Table 2. Summary of All Recommendations
Agent Recommendations
Strength of
Recommendation
and Strength of
Evidence
Anastrozole
(cont'd)
• Prior to initiating an aromatase inhibitor, clinicians
should evaluate patients for baseline fracture risk and
measure bone mineral density. Multiple studies have
reported an increased rate of bone loss in women
treated with aromatase inhibitors. Clinicians should
use anastrozole with caution in postmenopausal
women with moderate bone mineral density loss and
if used consider the use of bone protective agents such
as bisphosphonates and RANK ligand inhibitors. All
patients on aromatase inhibitors should be encouraged
to exercise regularly, take adequate calcium/vitamin
D supplementation. A history of osteoporosis and/
or severe bone loss is a relative contraindication for
the use of anastrozole. In IBIS II women with severe
osteoporosis (T score <-4 or more than two vertebral
fractures) were excluded. Other endocrine preventive
therapies that do not reduce bone density, such as
tamoxifen or raloxifene, are also available for this
group of women.
• Clinicians should inform women also of the
possibility of joint stiffness, arthralgias, vasomotor
symptoms, hypertension, dry eyes, vaginal dryness
while taking anastrozole.
Evidence based,
benefits outweigh
harms; Evidence
quality: high
Strength of
recommendation:
Strong-based on 1
RCT with low risk
of bias
(cont'd)
