Management of Bone Health in Breast Cancer Survivors

The management of bone health in breast cancer survivors encompasses risk assessment, preventive strategies and therapeutic interventions aimed at mitigating treatment‐induced bone loss and reducing fracture risk. Breast cancer therapies, notably aromatase inhibitors and chemotherapy leading to ovarian failure, accelerate bone resorption and compromise bone microarchitecture. Survivors require baseline evaluation of bone mineral density (BMD) alongside clinical risk factors such as age, menopausal status and prior fractures. Monitoring may include dual‐energy X-ray absorptiometry, vertebral fracture assessment and trabecular bone score to detect early changes. Preventive measures focus on lifestyle modifications—weight-bearing exercise, adequate calcium and vitamin D intake—and tailored pharmacotherapy. Bone-targeting agents such as bisphosphonates and the RANKL inhibitor denosumab have demonstrated efficacy in preserving BMD, reducing fracture incidence and, in certain settings, delaying disease recurrence. Emerging approaches integrate genetic risk profiling to refine individual fracture risk prediction. A multidisciplinary model that combines oncology follow-up with endocrine and metabolic bone expertise is essential to ensure long-term skeletal health and quality of life in this growing population of survivors.

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Management of Bone Health in Breast Cancer Survivors publication trend

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Technical terms

Cancer treatment-induced bone loss (CTIBL): Accelerated reduction in bone mass and strength resulting from oncological therapies.

Bone mineral density (BMD): A quantitative measure of bone strength assessed by dual-energy X-ray absorptiometry.

Aromatase inhibitor: A class of drugs that suppress oestrogen synthesis in postmenopausal women, commonly used in hormone receptor-positive breast cancer.

Bisphosphonate: An antiresorptive agent that inhibits osteoclast activity to preserve bone mass.

Denosumab: A monoclonal antibody targeting RANK ligand to reduce osteoclast-mediated bone resorption.

References

1. Risk of fractures in half a million survivors of 20 cancers: a population-based matched cohort study using linked English electronic health records. The Lancet Healthy Longevity (2024).
2. A polygenic score associated with fracture risk in breast cancer patients treated with aromatase inhibitors. npj Breast Cancer (2024).
3. Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. The Lancet (2015).
4. 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 (2021).