of MRONJ in breast cancer patients with CTIBL.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025Article
- A New Model for Bone Health Management in Postmenopausal Early Breast Cancer Patients Undergoing Adjuvant Endocrine Therapy-The Predict & Prevent Project.Healthcare (Basel, Switzerland) · 2025Article
- Differential fracture risk in breast cancer patients based on endocrine therapy and age: a nationwide cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Management of aromatase inhibitor-associated bone loss (AIBL) in women with hormone-sensitive breast cancer: An updated joint position statement of the IOF, CABS, ECTS, IEG, ESCEO, IMS, and SIOG.Journal of bone oncology · 2025Review
- Aromatase inhibitors therapy and major osteoporotic fracture risk in postmenopausal breast cancer patients: a nationwide real-world cohort study.Breast cancer research : BCR · 2025Article
- Aromatase inhibitors and fracture prevention - do 2017 guidelines work in real world?BJC reports · 2024Article
- Clinical practice guidelines for full-cycle standardized management of bone health in breast cancer patients.Cancer innovation · 2024Article
- Endocrine Therapy for Surgeons: Practical Pearls for Managing Menopausal, Bone Loss and Sexual Adverse Effects.Annals of surgical oncology · 2023Review
- An Exemestane Derivative, Oxymestane-D1, as a New Multi-Target Steroidal Aromatase Inhibitor for Estrogen Receptor-Positive (ERMolecules (Basel, Switzerland) · 2023Article
- Indication and adverse event profiles of denosumab and zoledronic acid: based on U.S. FDA adverse event reporting system (FAERS).Frontiers in pharmacology · 2023Article
- Identifying women with increased risk of breast cancer and implementing risk-reducing strategies and supplemental imaging.Breast cancer (Tokyo, Japan) · 2022Review
- Updated guidance on the management of cancer treatment-induced bone loss (CTIBL) in pre- and postmenopausal women with early-stage breast cancer.Journal of bone oncology · 2021Review
- Managing Common Estrogen Deprivation Side Effects in HR+ Breast Cancer: an Evidence-Based Review.Current oncology reports · 2021Review
- Serum bone markers and risk of osteoporosis and fragility fractures in women who received endocrine therapy for breast cancer: a prospective study.Breast cancer research and treatment · 2020Article
- Inhibition of CDK2 reduces EZH2 phosphorylation and reactivates ERα expression in high-grade serous ovarian carcinoma.American journal of cancer research · 2020Article
- Cancer- and Chemotherapy-Induced Musculoskeletal Degradation.JBMR plus · 2019Review
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn this paper, our aim was to systematically evaluate published evidence of bone fracture risk associated with tamoxifen and aromatase inhibitors in women aged 65 and under, and diagnosed with nonmetastatic breast cancer.
methodsWe comprehensively searched MEDLINE, EMBASE and CINAHL databases from January 1997 through May 2015, and reference lists of the selected articles to identify English-language randomized controlled trials and cohort studies of fracture risk. Two independent reviewers screened articles and assessed methodological quality using Risk of Bias assessment for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies. Fracture risk was estimated as pooled risk ratios using a random-effects model and inverse variance method.
resultsOf 1926 identified articles, 21 independent studies fulfilled our selection criteria. Similar fracture risk was observed in women treated and not treated with tamoxifen [pooled risk ratio (RR) 0.95; 95% confidence interval (CI) 0.84-1.07]. A 35% (95% CI 1.21-1.51) higher fracture risk was observed in the aromatase inhibitor group compared with the tamoxifen group. A 17% (95% CI 1.07-1.28) higher fracture risk was observed in the aromatase inhibitor group than the no aromatase inhibitor group. Compared with the tamoxifen group, aromatase inhibitor-associated fracture risk increased by 33% (pooled RR 1.33; 95% CI 1.21-1.47) during the tamoxifen/aromatase inhibitor treatment period, but did not increase (pooled RR 0.99; 95% CI 0.72-1.37) during the post-tamoxifen/aromatase inhibitor treatment period.
conclusionsFracture risk is significantly higher in women treated with aromatase inhibitors, especially during the treatment period. Tamoxifen is not associated with lower fracture risk while tamoxifen could potentially preserve bone mass. Better osteoporosis management programs, especially during the treatment period, are needed for this group of women.
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