{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:18:58Z","timestamp":1788153538763,"version":"build-2803163510"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Breast cancer survivors may be at increased risk of osteoporosis and fractures because of disease-related factors and treatment-induced bone loss. However, the available evidence remains inconsistent. This study aimed to evaluate the associations between breast cancer and the risks of osteoporosis and fracture through a systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched from database inception to May 1, 2026. Cohort studies investigating the associations between breast cancer and the risks of osteoporosis or fracture were included. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were pooled using random-effects models. Subgroup analyses were performed according to age and treatment modality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 16 cohort studies were included in this meta-analysis. The pooled analysis demonstrated that breast cancer was associated with significantly increased risks of osteoporosis (HR\u00a0=\u00a01.54, 95% CI: 1.13-2.09) and fracture (HR\u00a0=\u00a01.49, 95% CI: 1.03-2.16). Age-stratified findings suggested comparable osteoporosis risks between women aged &amp;lt;50 years and those aged \u226550 years. In the treatment subgroup analysis, aromatase inhibitor therapy was associated with a significantly increased risk of osteoporosis (HR\u00a0=\u00a01.65, 95% CI: 1.05-2.60), whereas no significant associations were observed among tamoxifen users or patients receiving chemotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Breast cancer is significantly associated with increased risks of both osteoporosis and fracture. Aromatase inhibitor therapy may further contribute to osteoporosis risk. These findings highlight the importance of bone health monitoring and fracture prevention strategies in breast cancer survivors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261419796<\/jats:ext-link>\n                      , identifier CRD420261419796.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1905334","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:29:40Z","timestamp":1788150580000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk of osteoporosis and fracture among patients with breast cancer: a systematic review and meta-analysis of cohort studies"],"prefix":"10.3389","volume":"16","author":[{"given":"Ke","family":"Li","sequence":"first","affiliation":[{"name":"Faculty of Traumatology and Orthopedics, Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanan","family":"Qian","sequence":"additional","affiliation":[{"name":"Faculty of Traumatology and Orthopedics, Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujing","family":"Cao","sequence":"additional","affiliation":[{"name":"Faculty of Traumatology and Orthopedics, Henan University of Chinese Medicine","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2022.847920","article-title":"Breast cancer mortality trends and predictions to 2030 and its attributable risk factors in east and south Asian countries","volume":"9","author":"Mubarik","year":"2022","journal-title":"Front Nutr"},{"key":"B2","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3322\/caac.21820","article-title":"Cancer statistics, 2024","volume":"74","author":"Siegel","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.2147\/ijwh.s613218","article-title":"Epidemiological trends, inequalities, and projections of breast and gynecological cancers in older Asian women","volume":"18","author":"Wang","year":"2026","journal-title":"Int J Womens Health"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(03)01037-4","article-title":"Why is breast-cancer mortality declining","volume":"4","author":"Jatoi","year":"2003","journal-title":"Lancet Oncol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1001\/jama.2018.19323","article-title":"Breast cancer treatment: A review","volume":"321","author":"Waks","year":"2019","journal-title":"Jama"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2025.105029","article-title":"Comparative accuracy of osteoporosis risk assessment tools in postmenopausal women: A systematic review and network meta-analysis","volume":"165","author":"Wang","year":"2025","journal-title":"Int J Nurs Stud"},{"key":"B8","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1186\/s40001-024-02081-2","article-title":"Utilizing surface-enhanced Raman spectroscopy for the adjunctive diagnosis of osteoporosis","volume":"29","author":"Yang","year":"2024","journal-title":"Eur J Med Res"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1038\/550s15a","article-title":"Osteoporosis: Staying strong","volume":"550","author":"Brown","year":"2017","journal-title":"Nature"},{"key":"B10","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1186\/s13018-018-0865-3","article-title":"Denosumab compared to bisphosphonates to treat postmenopausal osteoporosis: a meta-analysis","volume":"13","author":"Wu","year":"2018","journal-title":"J Orthop Surg Res"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-026-01980-z","article-title":"Increased risk of fracture among breast cancer patients: a nationwide retrospective cohort study","author":"Cho","year":"2026","journal-title":"J Cancer Surviv"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbo.2019.100254","article-title":"Incidence of fractures in young women with breast cancer - a retrospective cohort study","volume":"18","author":"Stumpf","year":"2019","journal-title":"J Bone Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/s2666-7568(23)00285-4","article-title":"Risk of fractures in half a million survivors of 20 cancers: a population-based matched cohort study using linked English electronic health records","volume":"5","author":"Buzasi","year":"2024","journal-title":"Lancet Healthy Longev"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-016-3899-6","article-title":"Long-term effect of aromatase inhibitors on bone microarchitecture and macroarchitecture in non-osteoporotic postmenopausal women with breast cancer","volume":"28","author":"Hong","year":"2017","journal-title":"Osteoporos Int"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2006.07.5382","article-title":"Aromatase inhibitors and bone health in women with breast cancer","volume":"24","author":"Chien","year":"2006","journal-title":"J Clin Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbo.2020.100292","article-title":"Influence of