Medical Oncologist
Medicines
Cholesterol, bone density and long-term effects of anastrozole
Anastrozole is taken for years, so its long-term effects matter. The main concern is bone thinning, which can be checked and treated, and some women see a modest rise in cholesterol. This page explains what is known about bones, cholesterol and the heart, how anastrozole compares with tamoxifen, and how to protect yourself.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
On this page
- What are the long-term effects of anastrozole on bones, cholesterol and the heart?
- Four long-term effects and what they mean
- Long-term effects compared with tamoxifen, in general terms
- The vocabulary, in plain language
- What is known and what is still uncertain
- How bone loss on anastrozole is managed
- Looking after your heart on anastrozole
- Questions to ask about long-term effects
- What people assume about long-term effects
- Common questions about long-term effects of anastrozole
The short answer
What are the long-term effects of anastrozole on bones, cholesterol and the heart?
Because anastrozole is usually taken for five years or more, its long-term effects matter as much as the side effects you notice day to day. The most important is bone thinning. Oestrogen helps keep bones strong, and when anastrozole lowers it, bone is lost faster than normal, particularly in the spine and hip. Over years this raises the risk of osteoporosis and fractures, and large trials found more fractures in women taking anastrozole than in those taking tamoxifen during treatment. The good news is that this risk can be checked with bone density scans and reduced with vitamin D, calcium, weight-bearing exercise and, when needed, bone-strengthening medicines such as bisphosphonates or denosumab. Bone density also tends to recover partly after anastrozole stops, and the extra fracture risk seen in trials did not persist after treatment ended. Anastrozole can also raise cholesterol modestly in some women, so blood fats are usually checked and managed like any other heart risk factor. Research on heart disease is less clear: some studies suggest slightly more heart problems with aromatase inhibitors than with tamoxifen, partly because tamoxifen may protect the heart, while others find little difference. Unlike tamoxifen, anastrozole does not raise the risk of blood clots or womb cancer. Longer-term effects on memory and mood are still being studied. With good monitoring, most women complete treatment safely, and a healthy lifestyle protects both bones and heart.
Bone thinning is the key concern
It can be measured, slowed and treated, and it partly recovers after stopping.
Cholesterol is worth checking
Modest rises are managed with lifestyle changes and, if needed, medicines.
No raised risk of clots or womb cancer
These tamoxifen concerns do not apply to anastrozole.
This page gives general information only. Your team will assess your own bone and heart health.Areas to watch
Four long-term effects and what they mean
Each can be monitored and, in most cases, managed.
Bone density
Bone is lost faster on anastrozole, raising fracture risk, especially in women whose bones were already thin.
Cholesterol
Some women see a modest rise in total or LDL cholesterol over the course of treatment.
A lipid profile helps track this.Heart health
Evidence is mixed. Doctors pay attention to blood pressure, diabetes, weight and smoking.
Joints and muscles
Stiffness can continue for years in some women, affecting activity and fitness.
Protective habits
- Regular weight-bearing exercise
- Calcium-rich foods and vitamin D
- Not smoking and limiting alcohol
Side by side
Long-term effects compared with tamoxifen, in general terms
Effect
Anastrozole compared with tamoxifen
Bone thinning and fractures
More with anastrozole during treatment
Cholesterol
Tends to be higher on anastrozole
Blood clots
Fewer with anastrozole
Womb lining changes and womb cancer
Fewer with anastrozole
Joint pain
More with anastrozole
Words you will hear
The vocabulary, in plain language
- Bone mineral density
- A measure of how much mineral is in your bones, used to judge their strength.
- Osteopenia
- Bone density lower than normal, but not low enough to be called osteoporosis.
- Bisphosphonate
- A group of medicines, such as zoledronic acid or alendronate, that slow bone loss.
- Denosumab
- An injection that strengthens bones by slowing the cells that break bone down.
- LDL cholesterol
- The type of cholesterol linked with narrowing of the arteries.
- FRAX score
- A tool that estimates the chance of a major fracture over the next ten years.
Being straight with you
What is known and what is still uncertain
Long-term effects have been studied for many years, but some questions remain open.
Bone effects are well established
The link between aromatase inhibitors and bone loss is clear, which is why checks are routine.
Heart effects are less certain
Studies differ, and much of the comparison is with tamoxifen rather than no treatment, which makes the true effect hard to judge.
