Aromatase inhibitor-associated arthralgia in breast cancer: etiopathogenesis and treatment

Background: Aromatase inhibitors (AIs) are currently used for the chemoprevention and treatment of hormone-dependent (HR+) breast cancer (BC). In premenopausal women with HR+ BC at high risk of recurrence, as determined by clinicopathological characteristics, the use of these drugs reduces the risk by 10–15%.

Objective: Review of literature on the incidence and mechanisms of AI-associated arthralgia, as well as methods for preventing musculoskeletal disorders (MSDs) during treatment with these medications.

Results: The studies reviewed in this study demonstrate that over 50% of women experience pain, necessitating further investigation of the underlying mechanisms of these complications and the development of strategies to minimize them. CDK4/6 inhibitors may be an alternative, as they have less pronounced side effects on the musculoskeletal system. Observations also confirm a link between side effects and recurrence rates. Duloxetine has been shown to be effective in reducing the incidence of arthralgia, although its effect in patients with a high body mass index requires further analysis. The risk of osteoporosis associated with AI treatment can be reduced with bisphosphonates, which is also supported by a reduction in fracture rates in high-risk patients. True acupuncture is an effective method for reducing arthralgia associated with AI use in women with HR+ BC. Moderate physical activity is an effective non-pharmacological strategy for relieving arthralgia during AI therapy in BC, associated with a reduction in systemic inflammation and an improvement in quality of life.