chemotherapy and endocrine treatment on fractures in postmenopausal women with breast cancer - a retrospective cohort study","volume":"22","author":"Stumpf","year":"2020","journal-title":"J Bone Oncol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"n160","DOI":"10.31222\/osf.io\/gwdhk_v1","article-title":"PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"Bmj"},{"key":"B18","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1007\/s00198-018-4758-4","article-title":"Hormone therapy and osteoporosis in breast cancer survivors: assessment of risk and adherence to screening recommendations","volume":"30","author":"Hamood","year":"2019","journal-title":"Osteoporos Int"},{"key":"B19","doi-asserted-by":"publisher","first-page":"5489","DOI":"10.1038\/s41598-022-09542-w","article-title":"Temporal patterns of chronic disease incidence after breast cancer: a nationwide population-based cohort study","volume":"12","author":"Kang","year":"2022","journal-title":"Sci Rep"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2025.101519","article-title":"Non-cancer risks among female breast cancer survivors: a matched cohort study in Japan","volume":"56","author":"Kawamura","year":"2025","journal-title":"Lancet Reg Health West Pac"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2011.420","article-title":"Long-term health outcomes in a British cohort of breast, colorectal and prostate cancer survivors: a database study","author":"Khan","year":"2011","journal-title":"Br J Cancer"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1236188","article-title":"Association between tamoxifen and incidence of osteoporosis in Korean patients with ductal carcinoma in situ","volume":"13","author":"Kim","year":"2023","journal-title":"Front Oncol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-025-07639-2","article-title":"Differential fracture risk in breast cancer patients based on endocrine therapy and age: a nationwide cohort study","volume":"36","author":"Kwak","year":"2025","journal-title":"Osteoporos Int"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.00366","article-title":"Effect of tamoxifen on the risk of osteoporosis and osteoporotic fracture in younger breast cancer survivors: a nationwide study","volume":"10","author":"Lee","year":"2020","journal-title":"Front Oncol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"4413","DOI":"10.1038\/s41598-025-89059-0","article-title":"Risk factors for and incidence of osteoporosis in patients with breast cancer by gender : a nationwide cohort study","volume":"15","author":"Lee","year":"2025","journal-title":"Sci Rep"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2019-0149","article-title":"Fracture risk in women with breast cancer initiating aromatase inhibitor therapy: a registry-based cohort study","volume":"24","author":"Leslie","year":"2019","journal-title":"Oncologist"},{"key":"B27","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1186\/s13058-025-02050-5","article-title":"Aromatase inhibitors therapy and major osteoporotic fracture risk in postmenopausal breast cancer patients: a nationwide real-world cohort study","volume":"27","author":"Liu","year":"2025","journal-title":"Breast Cancer Res"},{"key":"B28","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1186\/s13058-018-1061-4","article-title":"Evaluation of osteopenia and osteoporosis in younger breast cancer survivors compared with cancer-free women: a prospective cohort study","volume":"20","author":"Ramin","year":"2018","journal-title":"Breast Cancer Res"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbo.2023.100501","article-title":"DXA assessment and fracture prevention in hormone positive breast cancer patients after treatment initiation with aromatase inhibitors: a registry-based cohort study","volume":"42","author":"Rouach","year":"2023","journal-title":"J Bone Oncol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2005.02.3515","article-title":"Tamoxifen treatment after adjuvant chemotherapy has opposite effects on bone mineral density in premenopausal patients depending on menstrual status","volume":"24","author":"Vehmanen","year":"2006","journal-title":"J Clin Oncol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1007\/s00210-026-05301-0","article-title":"Association study of aromatase inhibitors and adverse events related to osteoporosis: based on pharmacovigilance data","author":"Yang","year":"2026","journal-title":"Naunyn Schmiedebergs Arch Pharmacol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.tem.2012.03.008","article-title":"Estrogen and the skeleton","volume":"23","author":"Khosla","year":"2012","journal-title":"Trends Endocrinol Metab"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22041568","article-title":"Critical role of estrogens on bone homeostasis in both male and female: from physiology to medical implications","volume":"22","author":"Emmanuelle","year":"2021","journal-title":"Int J Mol Sci"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2007.06.004","article-title":"Estrogen-dependent increase in bone turnover and bone loss in postmenopausal women with breast cancer treated with anastrozole. Prevention with bisphosphonates","volume":"41","author":"Confavreux","year":"2007","journal-title":"Bone"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1188\/11.onf.273-276","article-title":"Management of aromatase inhibitor-associated bone loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG","volume":"7","author":"Hadji","year":"2017","journal-title":"J Bone Oncol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2001.19.14.3306","article-title":"Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early-stage breast cancer","volume":"19","author":"Shapiro","year":"2001","journal-title":"J Clin Oncol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1186\/s12891-021-04616-8","article-title":"Relationship between bone mineral density and fragility fracture risk: a case-control study in Changsha, China","volume":"22","author":"Li","year":"2021","journal-title":"BMC Musculoskelet Disord"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1905334\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:29:41Z","timestamp":1788150581000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1905334\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":37,"alternative-id":["10.3389\/fonc.2026.1905334"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1905334","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]},"article-number":"1905334"}}