Medical Oncologist
Bone health
Fracture risk and fall prevention on endocrine therapy
Aromatase inhibitors and ovarian suppression speed up bone loss and raise fracture risk. Most fractures follow a fall, so protection combines stronger bones with fall prevention. This page explains who is at risk, how to protect bones and simple ways to prevent falls at home.
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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
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On this page
- Do hormone treatments raise the risk of fractures?
- Simple changes that prevent falls at home
- Steps that lower fracture risk on hormone therapy
- The vocabulary, in plain language
- Keeping fracture risk in perspective
- What to do after a fall or suspected fracture
- Improving balance and strength
- Why low oestrogen makes bones more fragile
- How family can help prevent falls
- What people assume about fractures on hormone therapy
- Common questions about fracture risk and falls
The short answer
Do hormone treatments raise the risk of fractures?
Aromatase inhibitors, a family of hormone tablets used after menopause, lower oestrogen to very low levels. Because oestrogen helps keep bones strong, women taking them lose bone faster and have a higher chance of fractures than women not taking them, particularly of the spine, wrist and hip. Ovarian suppression in younger women has a similar effect. Most fractures in older women happen after a fall, so the most effective protection combines two approaches: keeping bones as strong as possible, and preventing falls. With bone density checks, exercise, calcium and vitamin D, and bone medicines when needed, most women complete hormone therapy without a fracture.
Who is most at risk
Women who already have thin bones, have had a previous fracture, are older, thin, smoke, drink heavily, take steroids, or have conditions or medicines that affect balance, such as poor eyesight, dizziness or sleeping tablets.
The two sides of prevention
Stronger bones are less likely to break, and fewer falls mean fewer chances to break them. Working on both gives the best protection.
Why this should not stop treatment
For most women, the protection hormone therapy gives against breast cancer returning far outweighs the fracture risk, especially when bones are monitored and protected.
This page gives general information only. Your bone and falls risk should be assessed by your team.Preventing falls
Simple changes that prevent falls at home
Most falls happen at home, and many are preventable.
Clear the floors
Remove loose rugs, trailing wires and clutter from walkways and stairs.
Light the way
Use bright lights on stairs and a night light between the bedroom and bathroom.
Keep a torch by the bed.Make the bathroom safer
Non-slip mats, grab rails near the toilet and bath area, and a stool for sitting while washing help.
Wear safe footwear
Well-fitting shoes or slippers with grip reduce slips, especially on wet floors.
Also check
- Eyesight regularly
- Medicines that cause dizziness
- Blood pressure when standing
Not sure whether this applies to you?
Ask an oncologistProtecting bones
Steps that lower fracture risk on hormone therapy
Get a bone density scan
A DEXA scan before or soon after starting shows your baseline bone strength.
Correct vitamin D and calcium
Blood tests and supplements when needed support bone health.
Exercise regularly
Weight-bearing, strength and balance exercises strengthen bones and reduce falls.
Consider bone medicines
If bones are thin or risk is high, bone-strengthening medicines greatly lower fracture risk.
Repeat checks
Repeat scans show whether bones are stable and whether treatment needs adjusting.
Words you will hear
The vocabulary, in plain language
- Fragility fracture
- A break from a minor fall or strain that would not normally break a healthy bone.
- Vertebral fracture
- A break in a spinal bone, which can cause back pain or loss of height.
- Aromatase inhibitor
- A family of hormone tablets that lower oestrogen after menopause.
- FRAX
- A tool estimating fracture risk over ten years.
- Falls risk assessment
- A check of balance, strength, eyesight and home safety.
- Bone-strengthening medicine
- A medicine that slows bone loss and lowers fracture risk.
Being straight with you
Keeping fracture risk in perspective
The rise in fracture risk on aromatase inhibitors is real but manageable. With checks and protective steps, most women never have a fracture during treatment. Fracture risk also tends to return towards normal after treatment ends.
Spinal fractures can be silent
Some spinal fractures cause little pain and are noticed only as loss of height or a stooped back. Report these changes to your doctor.
Bone medicines are effective
For women at higher risk, bone-strengthening medicines substantially reduce fractures. They have their own side effects, which your team will explain.
Falls prevention helps at every age
Even women with good bone density benefit from reducing falls, particularly as they get older.
What this page cannot tell you
It cannot estimate your personal fracture risk. Ask your team for an assessment.
