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Key PointsQuestionIs fat body mass associated with the prevalence of vertebral fracture in patients with breast cancer undergoing aromatase inhibitor therapy?FindingsThis cross-sectional study of 556 postmenopausal women with early-stage breast cancer treated with aromatase inhibitors found that high fat body mass was associated with a numerically but not significantly lower proportion of vertebral fractures in aromatase inhibitor–naive women and a significantly higher proportion of vertebral fractures in aromatase inhibitor–treated women. This opposite trend in fracture prevalence was confirmed after propensity-score matching.MeaningFat body mass may be a factor associated with vertebral fractures in postmenopausal women with breast cancer receiving aromatase inhibitors.