Vitamin D3 for Aromatase Inhibitor-associated Musculoskeletal Symptoms (AIMSS)

Vitamin D is involved in maintaining the collagen-rich osteoid surface of the skeleton. Low levels of vitamin ​D may lead to demineralization of that surface, which may​ contribute to pressure and pain (Felson & Cummings, 2005; Holick, 2006, 2007; Shapiro et al., 2016). The active hormone 1a,25-dihydroxyvitamin D3 promotes muscle cell growth, which may foster better ​muscle function (Boonen  et al., 2006; Ceglia, 2008; Shapiro et al., 2016) and decreased skeletal pain​ (Shapiro et al. 2016). D3 has been studied in the treatment of aromatase inhibitor-associated musculoskeletal pain. 

Boonen, S., Bischoff-Ferrari, H.A., Cooper, C., Lips, P., Ljunggren, O., Meunier, P.J., & Reginster, J.Y. (2006). Addressing the musculoskeletal components of fracture risk with calcium and vitamin D: A review of the evidence. Calcified Tissue International, 78, 257–270. https://doi.org/10.1007/s00223-005-0009-8

Ceglia, L. (2008). Vitamin D and skeletal muscle tissue and function. Molecular Aspects of Medicine, 29, 407–414. https://doi.org/10.1016/j.mam.2008.07.002  

Felson, D.T., & Cummings, S.R. (2005). Aromatase inhibitors and the syndrome of arthralgias with estrogen deprivation. Arthritis & Rheumatism, 52, 2594–2598. https://doi.org/10.1002/art.21364 

Holick, M.F. (2006). High prevalence of vitamin D inadequacy and implications for health. Mayo Clinic Proceedings, 81, 353–373. https://doi.org/10.4065/81.3.353 

Holick, M.F. (2007). Vitamin D deficiency. New England Journal of Medicine, 357, 266–281. https://doi.org/10.1056/NEJMra070553 

Shapiro, A.C., Adlis, S.A., Robien, K., Kirstein, M.N., Liang, S., Richter, S.A., & Lerner, R.E. (2016). Randomized, blinded trial of vitamin D3 for treating aromatase inhibitor-associated musculoskeletal symptoms (AIMSS). Breast Cancer Research and Treatment, 155, 501–512. https://doi.org/10.1007/s10549-016-3710-6  

Guideline / Expert Opinion