August 12, 2008

experts comment on research into causes of joint symptoms in post-menopausal women, as published in The Lancet Oncology

The research draws a link between obesity, HRT and treatment with aromatase inhibitors, which together may amount to an increased risk of joint symptoms in postmenopausal women with breast cancer.

Dr Peter Selby, Consultant Physician and Senior Lecturer in Medicine, Manchester Royal Infirmary and spokesperson for the Society for Endocrinology, said:

“The use of aromatase inhibitors such as anastrozole has been one of most important recent advances in the care of the majority of women with breast cancer. Unfortunately a significant minority of patients (usually about one third) of women receiving these treatments get significant bone and joint pains which can sometimes be so severe as to make them stop therapy. Dr Sestak’s paper shows that the main risk factors associated with developing these symptoms are those which predict a large fall in the female hormone, oestrogen, on treatment. Although this might enable to warn women who are at high risk of bone and joint pain that they could expect symptoms, it does not offer a simple solution to these problems. The benefit of these treatments derives from their ability to reduce oestrogen levels and so any attempts to reverse this would undermine the effectiveness of therapy.”

Dr John C. Stevenson, Consultant Physician and Reader at the National Heart & Lung Institute, Imperial College London, said:

“It is well recognised that oestrogen deficiency may result in increased joint pains (arthralgia), and a significant increase in arthralgia has been reported after discontinuation of hormone replacement therapy (HRT) in the large Women’s Health Initiative HRT trial in the USA. The new report from the ATAC trial confirms an increased incidence of arthralgia in previous HRT users, and now finds an additive effect with the use of an aromatase inhibitor in increasing joint pains. This reflects the further lowering of oestrogen levels with the use of such drugs. The authors note that in most women the arthralgia was mild to moderate, so women may accept this drawback to obtain the advantages of aromatase inhibitor therapy in the treatment of their breast cancer. However, the paper highlights the fact that the profound oestrogen deficiency induced by these drugs does have clinical disadvantages, as has already been seen with the increased risk of osteoporosis. It must raise concerns about potential cardiovascular risks with the treatment, as oestrogen deficiency is associated with increased risk of coronary disease. Studies to address this issue are urgently needed.”