“Endocrine therapies: the point of view of the rheumatologist”: this is the title of the speech by Professor Bianca Marasini, senior consultant in Rheumatology and Clinical Immunology at Humanitas, during Mamazone 2017, the seventh edition of “Paziente Diplomata”, a day dedicated to women with and without breast cancer, organized by Humanitas last 14 October.

“A breast cancer patient on hormone therapy can be referred to the rheumatologist for osteoporosis or joint pain, both of which are called aromatase inhibitor syndrome.

Pain affects 20-50% of patients, varies from woman to woman, is most often symmetrical (to the hands, wrists, knees) and appears from 2 to 10 months after the start of therapy. The cause of the pain seems to be mutifactorial, but the decrease in estrogen plays a major role: it seems that low levels of these hormones can promote an inflammatory state at the joint level,” explained the specialist.


What do you do in the presence of these pains?

“One of the solutions is to change the aromatase inhibitor compound or to use pharmacological or non-pharmacological therapy; it is then important that the rheumatologist explains to the patient what the pain is due to and what prospects there are in his or her control.

The pharmacological approach must be sequential and adapt to the intensity of pain, which is quantified using appropriate scales. The drugs available are NSAIDs, analgesics, cortisone and vitamin D. NSAIDs have analgesic and anti-inflammatory activity, but the response to these drugs is individual and varies from patient to patient, as do different adverse affections. Analgesics, on the other hand, act on pain but not on inflammation and the choice of medication varies according to the extent of the pain (mild pain, non-opioid medications; moderate pain, weak opioids; intense pain, major opioids). Cortisone should be carefully prescribed, including for long-term side effects. Finally, vitamin D is certainly important for bones, but the results regarding its effects on pain are mixed.

Non-pharmacological therapy includes exercise, acupuncture and relaxation techniques. Physical activity is certainly important, also because according to some studies it releases anti-inflammatory cytokines with consequent reduction of pain. We recommend at least 150 minutes of physical activity per week and recommend, for example, walking fast. We also have encouraging results on acupuncture, but we do not have reliable data and therefore new studies will be needed. The same applies to relaxation techniques,” said the professor.


What to do in case of osteoporosis?

“Aromatase inhibitor therapy exposes women to increased bone reabsorption and bone loss. Osteoporosis is characterized by a change in bone structure resulting in brittleness and increased risk of fractures, the most frequent being those affecting the spine, femur and wrist. 80% of fractures in patients with osteoporosis result from minor injuries such as redoing the bed, holding a child, carrying shopping bags, and are referred to as fractures from fragility or stress fractures.

In these patients it is essential to improve the quality of the bone, avoiding fractures and preventing fractures after the first one. It has been shown, for example, that there is an increased risk of subsequent vertebral fractures in the presence of a vertebral fracture. It is important, in addition to therapy, to take care of the lifestyle by dedicating yourself to regular physical activity (it is very useful to walk), preventing the risk of falls and avoiding incorrect movements, especially in the column”, recommended the specialist.

Professor Marasini then explained the drugs that can be used to treat osteoporosis, explained when treatment should begin and spoke about the role of calcium and vitamin D.


Watch the full intervention of Professor Bianca Marasini, click here