AIs and Aches and Pains
One common side effect of all three aromatase inhibitors (as well as some chemotherapies) is muscoluskeletal symptoms (meaning, aches and pains). Many women experience relatively mild discomfort, often worse first thing in the morning and eased by movement and activity. Fewer women, but still too many, are so uncomfortable that they can't tolerate any of these medications. There does not seem to be a lot to be done about them--the usual suggestions involve exercise, heat, perhaps ibupofran if it is really bad. My observation is that, like most things in life. we generally adat. Maybe we just become accustomed to a background level of discomfort or maybe it does improve over time.
This is a prosective study from Breast Cancer Research and Treatment that examines these symtoms in two groups of women: those who are taking an AI and those who have not had breast cancer and are not. Here is the abstract and then a link (note that the link is to the right of the page):
A prospective study of aromatase inhibitor therapy, vitamin D, C-reactive protein and musculoskeletal symptoms
Kathy J. Helzlsouer • Lisa Gallicchio • Ryan MacDonald • Bethany Wood • Errol Rushovich
Abstract This study compared type, severity and loca- tion of musculoskeletal symptoms and associations with 25-hydroxyvitamin D (25(OH)D) and C-reactive protein (CRP) concentrations between women initiating aromatase inhibitor (AI) therapy and an unexposed comparison group. A 6-month prospective cohort study was conducted, enrolling 100 breast cancer patients prior to initiating AI treatment and an unexposed comparison group of 200 postmenopausal women. Multivariate associations were assessed with generalized linear models. At baseline, 55% of breast cancer patients and 63% of the comparison group reported any musculoskeletal symptoms. Among the unexposed group, prevalence and severity of symptoms remained constant with no statistically significant change over 6 months. Among breast cancer patients, but not unexposed women, the pain severity score significantly increased over the 6month period for joint (Ptrend \ 0.001), muscle (Ptrend = 0.004), and bone pain (Ptrend = 0.01). Women treated with AIs were more likely to report pain in wrists/palms (63% at 6 months) compared to unexposed women (31% at 6 months) (P \ 0.001). 25(OH)D concentrations increased over the study period among breast cancer patients (Ptrend = 0.004). An increase in pain severity and prevalence was observed among breast cancer patients despite an increase in 25 (OH)D concen- tration. CRP concentrations were not associated with symptoms. Musculoskeletal symptoms are common among postmenopausal women. Breast cancer patients initiating AI treatment were at increased risk for developing new onset and more severe joint, muscle and bone pain com- pared to unexposed women, with a distinct distribution. AI-associated symptoms were not associated with 25(OH)D or CRP concentrations.