New guidance on the management of aromatase inhibitor-associated bone loss in women with hormone-sensitive breast cancer

An updated joint position statement on the management of aromatase inhibitor-associated bone loss (AIBL) addresses the heightened fracture risk in women undergoing endocrine therapy for estrogen-responsive breast cancer, providing practical guidance for both osteoporosis specialists and oncologists. 

Aromatase inhibitors are a cornerstone of adjuvant treatment for hormone-responsive breast cancer, significantly reducing the risk of recurrence. However, they also accelerate bone resorption, leading to a higher incidence of osteoporosis and fractures.

This new publication, an update to recommendations from 2017, is a joint statement by experts from the IOF, CABS, ECTS, IEG, ESCEO, IMS, and SIOG.*
The statement incorporates information from recent clinical trials, systematic reviews, and meta-analyses. It offers clinicians an evidence-based treatment algorithm to assess fracture risk and guide bone-directed therapy in women receiving aromatase inhibitors.

Key updates include:

• Enhanced risk stratification for fracture assessment.
• Expanded data on the impact of long-term aromatase inhibitor use (>5 years).
• Updated guidance on pharmacologic interventions to mitigate bone loss.
• New insights on how bone-protective therapies may influence breast cancer outcomes, including bone metastasis and overall survival.

Lead author, Professor Peyman Hadji of the Frankfurt Centre for Bone Health and Endocrinology, Frankfurt, and Philipps University of Marburg, Marburg, Germany, stated: “The significant negative impact that aromatase inhibitors and other breast cancer therapies can have on bone health in postmenopausal women reinforces the need for clear strategies to routinely assess and appropriately treat this patient group alongside their primary disease management. This updated position statement reflects the latest combined thinking on fracture and risk assessment in postmenopausal women with breast cancer who are receiving adjuvant aromatase inhibitor therapy and summarizes the most suitable treatment modalities and an ideal treatment algorithm for the management of AIBL.”

Professor Nicholas Harvey, IOF President, added: “Every woman undergoing aromatase inhibitor therapy deserves to understand her heightened fracture risk and its consequences. This updated guidance unites the latest expertise in fracture prevention and treatment, and calls on osteoporosis specialists and oncologists to integrate it into everyday practice.”

“By working together, physicians and patients can promote a personalized, evidence-based strategy that safeguards bone health while optimizing cancer care.”

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Reference:
Hadji, P., Aapro, M., Al-Dagri, N., Alokail, M., Biver, E., Body, J. J., Brandi, M. L., Brown, J., Confavreux, C., Cortet, B., Drake, M., Ebeling, P., Eriksen, E. F., Fuleihan, G. E., Guise, T. A., Harvey, N. C., Kurth, A., Langdahl, B., Lems, W., Matijevic, R., McCloskey, E., Nappi, R., Palacios, S., Pfeiler, G., Reginster, J. Y., Rizzoli, R., Santini, D., Tuzun, S., Van Poznak, C., Villiers, T., Zillikens, M. C., & Coleman, R. (2025). 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, 53, 100694. https://doi.org/10.1016/j.jbo.2025.100694

*Abbreviations:
IOF: International Osteoporosis Foundation; CABS: Cancer and Bone Society; ECTS: European Calcified Tissue Society; IEG: International Expert Group for AIBL; ESCEO: European Society for Clinical and Economics Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases;
IMS: International Menopause Society; SIOG: International Society for Geriatric Oncology.

About IOF
The International Osteoporosis Foundation (IOF) is the world's largest nongovernmental organization dedicated to the prevention, diagnosis and treatment of osteoporosis and related musculoskeletal diseases. IOF’s network includes membership committees comprised of scientific experts, 340 patient, medical societies and universities in more than 150 countries, as well as over 1100 Fracture Liaison Services in all regions of the world. The IOF network is united in its mission to prioritize bone health and fracture prevention, striving toward a shared vision of a world free from fragility fractures, where healthy mobility is a reality for all. @iofbonehealth
Websites: www.osteoporosis.foundation ; www.capturethefracture.org ; www.worldosteoporosisday.org ; www.buildbetterbones.org ; https://www.iofacademy.org/