{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T20:27:15Z","timestamp":1778617635197,"version":"3.51.4"},"reference-count":64,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2005,1,11]],"date-time":"2005-01-11T00:00:00Z","timestamp":1105401600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2005,5,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Estrogen plays an important role in the skeletal health of all women. Many therapies used in the treatment of breast cancer reduce estrogen levels and have the potential to affect bone negatively by increasing the risk of osteoporosis and associated bone fractures. The long\u2010term effects of systemic endocrine therapy on bone, therefore, are an important consideration in the adjuvant setting. Tamoxifen has been shown to have a moderate protective effect on postmenopausal bone due to its partial estrogen agonist activity; however, its long\u2010term use is potentially associated with negative side effects, such as an increased risk of thromboembolic disease and endometrial cancer. Newer agents, the third\u2010generation aromatase inhibitors (AIs), anastrozole, letrozole and exemestane, for example, do not possess estrogen agonist effects and have improved breast cancer outcomes when compared to the standard 5 years of tamoxifen. However, patients treated with adjuvant AIs have been shown to have an increased incidence of osteoporosis and osteoporotic fractures. In order to select the optimal adjuvant therapy for each patient, it is important to assess the overall risk:benefit ratio for each endocrine strategy. All postmenopausal women should follow published guidelines to assess the risk of osteoporosis and, where appropriate, they should receive bone mineral density monitoring. Postmenopausal women with breast cancer who are at increased risk of osteoporotic fracture should be identified and managed with appropriate nonpharmacologic and pharmacologic measures. \u00a9 2004 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/ijc.20826","type":"journal-article","created":{"date-parts":[[2005,1,11]],"date-time":"2005-01-11T16:47:54Z","timestamp":1105462074000},"page":"1010-1015","source":"Crossref","is-referenced-by-count":34,"title":["Skeletal health in postmenopausal survivors of early breast cancer"],"prefix":"10.1002","volume":"114","author":[{"given":"John R.","family":"Mackey","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anil A.","family":"Joy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2005,1,11]]},"reference":[{"key":"e_1_2_6_2_2","volume-title":"Osteoporosis in the European community: a call to action\u2014an audit of policy developments since 1998","author":"International Osteoporosis Foundation","year":"2003"},{"key":"e_1_2_6_3_2","volume-title":"Assessment of fracture risk and its application to screening for postmenopausal osteoporosis","author":"World Health Organization","year":"1994"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.7.1570"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s001980200074"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)08657-9"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(05)80037-3"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.84.8.1287"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/45.3.M101"},{"key":"e_1_2_6_10_2","volume-title":"Osteoporosis and related bone disease National Resource Center","author":"National Institutes of Health","year":"2003"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.2002.17.4.716"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.2000.15.8.1526"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(01)00584-1"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)08706-8"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.74.1.20"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.2165\/00002512-199812001-00001"},{"key":"e_1_2_6_17_2","volume-title":"Cancer facts and figures 2004","author":"American Cancer Society","year":"2004"},{"key":"e_1_2_6_18_2","first-page":"159","article-title":"Epidemiology of susceptibility to breast cancer","volume":"395","author":"Hulka BS","year":"1996","journal-title":"Prog Clin Biol Res"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)08827-X"},{"key":"e_1_2_6_20_2","first-page":"293","article-title":"American Association of Clinical Endocrinologists 2001 medical guidelines for clinical practice for the prevention and management of postmenopausal osteoporosis","volume":"7","author":"Hodgson SF","year":"2001","journal-title":"Endocr Pract"},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)08761-5"},{"key":"e_1_2_6_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/90.18.1371"},{"key":"e_1_2_6_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-0690(02)00114-3"},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1996.14.1.78"},{"key":"e_1_2_6_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)09962-2"},{"key":"e_1_2_6_26_2","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.1996.531"},{"key":"e_1_2_6_27_2","first-page":"1511","article-title":"In vivo measurement of aromatase inhibition by letrozole (CGS 20267) in postmenopausal patients with breast cancer","volume":"1","author":"Dowsett M","year":"1995","journal-title":"Clin Cancer Res"},{"key":"e_1_2_6_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0960-0760(97)80021-0"},{"key":"e_1_2_6_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0960-0760(99)00051-5"},{"key":"e_1_2_6_30_2","first-page":"102a","article-title":"Letrozole suppresses plasma estrogen levels in postmenopausal breast cancer patients more completely than anastrozole","volume":"19","author":"Geisler J","year":"2000","journal-title":"Proc Am Soc Clin Oncol"},{"key":"e_1_2_6_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)09088-8"},{"key":"e_1_2_6_32_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11745"},{"issue":"1","key":"e_1_2_6_33_2","first-page":"S156","article-title":"Beneficial side\u2010effect profile of anastrozole compared with tamoxifen confirmed by additional 7 months of exposure data: a safety update from the Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial","volume":"76","author":"Sainsbury R","year":"2002","journal-title":"Breast Cancer Res Treat"},{"key":"e_1_2_6_34_2","first-page":"25","article-title":"The time course of bone fractures observed in the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial","volume":"22","author":"Locker GY","year":"2003","journal-title":"Proc Am Soc Clin Oncol"},{"key":"e_1_2_6_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(01)00614-7"},{"key":"e_1_2_6_36_2","doi-asserted-by":"crossref","unstructured":"EastellR.Effect of anastrozole of bone mineral density: 2 year results of the Arimidex (Anastrozole) Tamoxifen Alone or in Combination (ATAC) trial. Minneapolis MN: 25th American Society for Bone and Mineral Research Annual Meeting 2003.","DOI":"10.1016\/S1359-6349(04)90892-0"},{"key":"e_1_2_6_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(02)00678-6"},{"key":"e_1_2_6_38_2","first-page":"614","article-title":"Effects of the aromatase inhibitor letrozole on normal breast epithelial cell proliferation and metabolic indices in postmenopausal women: a pilot study for breast cancer prevention","volume":"11","author":"Harper\u2010Wynne C","year":"2002","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"e_1_2_6_39_2","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.2002.17.1.172"},{"key":"e_1_2_6_40_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032312"},{"key":"e_1_2_6_41_2","first-page":"87","article-title":"Updates analysis of the NCI CTG MA.17 randomized placebo (P) controlled trial of letrozole (L) after five years of tamoxifen in postmenopausal women with early stage breast cancer","volume":"23","author":"Goss PE","year":"2004","journal-title":"Proc Am Soc Clin Oncol"},{"key":"e_1_2_6_42_2","unstructured":"GossPE.NCIC CTG MA.17 final analysis of updated data: a placebo\u2010controlled trial of letrozole following tamoxifen as adjuvant therapy in postmenopausal women with early stage breast cancer. American Society of Clinical Oncology Annual Meeting New Orleans LA 2004."},{"key":"e_1_2_6_43_2","first-page":"1081","article-title":"Could exemestane affect insulin\u2010like growth factors, interleukin 6 and bone metabolism in postmenopausal advanced breast cancer patients after failure on aminoglutethimide, anastrozole or letrozole?","volume":"22","author":"Ferrari L","year":"2003","journal-title":"Int J Oncol"},{"issue":"1","key":"e_1_2_6_44_2","first-page":"S101","article-title":"Effects of steroidal and nonsteroidal aromatase inhibitors on markers of bone turnover and lipid metabolism in healthy volunteers","volume":"82","author":"Goss PE","year":"2003","journal-title":"Breast Cancer Res Treat"},{"key":"e_1_2_6_45_2","first-page":"9","article-title":"Estrogens and bone metabolism in postmenopausal women with early breast cancer at low risk treated with exemestane: a randomized placebo\u2010controlled study","volume":"23","author":"Geisler J","year":"2004","journal-title":"Proc Am Soc Clin Oncol"},{"key":"e_1_2_6_46_2","first-page":"6","article-title":"Effect of exemestane on bone: a randomized placebo controlled study in postmenopausal women with early breast cancer at low risk","volume":"23","author":"Lonning PE","year":"2004","journal-title":"Proc Am Soc Clin Oncol"},{"key":"e_1_2_6_47_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040331"},{"key":"e_1_2_6_48_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.1.57"},{"issue":"10","key":"e_1_2_6_49_2","first-page":"S1","article-title":"2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada","volume":"167","author":"Brown JP","year":"2002","journal-title":"Can Med Assoc J"},{"key":"e_1_2_6_50_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.1030757"},{"key":"e_1_2_6_51_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.08.017"},{"key":"e_1_2_6_52_2","doi-asserted-by":"publisher","DOI":"10.4158\/EP.9.6.544"},{"key":"e_1_2_6_53_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.85.5.1783"},{"key":"e_1_2_6_54_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02561370"},{"key":"e_1_2_6_55_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.3.321"},{"key":"e_1_2_6_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15493-7"},{"key":"e_1_2_6_57_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.7.637"},{"key":"e_1_2_6_58_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.2.216"},{"key":"e_1_2_6_59_2","first-page":"151","article-title":"Raloxifene: handle with care","volume":"165","author":"Pritchard KI","year":"2001","journal-title":"Can Med Assoc J"},{"issue":"1","key":"e_1_2_6_60_2","first-page":"S31","article-title":"Changes in bone mineral density caused by anastrozole or tamoxifen in combination with goserelin (\u00b1 zoledronate) as adjuvant treatment for hormone receptor\u2010positive premenopausal breast cancer: results of a randomized multicenter trial","volume":"76","author":"Gnant M","year":"2002","journal-title":"Breast Cancer Res Treat"},{"key":"e_1_2_6_61_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1997.15.4.1341"},{"key":"e_1_2_6_62_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/90.9.704"},{"key":"e_1_2_6_63_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.11.080"},{"key":"e_1_2_6_64_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199808063390601"},{"key":"e_1_2_6_65_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.1.10"}],"container-title":["International Journal of Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fijc.20826","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijc.20826","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T00:31:32Z","timestamp":1696897892000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ijc.20826"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,1,11]]},"references-count":64,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2005,5,10]]}},"alternative-id":["10.1002\/ijc.20826"],"URL":"https:\/\/doi.org\/10.1002\/ijc.20826","archive":["Portico"],"relation":{},"ISSN":["0020-7136","1097-0215"],"issn-type":[{"value":"0020-7136","type":"print"},{"value":"1097-0215","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,1,11]]}}}