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Current Oncology Reports
Erschienen in: Current Oncology Reports 7/2023

13.04.2023

Aromatase Inhibitor Musculoskeletal Syndrome and Bone Loss: a Review of the Current Literature

verfasst von: Sara Christensen Holz

Erschienen in: Current Oncology Reports | Ausgabe 7/2023

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Abstract

Purpose of Review

The study aims to review the literature regarding musculoskeletal complications of aromatase inhibitors and treatment options for these complications.

Recent Findings

Aromatase inhibitors are common medications to treat hormone receptor-positive breast cancer in postmenopausal women and have been shown to improve survival and prevent disease recurrence. However, 20–60% patients stop treatment prematurely due to side effects. Side effects include joint stiffness and pain, tendonitis, tendon tears, muscle pain, and carpal tunnel syndrome known as aromatase inhibitor musculoskeletal syndrome (AIMSS) as well as bone loss. Proposed mechanisms of AIMSS include decreased estrogen levels, inflammation, and genetic factors. Switching aromatase inhibitors, exercise, non-steroidal anti-inflammatory medications, duloxetine, acupuncture, prednisone, and bisphosphonates are some treatment options for this syndrome and will be discussed in more detail in this review.

Summary

Aromatase inhibitors are important in the treatment of hormone receptor-positive breast cancer in postmenopausal women. As we study the incidence of side effects of these medications including bone loss and AIMSS and determine the mechanisms of these symptoms and possible treatment options, we will decrease the incidence of patients discontinuing treatment prematurely and improve symptoms, quality of life, and survival in this patient population.
Literatur
1.
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomized trials. Lancet. 2015;386(10001):1341–52.CrossRef
2.
Xu X, Chlebowski RT, Shi J, Barac A, Haque R. Aromatase inhibitor and tamoxifen use and the risk of venous thromboembolism in breast cancer survivors. Breast Cancer Res Treat. 2019;174:785–94.CrossRefPubMed
3.
Wagner LI, Zhao F, Goss PE, Chapman JW, Shepherd LE, Whelan TJ, Mattar BI, Bufill JA, Schultz WC, LaFrancis IE, Nagargoje GG, Vemuri R, Nikcevich DA, Sledge GW, Cella D. Patient-reported predictors of early treatment discontinuation: treatment-related symptoms and health-related quality of life among postmenopausal women with primary breast cancer randomized to anastrozole or exemestane on NCIC. Clinical Trials Group Breast Cancer Res Treat. 2018;169(3):537.CrossRef
4.
Presant CA, Bosserman L, Young T, Vakil M, Horns R, Upadhyaya G, Ebrahimi B, Yeon C, Howard F. Aromatase inhibitor-associated arthralgia and/ or bone pain: frequency and characterization in non-clinical trial patients. Clin Breast Cancer. 2007;7(10):775–8.CrossRefPubMed
5.
Henry NL, Azzouz F, Desta Z, Li L, Nguyen AT, Lemler S, Hayden J, Tarpinian K, Yakim E, Flockhart DA, Stearns V, Hayes DF, Storniolo AM. Predictors of aromatase inhibitor discontinuation as a result of treatment-emergent symptoms in early-stage breast cancer. AM J Clin Oncol. 2012;30(9):936–42.CrossRef
6.
