Hope for those with AI-associated musculoskeletal complaints

[Lani]

Vitamiin D supplementation may help according to this Phase II trial


Breast Cancer Res Treat. 2011 Jun 21. [Epub ahead of print]
Vitamin D and aromatase inhibitor-induced musculoskeletal symptoms (AIMSS): a phase II, double-blind, placebo-controlled, randomized trial.
Rastelli AL, Taylor ME, Gao F, Armamento-Villareal R, Jamalabadi-Majidi S, Napoli N, Ellis MJ.
Source
Department of Medicine, Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8056, St. Louis, MO, 63110, USA, arastell@dom.wustl.edu.
Abstract
A double-blind placebo-controlled randomized phase II trial was performed to determine whether High Dose Vitamin D2 supplementation (HDD) in women receiving adjuvant anastrozole improves aromatase inhibitor-induced musculoskeletal symptoms (AIMSS) and bone loss. Patients with early breast cancer and AIMSS were stratified according to their baseline 25-hydroxy vitamin D (25OHD) level. Stratum A (20-29 ng/ml) received either HDD 50,000 IU capsules weekly for 8 weeks then monthly for 4 months or placebo. Stratum B (10-19 ng/ml) received either HDD for 16 weeks and then monthly for 2 months, or placebo. AIMSS was assessed by the Brief Pain Inventory-Short Form (BPI-SF), the Fibromyalgia Impact Questionnaire (FIQ), and the Health Assessment Questionnaire-Disability Index (HAQ-DI) at baseline, 2, 4, and 6 months. Bone Mineral Density (BMD) was measured at baseline and at 6 months. The primary endpoint of the study was the change-from-baseline musculoskeletal pain. The secondary endpoint was the percent change in BMD at 6 months. Sixty women were enrolled. Baseline characteristics were comparable between the groups. At 2 months, FIQ pain (P = 0.0045), BPI worst-pain (P = 0.04), BPI average-pain (P = 0.0067), BPI pain-severity (P = 0.04), and BPI interference (P = 0.034) scores were better in the HDD than placebo group. The positive effect of HDD on AIMSS was stronger across all time points in Stratum B than Stratum A (FIQ pain, P = 0.04; BPI average, P = 0.03; BPI severity, P = 0.03; BPI interference, P = 0.04). BMD at the femoral neck decreased in the placebo and did not change in the HDD group (P = 0.06). Weekly HDD improves AIMSS and may have a positive effect on bone health. Vitamin D supplementation strategies for breast cancer patients on AI should be further investigated.

PMID: 21691817 [PubMed

[tricia keegan]

Thanks for this Lani, I take a daily supplement of vitd along with my calcium but think I'll talk to my onc about increasing the amount as my last dexa showed some osteopenia.

[Becky]

Food for thought - I had my ovaries removed in August 2005 so I could take an AI instead of tamoxifen. 4 days after removal, my gyne wanted a dexa just so he knew what we were dealing with. I already had mild osteopenia.

I was on Herceptin alone and since I was getting infusions, the gyne talked to my onc about getting
Zometa which I started every 6 months.

Onc dexa scanned me every year - slight degression but he was happy that Zometa was keeping me stable. I started Vitamin D supplementation when I found that my daughter, mother, sister and cousin (later 3 also had bc) had zero circlulating Vitamin D (my daughter was 8).

Took 4000iu per day. 6 months later, I measure 46 for circulating Vitamin D. 6 months after that, total normal DEXA - "over normal". Good hard bones. Insurance wouldn't allow more Zometa. One year after that, still good hard bones and I am still on Arimidex (6 years now).

I also do not have joint pain (as my mom has and my cousin has mega big time). Neither my cousin or mom keep up with Vitamin D (daughter does as we see this as a potential metabolic problem in the family - potential risk for us for bc - low Vitamin D).

This works for me.

[sassy]

Becky,

How do you take the supplemental vitamin D? OTC or prescription? I take calcium with D, my D levels are normal, but if I can increase in the hopes of relieving more joint pain, I'd like to give it a shot.

Thanks!