Talk to our team
Have a question about your situation?
Call the helpline or leave your details, and someone will help you arrange a consultation at the CION centre nearest you. One helpline serves every CION centre.
Call 1800 202 8726
Helpline open 24/7
If you fall
What to do after a fall or suspected fracture
Knowing what to do after a fall can prevent further injury and ensure a fracture is not missed.
Get up carefully, or wait for help
If you feel able, roll onto your side, get onto your hands and knees, and use a sturdy chair to rise slowly. If you are hurt or cannot get up, call for help and keep warm.
Seek medical assessment
Pain that does not settle, swelling, deformity, inability to bear weight or new back pain after a fall should be checked with an X-ray.
Tell your oncology team
A fracture from a minor fall may signal osteoporosis needing treatment, and your team may review your bone health plan.
Learn from the fall
Think about what caused it, such as a rug, poor lighting or dizziness, and fix that cause to prevent another.
Balance
Improving balance and strength
Better balance and leg strength are among the most effective ways to prevent falls.
Simple balance exercises
Standing on one leg near a counter, heel-to-toe walking along a hallway and rising slowly from a chair without using your hands all build steadiness.
Classes that help
Yoga and tai chi improve balance, flexibility and confidence. Choose gentle classes and tell the instructor about any bone thinning.
Stay active every day
Regular walking keeps leg muscles strong and supports balance.
Understanding the cause
Why low oestrogen makes bones more fragile
Bone is constantly renewed. Old bone is broken down and replaced with new bone in a balanced cycle that keeps the skeleton strong. Oestrogen plays an important part in keeping that cycle balanced.
Oestrogen as a brake
Oestrogen slows the cells that break down bone. When oestrogen falls sharply, as it does on aromatase inhibitors or with ovarian suppression, bone is removed faster than it is replaced.
Where the loss shows first
The spongy inner bone of the spine and wrist is renewed quickly, so it tends to lose strength first. This is why spinal and wrist fractures are common early signs of weakened bone.
Why speed matters
Hormone treatments can cause faster bone loss than a natural menopause, particularly in the first couple of years. Checking bone density early allows protection to start before much strength is lost.
Recovery after treatment
Once aromatase inhibitors are finished, bone loss usually slows, and some recovery of bone density often follows.
For families
How family can help prevent falls
Family members can make the home safer and support healthy habits.
A home safety walk-through
Walk through the home together looking for loose rugs, poor lighting, slippery floors and awkward steps, and fix what you find.
Help with risky tasks
Offer to help with climbing ladders, reaching high shelves or carrying heavy loads on stairs, which are common causes of falls at home.
Encourage activity
Joining walks or exercise sessions keeps muscles strong and makes it more enjoyable.
Commonly believed
What people assume about fractures on hormone therapy
Fractures only happen to very old women.
Hormone treatments can raise fracture risk at younger ages, especially with ovarian suppression.
If I have not broken a bone, my bones are fine.
Bone loss is silent. A scan shows bone strength before a fracture happens.
Staying still is the best way to avoid falls.
Inactivity weakens muscles and balance, making falls more likely.
I should stop hormone tablets to protect my bones.
Bones can usually be protected without stopping cancer treatment.
Questions we are asked
Common questions about fracture risk and falls
Does fracture risk go down after I finish?
Studies suggest fracture risk tends to fall towards normal after aromatase inhibitors end, though bone care remains important.
Which bones break most often?
The spine, wrist and hip are most commonly affected.
Does tamoxifen raise fracture risk too?
After menopause it tends to protect bones. Your team can explain how this applies to you.
Can medicines make me dizzy and fall?
Some can. Ask your doctor to review your medicines if you feel unsteady.
Should I use a walking stick?
If balance is poor, a physiotherapist can advise whether a stick or frame would help.
How do I know if I have a spinal fracture?
Sudden back pain, height loss or a stoop may signal one. An X-ray can confirm.
Can I still travel and be active?
Yes. With sensible precautions, staying active is encouraged.
Who can assess my falls risk?
Your doctor, a physiotherapist or an occupational therapist.
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Speak to a breast cancer specialist
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Sources
- American Society of Clinical Oncology — Management of osteoporosis in survivors of adult cancers with nonmetastatic disease
- World Health Organization — Falls fact sheet
- Royal Osteoporosis Society — Preventing falls and fractures
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.