Topic: Hip Joint problems and arimidex

I haven't heard anything per say about the hip joint and Arimidex, Lisa, other than the bone thinning that occurs variably with all AI's. There's even a title for it: AIBL-Aromatase Inhibitor-associated Bone Loss.

Here's an abstract on it:

Bone loss in patients with breast cancer receiving aromatase inhibitors and associated treatment strategies

"Hormone-receptor-positive breast cancer in postmenopausal women is treated increasingly with aromatase inhibitors because of increased efficacy and reduced incidence of endometrial cancer compared with tamoxifen. However, aromatase inhibitor therapy increases bone turnover as a result of nearly complete oestrogen depletion, leading to increases in bone loss and fragility fractures that erode patients’ functional independence and quality of life. Management of patients with aromatase inhibitor–associated bone loss (AIBL) is currently evolving and intervention strategies are under investigation. Although no treatments are specifically approved for AIBL, bisphosphonates are currently the intervention of choice for patients with low bone mineral density or evidence of rapid bone turnover, along with adequate calcium and vitamin D supplementation and a healthy lifestyle. In this setting, the majority of information available regarding bisphosphonate efficacy is from studies of intravenous zoledronic acid (4 mg) every 6 months. Data from four large international studies (three of identical design in postmenopausal women and one in premenopausal women) indicate that zoledronic acid is effective in the management of AIBL. Treatment algorithms based on risk factors and bone mineral density are under development, and the results of ongoing studies should help define optimal bone health management for patients undergoing aromatase inhibitor treatment for early breast cancer. "

 Maybe this is what your oncologist is referring to.

Best,

Tender

Lisa, I don't know about hip joints, but there is plenty of evidence that the AI's contribute to (or even cause) orthopedic problems.  My BS and my med onco both told me that. 

At my recheck in September, my BS (a surgical onco) said the AI's can worsen the joint pain in someone who already has some tendency toward arthritis. 

My med onco told me just this week that the AI's can cause joint pain all by themselves (it's not necessary for the arthritis to be pre-existing).  She said in most women it's the hands and feet that are affected the most by the AI "arthritis".  We also talked about other orthopedic problems that have been attribued to the AI's, such as tenosynovitis.  She said it's not very common, but it does happen.

Both my BS and my med onco are really up-to-date on things.  They go to all the national onco and breast cancer meetings; they seem to read all the journal papers as soon as they come out; and they participate in the review panels that establish national guidelines for dx and tx of BC.  So, I'm not surprised at their willingness to admit there are joint problems associated with the AI's. Those problems are appearing in the peer-reviewed medical journals lately.

otter 

 This is a nice, needed discussion thread on AI's and joints/bone etc pain. Lots of us out there with this problem, so thanks for bringing it up Lisa.

Duh, I forgot about the MMPI's: Matrix Metalloproteinase Inhibitors. I've long thought the AI's (at least Letrozole is documented as a MMPI) are not commented on enough as possible arthritic or joint destabilizing drugs.

Matrix Metalloproteins (MMP's) are intricately involved with collagen and collagen breakdown in our body. I discovered this when reading about joints, as mine hurt so much on the AI's. I also discovered Femera for ER+ bc is a potent inhibitor of MMP's. I wrote about it in a past post:

"...Femara can influence collagen proteins, and act on the MMPI family of proteins (matrix metalloproteinase inhibitors) which are important in collagen maintenance. Collagen is present in our bones and joints, and tendons. Collagen, as I understand it from my DH, does not divide or produce more due to the absence of nuclei within a collagen cell..."

 Since I started on the AI's some seven years ago, I first developed bilateral painful Carpel Tunnel Syndrome (now confirmed on AI's) and of late, severe TMJ from degenerative arthritis. Yes, all discs, even that in the TMJ, have a tenosynovium. I wonder if it's the MMPI affect of the Ai's... 

T.

Oh, cr*p.  Lisa, Even before I posted that nonsense yesterday (sorry for sounding so elementary), I googled "coxofemoral joint" x "aromatase [inhibitor]" ... and found nothing.  But obviously I'll need to do a Medline search, to see if there's something new in the medical literature.

I was hoping your doc didn't mean the problem was a true "hip joint" thing. (I was hoping it was just part of the annoying arthritis-like problems associated with AI's.)

Do you think your onco would be willing to give you more information about it?  Mine will talk about ongoing clinical trials, recent publications in Journal of Clinical Oncology, meeting reports, etc., as well as things her fellow oncos have been discussing around the table.  I'd sure like to see a paper or meeting abstract or case report on it.  (Please don't think I'm questioning the information -- it's just that I'm an info junkie.)

otter