Vitamin D to reduce joint pain with aromatase inhibitors

Aromatase inhibitors (listed below) are a class of drugs used to treat breast cancer and ovarian cancer in postmenopausal women. Joint pain (arthralgia) is the main reason women stop taking this drug.

Researchers at the University of Barcelona, in Spain, used vitamin D to lower the risk of arthralgia.

First, the details.

• 290 women starting treatment with an aromatase inhibitor received daily vitamin D(3) (800 IU) with calcium.
  • Women with vitamin D blood levels less than 30 ng/mL also received 16,000 IU of vitamin D by mouth every 2 weeks.
• The presence or worsening of joint pain from the start of the study to month 3 was assessed using a visual analogue scale (VAS) for joint pain.
• The potential for an association between vitamin D blood concentrations at 3 months and pain was determined after adjusting for age, BMI, season when the sample was drawn, aromatase inhibitor (exemestane [Aromasin] vs. letrozole/anastrozole [Femara/Arimidex]), prior tamoxifen therapy, N-telopeptide (NTx), and previous fracture.
  • NTx is a marker of bone break down, which correlates with outcomes in certain patients with metastatic breast cancer.

And, the results.

• At the start of the study, 90% of the women had a 25(OH)D blood level less than 30 ng/mL.
• After taking vitamin D (daily 800 IU + 16,000 IU every 2 weeks), 50% of the women failed to reach adequate vitamin D levels at 3 months.
• Among all the women, there was a significant increase in joint pain.
• The increase in joint pain was significantly less in those who reached concentrations of 25(OH)D of at least 40 ng/mL.

The bottom line?

The authors concluded, “A target concentration of 40 ng/mL 25(OH)D may prevent development of aromatase inhibitor arthralgia, but higher loading (initial) doses are required to attain this level in women with deficiency at baseline.”

These results are important because better adherence to treatment is associated with improved outcomes for women with breast cancer. As more and more patients survive breast cancer, compliance with follow-up therapy becomes increasingly important.

Prof. Dr. med. Peyman Hadji at the Philipps-University, in Marburg, Germany, tells us, “Most patients seem willing to accept the side effects of treatment with aromatase inhibitors in return for protection against disease recurrence… And analgesics, anti-inflammatory agents, and lifestyle changes such as exercise can help to alleviate joint/muscle aches.”

Better than treating side effects however, is preventing them or at least minimizing discomfort. To this end, this study offers a potentially important tactic.

Here’s a list of aromatase inhibitors.

• Aminoglutethimide
• Testolactone (Teslac)
• Anastrozole (Arimidex)
• Letrozole (Femara)
• Exemestane (Aromasin)
• Vorozole (Rivizor)
• Formestane (Lentaron)
• Fadrozole (Afema)

9/3/10 21:53 JR