Thorne C. Curr Opin Oncol 2007; Suppl 1: S19-S28.
The aromatase inhibitors anastrozole, exemestane and letrozole have been shown in several studies to be more effective than tamoxifen in the prevention of breast cancer recurrence in postmenopausal women, and are being used increasingly.
They block oestrogen production, so we might expect problems with reduced bone density and fractures in a group of women already at risk of these problems; unfortunately, this has been found to be the case.
The authors comment that while arthralgia, the other troublesome side-effect, can be treated with analgesics, no strategy is yet in place to detect or treat those who may develop osteoporosis. They suggest that DXA scanning should take place every one to two years for detection and monitoring, and that the usual methods for the prevention and treatment of osteoporosis, such as weight-bearing exercise, alcohol and smoking advice, calcium and vitamin D, and antiresorptive (bisphosphonate) drugs, should be instigated when required.
In common with many other advances in medicine, the benefits of these drugs appear to have been embraced before the side-effect profile has been fully evaluated. Given the current body of knowledge on osteoporosis detection and prevention, however, practical guidelines should soon be forthcoming.
- Dr Alison Glenesk is a GP with an interest in women's health in Aberdeen, Scotland.