Changes in Knee Articular Cartilage Volume in Women on Aromatase Inhibitors
Condition: Arthralgia
MeSH terms: Arthralgia
Study type: Observational

Summary: 
      Many women with breast cancer are treated with a class of drugs called aromatase inhibitors
      (mainly letrozole or anastrozole), which lowers the amount of estrogen being produced in the
      body. Women on aromatase inhibitors appear to experience joint pains and arthralgia. The aim
      of this study is to determine whether the joint pains experienced by some women on aromatase
      inhibitors is associated with more defects in their cartilage, compared to women not
      receiving this therapy. Using the magnetic resonance imaging (MRI) technique, the knee joint
      will be examined to assess changes in cartilage volume over time.
    

Detailed description: 
      The mechanism of increased bone loss and fracture risk is clearly related to the depletion of
      estrogen production in the bone. But why there is a higher rate of reporting arthralgia,
      fracture and joint pain amongst women on aromatase inhibitors is not understood.

      Using magnetic resonance imaging (MRI) to measure knee articular cartilage volume, we have
      demonstrated that post menopausal hormone therapy used for at least five years is associated
      with retention of articular cartilage in the knee, indicating that oestrogen may protect
      against the development of osteoarthritis in post menopausal women. Furthermore, we have
      recently observed that free testosterone is associated with loss of tibial cartilage, after
      taking into account age, body mass index, baseline tibial cartilage volume, tibial plateau
      area and total bone mineral content in healthy men. Whether an excess of testosterone to
      oestrogen as a consequence of aromatase inhibition has an adverse effect on articular
      cartilage volume warrants further investigation.

      This study will include non-hysterectomised women aged 40 to 65 years who have undergone
      breast surgery and then commenced on aromatase inhibitors within the preceding 12 weeks. The
      control group (which has been fully recruited) included non-hysterectomised, healthy women
      aged 40 to 65 years. A MRI of the dominant knee will be used to compare changes in knee
      articular volume over time. A MRI will be done at baseline and again at 2 years. Changes in
      knee articular volume is the primary outcome. We will also use this opportunity to compare
      menopausal symptoms (assessed using the Menopause Quality of Life (MENQOL)questionnaire)
      between women treated with aromatase inhibitors and those who are not. Well-being will also
      be assessed using the Psychological General Well-Being index.
    

Intervention name(s): aromatase inhibitors (letrozole, anastrozole)
Intervention type(s): Drug
Intervention description(s): Women prescribed an aromatase inhibitor by their clinician were compared with healthy controls in the community who had been recruited to a prior study
Other intervention name(s): no other names
Intervention MeSH terms: Letrozole; Anastrozole; Aromatase Inhibitors
Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Participants will be informed of study by their treating physician and invited to
        participate and by community sample.
      
Keywords: bone fracture; cartilage; osteoporosis; breast cancer; aromatase inhibitors; knee articular cartilage volume