• Tenti S, Correale P, Cheleschi S, Fioravanti A, Pirtoli L. Aromatase inhibitors-induced musculoskeletal disorders: current knowledge on clinical and molecular aspects. Int J Mol Sci. 2020;21(16):5625. This study has an up to date review on aromatase inhibitors effect on musculoskeletal syndromes and current understanding of mechanisms.CrossRefPubMedPubMedCentral
7.
• Hyder T, Marino CC, Ahmad S, Nasrazadani A, Brufsky AM. Aromatase inhibitor-associated musculoskeletal syndrome: understanding mechanisms and management. Front Endocrinol (Lausanne). 2021;27(12):713700. This article discusses proposed criteria for aromatase inhibitor arthralgia and gives a good overview of the current knowledge of the condition.CrossRef
8.
Niravath P. Aromatase inhibitor-induced arthralgia: a review. Ann Oncol. 2013;24(6):1443–9.CrossRefPubMed
9.
Din O, Dodwell D, Wakefield R, et al. Aromatase inhibitor induced arthralgia in early breast cancer: what do we know and how can we find out more? Breast Cancer Res Treat. 2010;120:525–38.CrossRefPubMed
10.
Morales L, Pans S, Paridaens R, et al. Debilitating musculoskeletal pain and stiffness with letrozole and exemestane: associated tenosynovial changes on magnetic resonance imaging. Breast Cancer Res Treat. 2007;104:87–91.CrossRefPubMed
11.
Bruzzese V, Hassan C, Zullo A, Zampa G. Rheumatoid arthritis: a complication of aromatase inhibitor therapy? Int J Immunopathol Pharmacol. 2011;24:1099–101.CrossRefPubMed
12.
Bertolini E, Letho-Gyselinck H, Prati C, Wendling D. Rheumatoid arthritis and aromatase inhibitors. Jt Bone Spine. 2011;78:62–4.CrossRef
13.
Chao J, Parker BA, Zvaifler NJ. Accelerated cutaneous nodulosis associated with aromatase inhibitor therapy in a patient with rheumatoid arthritis. J Rheumatol. 2009;36:1087–8.CrossRefPubMed
14.
Caprioli M, Carrara G, Sakellariou G, Silvagni E, Scirè CA. Influence of aromatase inhibitors therapy on the occurrence of rheumatoid arthritis in women with breast cancer: results from a large population-based study of the Italian Society for Rheumatology. RMD Open. 2017;3(2):e000523.CrossRefPubMedPubMedCentral
15.
Sestak I, Cuzick J, Sapunar F, Eastell R, Forbes JF, Bianco AR, et al. Risk factors for joint symptoms in patients enrolled in the atac trial: a retrospective, exploratory analysis. Lancet Oncol. 2008;9(9):866–72.CrossRefPubMed
16.
Yardley DA. Pharmacologic management of bone-related complications and bone metastases in postmenopausal women with hormone receptorpositive breast cancer. Breast Cancer (Dove Med Press). 2016;8:73–82.PubMed
17.
Mao JJ, Stricker C, Bruner D, Xie S, Bowman MA, Farrar JT, et al. Patterns and risk factors associated with aromatase inhibitor-related arthralgia among breast cancer survivors. Cancer. 2009;115(16):3631–9.CrossRefPubMed
18.
Eastell R, Adams JE, Coleman RE, Howell A, Hannon RA, Cuzick J, et al. Effect of anastrozole on bone mineral density: 5-year results from the anastrozole, tamoxifen, alone or in combination trial 18233230. J Clin Oncol. 2008;26(7):1051–7.CrossRefPubMed
19.
De Placido S, Gallo C, De Laurentiis M, Bisagni G, Arpino G, Sarobba MG. Adjuvant anastrozole versus exemestane versus letrozole, upfront or after 2 years of tamoxifen, in endocrine-sensitive breast cancer (FATAGIM3): a randomised, phase 3 trial. Lancet Oncol. 2018;19(4):474–85.CrossRefPubMed
20.
Coleman R, Body JJ, Aapro M, Hadji P, Herrstedt J. ESMO Guidelines Working Group. Bone health in cancer patients: ESMO clinical practice guidelines. ANN Oncol. 2014;25:124–37.CrossRef
