Adverse Effects of Tamoxifen Treatment on Bone Mineral Density in Premenopausal Patients with Breast Cancer: A Systematic Review and Meta-Analysis

Abstract The effects of adjuvant tamoxifen therapy on bone mineral density (BMD) in premenopausal patients with breast cancer remains uncertain and, the aim of this meta-analysis was to assess this in premenopausal women with primary breast cancer. Through April 2020, studies reporting BMD changes of lumbar spine or hip in premenopausal women with primary breast cancer treated with adjuvant tamoxifen and tamoxifen plus chemotherapy or ovarian function suppression (OFS) were collected from EMBASE and PubMed. The pooled analysis was performed using random effects model of the standardized mean difference (SMD) of BMD in patients. A total of 1,432 premenopausal patients from eight studies were included. After a 3-year median follow-up, adjuvant tamoxifen decreased the lumbar spinal and hip BMD by as much as an SMD of -1.17 and − 0.66, respectively. Compared with patients who received tamoxifen alone, patients who received combination therapy with chemotherapy or OFS showed lower bone loss compared with tamoxifen alone at the lumbar spine. Our meta-analysis demonstrated that adjuvant tamoxifen therapy in premenopausal patients caused bone loss after 3 years of follow-up, especially at the lumbar spines. For a definite evaluation of the adverse effects of tamoxifen on bone, it is necessary to accumulate more relevant studies.