Abstract
OBJECTIVE: To investigate the effects of different endocrine therapies (tamoxifen, aromatase inhibitors, selective estrogen receptor modulators) on bone mineral density (BMD) and fracture risk in postmenopausal breast cancer patients. METHODS: A systematic search was conducted in PubMed, Medline, Web of Science, Cochrane Library, and EMBASE databases to identify randomized controlled trials (RCTs). The quality of RCTs was assessed using the Cochrane Risk of Bias Tool, Meta-analysis was performed using RevMan 5.3 software, with primary outcome measures including changes in BMD and fracture risk. RESULTS: A total of five studies involving 20,531 patients were included. Meta-analysis results showed: Osteoporosis incidence: Pooled analysis of two studies yielded pooled odds ratio OR of 0.35 (95% CI: 0.04, 3.00), indicating a slight but non-significant advantage in reducing fracture risk in the experimental group compared to the control group (Z = 0.96, P = 0.34). This finding is based on only two studies, so there is uncertainty associated with it. Heterogeneity was low (I(2) = 97%). fracture risk: The pooled OR from four studies was 1.40 (95% CI: 1.25, 1.57), demonstrating a statistically significant increase in fracture risk in the experimental group (Z = 5.92, P < 0.001) with low heterogeneity (I (2) = 29%). CONCLUSION: The conclusions of this analysis were constrained by the limited number of available studies. Different endocrine therapies might exert varying effects on bone health. Aromatase inhibitors significantly reduce BMD and increase fracture risk, whereas selective estrogen receptor modulators might have a protective effect on bone. These relationships need confirmation in larger studies. Clinicians should consider bone health among other factors when selecting endocrine therapy.