Lisa:

There's a bit of ambiguity about his concern: (1) it may be the general concern attached to all AIs as to their adverse effects on BMD (bone mineral density) when BMD loss is untreated, that is, not countered with bisphosphonate therapy; (2) or it may be a new concern grown out of a just published Chinese study on anastrozole (Arimidex) using an experimental rat model in which it was found that Arimidex could potentially promote the progression of arthritis as well as the associated development of osteoporosis.  This is a preliminary concern given that it  is animal model-based research, but it cannot be dismissed since to my mind it has considerable "molecular plausibility" since AIs are now known to increase the levels of proinflammatory cytokines, which are players in arthritic-type inflammatory disorders.

The proviso here is that this finding was with Arimidex monotherapy, without any bisphosphonate therapy, so we do not know if the pro-arthritis effect would be maintained when the patient is on zoledronic acid (Zometa) or any other bisphosphonate therapy, and it strikes me that this is unlikely given the effects of bisphosphonates. I have been aware of this potential, independent of this particular study, for some while, and it serves as part of the motivation for inclusion of a powerful COX-2 inhibitor like curcumin into my Edge-CAM regimen, in addition to its antitumor benefits.

As to the suggestion of a scan, my sense is that it is not unreasonable if you were not on concomitant bisphosphonate therapy while on Arimidex, and although it is less imperative if you were, it is erring on the better side of caution to check any sustained hip pain post-AI therapy, to evaluate (1) any AI-induced BMD loss and/or fracture risk, (2) any AI-induced pro-arthritic process, or (3) any age-related BMD or bone-inflammatory progression, so all-in-all a smart suggestion in any case.

Constantine Kaniklidis

Breast Cancer Watch

edge@evidencewatch.com