Data from Indian women are limited
Low vitamin D and lower bone density at baseline are common in India, which may make bone care even more important here.
What this page cannot tell you
It cannot estimate your fracture or heart risk. Your doctors can.
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Protecting bones
How bone loss on anastrozole is managed
Bone care usually follows a step-by-step plan based on your scan and risk factors.
For everyone
Weight-bearing exercise, calcium from food, enough vitamin D, not smoking and limiting alcohol.
If bones are a little thin
Vitamin D and calcium supplements are often added, and the scan is repeated after one to two years.
If bones are thin or fracture risk is high
Bone-strengthening medicines such as zoledronic acid, alendronate or denosumab may be advised. A dental check beforehand is often recommended.
Preventing falls
Good lighting, removing loose rugs, sturdy footwear and balance exercises lower the chance of a fracture.
Heart and blood fats
Looking after your heart on anastrozole
Heart disease is a leading cause of illness in women after menopause, whether or not they have had breast cancer. Treatment years are a good time to review your heart health.
Know your numbers
Regular checks of blood pressure, blood sugar, cholesterol and weight help your family doctor act early.
Treat risk factors
Cholesterol-lowering medicines, blood pressure tablets and diabetes treatment can all be taken with anastrozole.
Healthy habits
Daily activity, meals rich in vegetables, whole grains and pulses, less fried food and not smoking protect the heart.
At your appointments
Questions to ask about long-term effects
Long-term effects are easier to manage when you and your team plan for them together. These questions can help at your next visit.
About bones
Ask when your last bone density scan was, what the result means, and whether you need vitamin D, calcium or a bone-strengthening medicine.
About the heart
Ask whether your cholesterol, blood pressure and blood sugar have been checked recently, and who will follow them up, your oncologist or your family doctor.
About the length of treatment
Ask how long anastrozole is planned for, and how bone health will be weighed if continuing beyond five years is being considered.
Commonly believed
What people assume about long-term effects
Bone loss from anastrozole is permanent.
Bone density often recovers partly after the tablet is stopped.
Thin bones mean you must stop anastrozole.
Most women continue with bone protection added.
Anastrozole causes womb cancer like tamoxifen.
That risk is linked with tamoxifen, not anastrozole.
Cholesterol medicines cannot be taken with anastrozole.
Common cholesterol medicines are generally fine alongside it.
Questions we are asked
Common questions about long-term effects of anastrozole
How quickly does anastrozole thin the bones?
Bone loss is usually fastest in the first couple of years and continues more slowly after that. The amount varies between women, which is why a baseline scan and follow-up scans help your doctor decide whether you need extra protection.
Can bone-strengthening medicines prevent the loss?
Yes. Studies show bisphosphonates and denosumab can prevent or reverse bone loss caused by aromatase inhibitors. They are advised when bones are thin or fracture risk is high, and they have their own side effects your team will explain.
Will my cholesterol go back to normal after stopping?
Cholesterol changes linked with anastrozole are usually modest and may ease after treatment ends, but age and lifestyle also affect cholesterol. Your family doctor can keep checking it and treat it if needed.
Is anastrozole safe if I already have heart disease?
Many women with heart disease take anastrozole safely. Your oncologist will consider your heart history, and your cardiologist or family doctor should know you are taking it, so that blood pressure, cholesterol and other risks are well controlled.
Does anastrozole cause blood clots?
Anastrozole is not associated with the raised clot risk seen with tamoxifen. Clots can still happen for other reasons, such as surgery, long journeys or cancer itself, so report a swollen, painful leg or sudden breathlessness urgently.
Can I do yoga or strength training with thin bones?
Exercise is encouraged, but with osteoporosis some movements, such as deep forward bends or heavy twisting, may need adapting. A physiotherapist can suggest safe strength and balance exercises for your bones.
Are there long-term effects on memory?
Some women report concentration or memory changes. Research has not shown clear lasting harm, and many other factors play a part. Tell your team if you notice changes, as sleep, mood and thyroid problems can be checked and treated.
Do long-term effects continue after ten years of treatment?
Extending treatment prolongs the time bones are exposed to low oestrogen, so fracture risk and bone care become more important. This is one reason bone health is weighed carefully when deciding whether to continue beyond five years.
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Sources
- Royal Osteoporosis Society — Breast cancer treatment and bone health
- National Cancer Institute — Anastrozole
- Cancer Research UK — Anastrozole
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.