Our analysis also showed that there were no meaningful
Our analysis also showed that there were no meaningful lipid changes with anastrozle, as a surrogate for cardiovascular health. This is in keeping with the TEAM Japan , TEAM Greek  sub-studies and the SABRE trial , which showed that AIs have no detrimental effects on lipid parameters. This is reassuring when using AIs in women with favourable prognosis breast cancer.
Three percent of the participants reported return of ovarian function while receiving adjuvant anastrozole. This raises concern that these patients were exposed to a period of inadequate adjuvant therapy as the anticancer effects from AIs would be abrogated due to return of ovarian production of oestradiol. AI′s may in fact induce Obeticholic Acid . Smith et al. suggested guidelines for patients with chemotherapy induced amenorrhoea recommending that women <40 years old should not receive an AI alone as adjuvant treatment . These guidelines were not published prior to the commencement of the trial. For women older than 40 years, it was suggested that serial monitoring of sexual hormone levels should be performed and requires a sensitive assay. We have observed reversal of chemotherapy-induced menopause in patients up to age 49 years. An alternative is to use tamoxifen alone, with the option of a later switch or an AI with concurrent ovarian function suppression. Women in this age group should be informed of the possibility of return of ovarian function and to report menstrual bleeding or the cessation of hot flushes to their treating oncologists . The reversals of ovarian function were all in women under 50, and we amended the entry criterion to exclude this age group.
Conclusions Aromatase inhibitor induced bone loss is less dramatic than expected, can be managed and does not contraindicate AI use. Osteoporosis dose intensity bisphosphonates are sufficient for these patients in regard to bone health . The Osteoporosis Australia algorithm proved cumbersome involving expensive biochemical tests of bone turnover, and has a high threshold. A simpler algorithm with a T score threshold of −2.0 as stated in the UK recommendation may be clinically useful.
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Conflict of interest statement
Introduction Bone pain is a common symptom in patients with metastatic disease and can be severe, debilitating, and significantly interfere with a patient\'s quality of life. It is therefore important to develop validated measures of patient-reported outcomes such as, bone pain, impact on daily activities, and quality of life (QoL) to evaluate the efficacy of both anti-cancer drugs and bone-targeted agents . The method of obtaining these measures also needs to be practical to allow for routine use in the clinic [2,3]. One of the most commonly used tools to assess pain is the Brief Pain Inventory (BPI) that was developed by the Pain Research Group of the WHO Collaborating Center for Symptom Evaluation in Cancer Care. BPI consists of 11 questions designed to assess pain location, severity, relief and interference . The Functional Assessment of Cancer Therapy-Bone Pain (FACT-BP)  was developed to specifically assess cancer-related bone pain and its effects on patient QoL. The FACT-BP is a 16-item scale. Fifteen of the items are used to calculate a summed score, with higher aggregate scores representing less bone pain, or better QoL. After its initial launch, the questionnaire was subsequently modified and currently two versions exist: the 16-item version and a 20-item version that includes minor rewording of five items and a more detailed assessment of the impact of pain on daily functioning  (Table 1). The 16-item version was evaluated in two prospective phase II trials of similar design in which less potent bisphosphonates were switched to a third-generation bisphosphonate (zoledronic acid in one and ibandronate in other study) . FACT-BP has been shown to be a robust and concise tool for assessing cancer-related bone pain in addition to the impact of that pain upon functioning and QoL .