21.
Pedersini R, Amoroso V, Maffezzoni F, Gallo F, Turla A, Monteverdi S, Ardine M, Ravanelli M, Vassalli L, Rodella F, et al. Association of fat body mass with vertebral fractures in postmenopausal women with early breast cancer undergoing adjuvant aromatase inhibitor therapy. JAMA Netw Open. 2019;2:e1911080.CrossRefPubMedPubMedCentral
22.
• Chung KY, Ho G, Novak CB, Baltzer HL. Aromatase inhibitor-induced carpal tunnel syndrome and stenosing tenosynovitis: a systematic review. Plast Reconstr Surg. 2022;149(3):445e–52e. This is the most up to date reference regarding carpal tunnel syndrome associated with aromatase inhibitors.CrossRefPubMed
23.
Shin DJ, Nam KE, Song DH, Im S, Won SJ, Kim YH, Lim SH, Lee JI. Carpal tunnel syndrome and tenosynovitis in women with breast cancer associated with hormone therapy: a multi-institutional analysis using a clinical data warehouse. Medicine (Baltimore). 2022;101(5):e28786.CrossRefPubMed
24.
Sheng JY, Blackford AL, Bardia A, Venkat R, Rosson G, Giles J, Hayes DF, Jeter SC, Zhang Z, Hayden J, Nguyen A, Storniolo AM, Tarpinian K, Henry NL, Stearns V. Prospective evaluation of finger two-point discrimination and carpal tunnel syndrome among women with breast cancer receiving adjuvant aromatase inhibitor therapy. Breast Cancer Res Treat. 2019;176(3):617–24.CrossRefPubMedPubMedCentral
25.
Mitsimponas N, Klouva E, Tryfonopoulos D, Grivas A, Demiri S, Koumakis G, Gouveris P. Aromatase inhibitor-associated tendinopathy and muscle tendon rupture: report of three cases of this exceedingly rare adverse event. Case Rep Oncol. 2018;11(2):557–61.CrossRefPubMedPubMedCentral
26.
Martens HA, Schröder CP, van der Eerden PJ, Willemse PH, Posthumus MD. Severe disabling tendinopathy caused by anastrazole. Rheumatology (Oxford). 2007;46(10):1619–21.CrossRefPubMed
27.
Briot K, Tubiana-Hulin M, Bastit L, Kloos I, Roux C. Effect of a switch of aromatase inhibitors on musculoskeletal symptoms in postmenopausal women with hormone-receptor-positive breast cancer: the (articular tolerance of letrozole) study. Breast Cancer Res Treat. 2010;120(1):127–34.CrossRefPubMed
28.
Colleoni M, Luo W, Karlsson P, Chirgwin J, Aebi S, Jerusalem G, et al. Extended adjuvant intermittent letrozole versus continuous letrozole in postmenopausal women with breast cancer (SOLE): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2018;19(1):127–38.CrossRefPubMed
29.
Arem H, Sorkin M, Cartmel B, Fiellin M, Capozza S, Harrigan M, Ercolano E, Zhou Y, Sanft T, Gross C, Schmitz K, Neogi T, Hershman D, Ligibel J, Irwin ML. Exercise adherence in a randomized trial of exercise on aromatase inhibitor arthralgias in breast cancer survivors: the hormones and physical exercise (HOPE) study. J Cancer Surviv. 2016;10(4):654–62.CrossRefPubMedPubMedCentral
30.
• Boing L, Vieira MCS, Moratelli J, Bergmann A, Guimarães ACA. Effects of exercise on physical outcomes of breast cancer survivors receiving hormone therapy - a systematic review and meta-analysis. Maturitas. 2020;141:71–81. This article reviews the most recent review on exercise treatment for aromatase inhibitor musculoskeletal syndrome.CrossRefPubMed
31.