[Laurel]

Rhonda,

I upped my Vit D to 4000-5000 IUs daily along with Strontium, Calcium, Magnesium, and Boron. I really only have stiff feet and ankles in the morning when I "Frankenstein Walk" to the bathroom first thing upon waking. Surprisingly to me, recently I was chatting with a few other ladies our age who are NOT breast cancer survivors. They all complained of the stiff feet and ankles in the morning just like me! I had chalked this up to my A.I., Femara, but in fact it may be due to aging or menopause! Wow, I'm NORMAL! Hot damn! Oh to be NORMAL and creeky and stiff in the morning! LOL!

In light of this, I have to say that I really have zero A.I. associated pain. I have had pain in my hands, but had been vigorously weeding my flower beds or some such activity as I reflect back upon it as I do not have continuous pain in my hands. My non-breast cancer friends experience the same symptoms as me under these circumstances. It is NOT the Femara. Yeah!

Here's the kicker. I have been taking minimally 2500 IUs of Vit D3 since my diagnosis. At dx I had a blood level of 23 for Vit D. Now I am around 50. It took me years to get that high. I found I had to increase my intake to 4000 IUs or so to achieve that result.

Just this week I began jogging, because as you know I am now a porker. Some of my weight gain may be due to menopause and my A.I., but it is mostly due to my love affair with all things tasty! Hence the need to exercise more. I take several "oils" to decrease inflammation, olive, fish, avocado, and coconut. I should be in serious pain, but I am only mildly sore. Amazing!

I think some of our aches and pains are due to aging. I suspect cancer treatment ages us a bit more rapidly than we otherwise would have, but still some of our complains would arise had we not acquired the "blessing" of cancer. Vit D seems to help our bones and comfort levels. We'll see how it assists against osteoporosis when I have my next bone scan. I had to discontinue my bisphosphonate due to GI problems relying now only upon my supplements. I'll let you know how I am faring. If my dexa is good then I will be singing the Monkeys' "I'm a Believer (believa if you are a Brit like Davy).

Yes, I have just totally dated myself.....;)

[Becky]

I take one OTC Vitamin D3 at 4000iu. I think I was like Laurel in a sense - I did not know my starting Vitamin d level but suspected it was bad due to the results of my family. So, I started at 4000iu. About 7 months later I had mine drawn and they measured 46. I figured I need alot to get it up and keep it up.

I just went to my onc on Monday. I asked that he run my Vitamin D again but he says they are doing this 1-2 times a year per patient now as they are feeling the Vitamin D level is more and more important. So... in a couple of days, I will let you know my level and whether or not I think I can drop down to a lower iu level or not. Hopefully I don't have a raging high result!

PS - I take my Vitamin D and omega 3 with dinner

[Becky]

Fyi - got my blood work results today and I am at 49 for Vitamin D3. Not overtly high for taking 4000iu, drinking some milk, eating fish and being outdoors a couple of hours a week but respectable.

[Laurel]

Nice one, Becky, but aren't you amazed at how much we need to dose ourselves with to maintain a level around 50?

[Becky]

Laurel

I agree with you. Even my cousin who had bc says that no doctor tells her to take as much as I do but her levels are never okay and I can't even discuss it with her. Some folks need much more than others and my family and I are in that group.

[Jean]

Becky,
I am right there with you sister...taking 5,000 D3,
grape seed, Reishi Shitaki & Maitake, my osteopenia has not advanced and remains stable. My vit. D level is 49.

I don't understand why the dr. do not tell their patients to
increase their intake or even mention taking Vit. D3.

jean

[Pray]

Hi Becky,

When your Dr. writes a test result as stable does that mead it is normal? Or just ok? I don't like recieving test results on weekends especialy on holiday weekends!

Ishy

[Becky]

To me, stable means the same as before. No change from before.

[Chelee]

The 1st time I requested my Vit D3 levels be checked...they were only 28. My Endo told me they were great. That was under the reference range of 30! So I now take 5000 IU's about 5 days per wk along with my Caltrate that has Calcium, vitamin D3 and minerals. In fact it's time to check my D3 levels at my next labs. I'd like to see them at 60 or so. :)

Chelee