Acupuncture and Vitamin D for the Management of Aromatase Inhibitor-Induced Arthralgia
Purpose of Review
Aromatase inhibitor-induced arthralgia (AIA) is a very common syndrome which significantly affects breast cancer survivors’ quality of life, and it often leads to non-compliance with aromatase inhibitor (AI) therapy. However, the treatment of AIA remains a clinical challenge. Here, we will review the current data for acupuncture and vitamin D in the management of AIA.
Acupuncture has been shown to improve AIA symptoms, but it has not consistently been proven to offer significantly more clinical benefit than sham acupuncture. Similarly, while some vitamin D trials have shown benefit, the studies have not consistently shown improvement in AIA symptoms.
Neither acupuncture nor vitamin D can be touted as standard treatments for AIA. However, many patients do experience subjective improvement of their symptoms with these therapies. When other treatments, such as exercise and duloxetine, are not feasible or not effective, it is reasonable to offer a trial of acupuncture or vitamin D to patients who are suffering from AIA, as the potential harms are very few, and they do offer possible relief from AIA symptoms.
KeywordsAcupuncture Vitamin D Aromatase inhibitor Breast cancer Arthralgia Quality of life Breast cancer survivors
Compliance with Ethical Standards
Conflict of Interest
Kartik Anand and Polly Niravath declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 12.Zhang Y, Lao L, Chen H, Ceballos R. Acupuncture use among american adults: what acupuncture practitioners can learn from national health interview survey 2007? Evidence-based Complement Altern Med. 2012;2012:710750.Google Scholar
- 19.Bao T, Cai L, Giles JT, Gould J, Tarpinian K, Betts K, et al. A dual-center randomized controlled double blind trial assessing the effect of acupuncture in reducing musculoskeletal symptoms in breast cancer patients taking aromatase inhibitors. Breast Cancer Res Treat. 2013;138:167–74.CrossRefGoogle Scholar
- 21.•• Hershman DL, Unger JM, Greenlee H, Capodice JL, Lew DL, Darke AK, et al. 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 - J Am Med Assoc. 2018. This paper is the largest trial of acupuncture for aromatase inhibitor-induced arthralgia with 3 arms: acupuncture, sham acupuncture, and waitlist control group.;320:167–76.CrossRefGoogle Scholar
- 38.•• Khan QJ, Kimler BF, Reddy PS, Sharma P, Klemp JR, Nydegger JL, et al. Randomized trial of vitamin D3 to prevent worsening of musculoskeletal symptoms in women with breast cancer receiving adjuvant letrozole. The VITAL trial. Breast Cancer Res Treat. 2017; This is a randomized, placebo-controlled trial of 160 patients, which failed to show benefit for high dose vitamin D in aromatase inhibitor-induced arthralgia.;166:491–500.CrossRefGoogle Scholar
- 39.Niravath, P, Wang, T, Hilsenbeck, SG, Lipscomb, K, Pavlick, A, Jiralerspong, S, Nangia, J, Ellis, M, Ademuyiwa, F, Cherian M, Frith, A, Ma C, Park H, Rigden C, Suresh R, Osborne CK, Rimawi M. A randomized, controlled trial of high dose vs standard dose vitamin D for aromatase inhibitor-induced arthralgia in breast cancer survivors. San Antonio Breast Cancer Symp. 2018.Google Scholar
- 41.Lønning PE, Geisler J, Krag LE, Erikstein B, Bremnes Y, Hagen AI, et al. Effects of exemestane administered for 2 years versus placebo on bone mineral density, bone biomarkers, and plasma lipids in patients with surgically resected early breast cancer. J Clin Oncol. 2005;23:5126–37.CrossRefGoogle Scholar
- 44.Henry NL, Unger JM, Schott AF, Fehrenbacher L, Flynn PJ, Prow DM, et al. 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;36:326–32.CrossRefGoogle Scholar
- 45.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 ATOLL (articular tolerance of letrozole) study. Breast Cancer Res Treat. 2010;120:127–34.CrossRefGoogle Scholar