Paulo TRS, Rossi FE, Viezel J, Tosello GT, Seidinger SC, Simões RR, de Freitas R Jr, Freitas IF Jr. The impact of an exercise program on quality of life in older breast cancer survivors undergoing aromatase inhibitor therapy: a randomized controlled trial. Health Qual Life Outcomes. 2019;17(1):17.CrossRefPubMedPubMedCentral
32.
•• Roberts KE, Adsett IT, Rickett K, Conroy SM, Chatfield MD, Woodward NE. Systemic therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer. Cochrane Database Syst Rev. 2022;1(1):CD013167. The most up to date review of the literature on the prevention and treatment of AIMSS.PubMed
33.
• Zhu XY, Li Z, Chen C, Feng RL, Cheng BR, Liu RY, Wang RT, Xu L, Wang Y, Tao X, Zhao P. Physical therapies for psychosomatic symptoms and quality of life induced by aromatase inhibitors in breast cancer patients: a systematic review and meta-analysis. Front Oncol. 2021;11:745280. Another good review of current exercise therapies for AIMSS.CrossRefPubMedPubMedCentral
34.
Kubo M, Onishi H, Kuroki S, Okido M, Shimada K, Yokohata K, et al. Short-term and low-dose prednisolone administration reduces aromatase inhibitor-induced arthralgia in patients with breast cancer. Anticancer Res. 2012;32(6):2331–6.PubMed
35.
Henry NL, Unger JM, Schott AF, Fehrenbacher L, Flynn PJ, Prow DM, Sharer CW, Burton GV, Kuzma CS, Moseley A, Lew DL, Fisch MJ, Moinpour CM, Hershman DL, Wade JL 3rd. Randomized, multicenter, placebo-controlled clinical trial of duloxetine versus placebo for aromatase inhibitor-associated arthralgias in early-stage breast cancer: SWOG S1202. J Clin Oncol. 2018;36(4):326.CrossRefPubMed
36.
Hershman DL, Unger JM, Greenlee H, Capodice JL, Lew DL, Darke AK, Kengla AT, Melnik MK, Jorgensen CW, Kreisle WH, Minasian LM, Fisch MJ, Henry NL, Crew KD. Effect of acupuncture vs sham acupuncture or waitlist control on joint pain related to aromatase inhibitors among women with early-stage breast cancer: a randomized clinical trial. JAMA. 2018;320(2):167–76.CrossRefPubMedPubMedCentral
37.
Anand K, Niravath P. Acupuncture and Vitamin D for the Management of Aromatase Inhibitor-Induced Arthralgia. Curr Oncol Rep. 2019;21(6):51.CrossRefPubMed
38.
Shen S, Unger JM, Crew KD, Till C, Greenlee H, Gralow J, Dakhil SR, Minasian LM, Wade JL, Fisch MJ, et al. Omega-3 fatty acid use for obese breast cancer patients with aromatase inhibitor-related arthralgia (SWOG S0927) Breast Cancer Res. Treat. 2018;172:603–10.
39.
Lustberg MB, Orchard TS, Reinbolt R, Andridge R, Pan X, Belury M, Cole R, Logan A, Layman R, Ramaswamy B, et al. Randomized placebo-controlled pilot trial of omega 3 fatty acids for prevention of aromatase inhibitor-induced musculoskeletal pain. Breast Cancer Res Treat. 2018;167:709–18.CrossRefPubMed
40.
Santa-Maria CA, Bardia A, Blackford AL, Snyder C, Connolly RM, Fetting JH, Hayes DF, Jeter SC, Miller RS, Nguyen A, et al. A phase II study evaluating the efficacy of zoledronic acid in prevention of aromatase inhibitor-associated musculoskeletal symptoms: the ZAP trial. Breast Cancer Res Treat. 2018;171:121–9.CrossRefPubMed
Metadaten
Titel
Aromatase Inhibitor Musculoskeletal Syndrome and Bone Loss: a Review of the Current Literature
verfasst von
Sara Christensen Holz
Publikationsdatum
13.04.2023
Verlag
Springer US
Erschienen in
Current Oncology Reports / Ausgabe 7/2023
Print ISSN: 1523-3790
Elektronische ISSN: 1534-6269
DOI
https://doi.org/10.1007/s11912-023-01413-5

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