JAMA Network Open · IF 10.5 · July 30, 2026 · LoE III
Adiposity Excess and Vertebral Fractures in Patients With Breast Cancer Taking Aromatase Inhibitors
Greta Schivardi, Deborah Cosentini, Giulia Scartabellati, Marco Ravanelli, Laura Moretti, Gherardo Mazziotti, M. Bazzoli, Salvatore Strazzeri, Andrea Delbarba, Salvatore Grisanti, Marta Laganà, Antonella Turla — Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia
This single-center 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.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersIt 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.
Conclusion strengthPotentially practice-changing
This identifies a risk factor rather than testing a treatment, so it cannot support a change in what we do.
Presenting this at rounds? Start here
- ?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?
- ?Given that appendicular lean mass was protective, should resistance training or muscle-preserving exercise programs be prioritized alongside bone-targeting agents in patients with excess adiposity on AI therapy?