Strategies for preventing and managing osteoporosis in elderly breast cancer patients undergoing aromatase inhibitor therapy

The development and progression of breast cancer are closely linked to estrogen levels. For patients with estrogen receptor-positive breast cancer, endocrine therapy targeting estrogen pathways remains a cornerstone of postoperative treatment. Aromatase, a critical enzyme in estrogen biosynthesis, exhibits heightened expression in breast tumors and their surrounding tissues. Consequently, aromatase inhibitors (AI) have become widely adopted as a primary endocrine therapy for breast cancer. While AI effectively lower tumor recurrence rates, they are associated with adverse effects such as bone loss, osteoporosis, and increased risk of osteoporotic fractures. These effects are particularly pronounced in elderly breast cancer patients, who are predisposed to accelerated bone mass loss and a higher prevalence of osteoporosis. This review explores the mechanisms of action of AI, the pathways through which they contribute to bone density reduction and osteoporosis, and the risk stratification for osteoporotic fractures. Additionally, it highlights evidence-based strategies for preventing and managing AI-induced osteoporosis in elderly breast cancer patients. By addressing these challenges, the review aims to enhance understanding of the bone health issues faced by this patient population, improve their quality of life, and reduce the incidence of complications.