A new study has reported that bone loss induced by cancer treatment results in hip fractures among mid-life women with breast cancer. Such hip fractures occur at younger ages and at higher bone mineral density levels than expected for women in this age group. Aromatase inhibitors recently have been reported to be associated with hip fractures. In the study, the authors present the cases of six breast cancer survivors with hip fractures from 2005 to 2008, in addition to performing an extensive review of bone health care in breast cancer patients by searching various databases (MEDLINE, PubMed, EMBASE, and the Food and Drug Administration Adverse Event Reporting System (FDA AERS)). Clinical assessments and bone mineral density testing of the breast cancer survivors with hip fractures were performed. Functional status (the ability to manage daily routines) before the hip fracture and a year afterwards were also assessed.

The median age of the women with hip fractures was 53.5 years, whereas hip fractures are rare in women under 70 in the general population. Five women had osteopenia (low bone mineral density), however only one had outright osteoporosis (thinning of bone tissue and loss of bone density resulting in fragile bones). The women had early-stage breast cancer and had received treatment including lumpectomy, radiation treatment and chemotherapy one to four years before the fracture occurred. They were all perimenopausal at the time of the hip fracture. One year after their hip fractures, functional decline was evident in the women, including difficulty in performing heavy housework, climbing stairs, and shopping. The FDA AERS database contained 228 cases of fractures associated with breast cancer treatment during the period 1998 to 2008, of which 77 (29.4%) were hip or femur fractures. Among mid-life women under 64 years of age, there were 78 fractures, of which 15 (19%) were hip and femur fractures. Aromatase inhibitors (Arimidex (anastrozole), Femara (letrozole), Aromasin (exemestane)) were the most common drug class associated with fractures (149 or 65% of the cases). The authors conclude that bone loss induced by cancer treatment results in hip fractures among mid-life women with breast cancer, resulting in considerable functional decline.

Please see our article on what to eat during aromatase inhibitor treatment for more information on how to optimize treatment with aromatase inhibitors and reduce side effects.