Vitamin D insufficiency and musculoskeletal symptoms in breast cancer survivors on aromatase inhibitor therapy

Cancer Nurs. Mar-Apr 2009;32(2):143-50. doi: 10.1097/01.NCC.0000339262.44560.92.


Breast cancer survivors (BCSs) on aromatase inhibitor (AI) therapy often experience musculoskeletal symptoms (joint pain and stiffness, bone and muscle pain, and muscle weakness), and these musculoskeletal symptoms may be related to low serum levels of vitamin D. The primary purpose of this pilot exploratory study was to determine whether serum levels of 25-hydroxyvitamin D (25[OH]D) concentration were below normal (<30 ng/mL) in 29 BCSs on AI therapy and if musculoskeletal symptoms were related to these low vitamin D levels. The mean (SD) serum 25(OH)D level was 25.62 (4.93) ng/mL; 86% (n = 25) had levels below 30 ng/mL. Patients reported muscle pain in the neck and back, and there was a significant inverse correlation between pain intensity and serum 25(OH)D levels (r = -0.422; P < .05 [2 tailed]). This sample of BCSs taking AIs had below normal levels of serum 25(OH)D despite vitamin D supplements. This is one of the few studies to document a significant relationship between vitamin D levels and muscle pain in BCSs on AI therapy. Findings from this pilot study can be used to inform future studies examining musculoskeletal symptoms in BCSs on AI therapy and relationships with low serum levels of vitamin D.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anastrozole
  • Aromatase Inhibitors / adverse effects*
  • Breast Neoplasms / drug therapy*
  • Female
  • Humans
  • Letrozole
  • Middle Aged
  • Musculoskeletal Diseases / etiology*
  • Nitriles / adverse effects
  • Pilot Projects
  • Selective Estrogen Receptor Modulators / therapeutic use
  • Survivors*
  • Tamoxifen / therapeutic use
  • Triazoles / adverse effects
  • Vitamin D Deficiency / blood
  • Vitamin D Deficiency / chemically induced*


  • Aromatase Inhibitors
  • Nitriles
  • Selective Estrogen Receptor Modulators
  • Triazoles
  • Tamoxifen
  • Anastrozole
  • Letrozole