Adiposity Excess and Vertebral Fractures in Patients With Breast Cancer Taking Aromatase Inhibitors
JAMA Network Open · 30 Jul 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
It suggests that BMI, the metric most oncologists use at the bedside, misses a substantial subset of AI-treated patients at high fracture risk, potentially changing how bone health is screened in breast cancer survivorship clinics.
The evidence
This single-centre retrospective cohort of 769 postmenopausal women with early breast cancer on aromatase inhibitors used serial DXA to test whether high body fat percentage (>40.8%) predicts worsening or new vertebral fractures over a median follow-up of about 46 months. Fat mass excess was seen in nearly half the cohort at some point and was independently linked to a doubled risk of vertebral fracture progression (adjusted HR 2.00, 95% CI 1.44-2.82, p<.001), while higher muscle mass (ALMI) and higher bone density were protective; BMI itself was not a significant predictor.
vertebral fracture (VF) progression: Hazard ratio 2 (95% CI 1.44 to 2.82; units not reported). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.
Why this rigour score?
Retrospective cohort
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedMet
- Comparable start of follow-upMet
- Adequate statistical powerNot reported
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
How to read this assessment
The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Should oncologists routinely obtain DXA-based fat mass percentage rather than relying on BMI alone when risk-stratifying breast cancer patients starting aromatase inhibitor therapy?
2.Given that appendicular lean mass was protective, should resistance training or muscle-preserving exercise programmes be prioritised alongside bone-targeting agents in patients with excess adiposity on AI therapy?
Original publication title
Adiposity Excess and Vertebral Fractures in Patients With Breast Cancer Taking Aromatase Inhibitors