Clinical management of arthralgia and bone health in women undergoing adjuvant aromatase inhibitor therapy

With substantial data accumulating on the safety and efficacy of the aromatase inhibitors as adjuvant therapies, the use of these drugs in the treatment of postmenopausal women with breast cancer is increasing. Arthralgia, decreasing bone mineral density, and increased fracture rates represent the most serious side effects associated with the use of aromatase inhibitors, and strategies for monitoring and managing these musculoskeletal complications are required. Arthralgia can be ameliorated with a combination of over-the-counter analgesics, non-steroidal anti-inflammatory drugs, and if necessary antidepressants. Strategies for reducing bone loss and minimizing fragility fractures include muscle-strengthening exercises, calcium and vitamin D supplementation, reducing alcohol consumption, cessation of smoking, and antiresorptive drugs. Dual X-ray absorptiometry scanning, currently the best method for monitoring bone mineral density loss, should be employed at regular intervals (1-2 years) to identify patients at heightened risk of fractures and to monitor the benefits of pharmacological or other interventions. A multifaceted approach to monitoring and managing bone health is vital for maintaining optimal bone health in postmenopausal women receiving adjuvant aromatase inhibitor therapy.