Objective To assess the impact of adjuvant endocrine therapy on vasomotor symptoms and osteoporosis in premenopausal breast cancer patients. Methods A total of 101 female patients with hormone-receptor（HR）positive premenopausal primary breast cancer who underwent breast cancer surgery by the same physician in West China Hospital of Sichuan University from December 2018 to December 2019 were collected. Clinical information of patients was collected and followed up. There were 24 patients treated with Toremifene (TOR) alone, 27 patients treated with Tamoxifen (TAM) alone, and 50 patients treated with Ovarian function suppression (OFS). The incidence of osteoporosis, the use of bone protective drugs, the incidence of osteoporotic pain and vasomotor symptoms were compared after endocrine therapy. Results The incidence of osteoporosis in TOR group, TAM group and combined OFS group was 4.17%, 18.52% and 40.00%, respectively, and the utilization rate of bone protective drugs was 0.00%, 7.41% and 24.00%, respectively. The incidence of vasomotor symptoms was 33.33%, 74.07% and 48.00%, respectively, with statistical significance (P＜0.05). Pound-wise comparison results showed that the incidence of osteoporosis and utilization rate of bone protective drugs in TOR group were lower than those in the combined OFS group, with statistical significance (P＜0.05). The probability of vasomotor symptoms in TOR group was lower than that in TAM group, with statistical significance (P＜0.05). Conclusion Compared with the combination of OFS, TOR alone has a lower probability of developing osteoporosis symptoms and the use of bone protective drugs. Compared with TAM, TOR alone has a lower incidence of vasomotor and a smaller impact on patients' quality of life. Therefore, it is a good choice for adjuvant endocrine therapy for breast cancer. In clinical use, individual treatment plans can be customized according to the patient's physical condition