Aromatase Inhibitor-Associated Tendinopathy and Muscle Tendon Rupture: Report of Three Cases of This Exceedingly Rare Adverse Event

Abstract

Aromatase inhibitors (AIs) are a commonly used antihormonal therapy in the treatment of breast cancer in postmenopausal women, specifically in the treatment of hormone receptor-positive breast cancer. AI-associated tendinopathy and muscle tendon rupture is exceedingly rare. Until now, only one case with AI-associated severe tendinopathy has been reported in the medical literature, and there are no recorded cases of AI-associated muscle tendon rapture. We report three cases of postmenopausal women with hormone receptor-positive breast cancer, who experienced tendinopathy or muscle tendon rupture under antihormonal treatment with letrozole. All of the three women were in the adjuvant setting, and the treatment of tendinopathy or tendon rupture consisted of AI discontinuation, initiation of corticosteroids, or surgical treatment. Diagnosis was made via MRI. Furthermore, in our cases, there were no signs of underlying systemic disease, there was no abnormal physical activity preceding the complaints, and there was no use of other drugs beside letrozole. AIs are one of the most commonly used drugs in antihormonal therapy for hormone receptor-positive breast cancer. In every case of a female patient with hormone receptor-positive breast cancer under treatment with AIs and arthralgia, an MRI should be performed in order to exclude the presence of tendinopathy or muscle tendon rupture.

Positive Association Between Fluoroquinolone Exposure and Tendon Disorders: A Nationwide Population-Based Cohort Study in Taiwan

“…Barring the relationship between fluoroquinolone exposure and tendon disorder occurrence, exposure to statins, aromatase inhibitors, and glucocorticoids is also reportedly related to the occurrence of tendon disorders ( Marie et al, 2008 ; Laroche et al, 2017 ; Mitsimponas et al, 2018 ; Wise et al, 2012 ; van der Linden et al, 2002 ). In this cohort, we found that only patients who used statins were predisposed to developing tendon disorders.…”

“…Some systemic diseases, including cardiac disease, diabetes mellitus (DM), obesity, lipid disorders, and rheumatologic disorders have been reported in patients with tendon disorders ( van der Vlist et al, 2019 ). Moreover, tendon disorders are reportedly associated with the use of statins ( Marie et al, 2008 ), aromatase inhibitors ( Laroche et al, 2017 ; Mitsimponas et al, 2018 ), and glucocorticoids ( Wise et al, 2012 ).…”

Cephalexin-associated Achilles Tendonitis: Case Report and Review of Drug-induced Tendinopathy

“…In addition to musculoskeletal adverse effects, aromatase inhibitors can be associated with tenosynovitis of the fingers, hands, and wrists in up to 50% of the treated patients. Rarely, aromatase-induced severe tendinopathy and rupture of larger tendons (such as the subscapularis, infraspinatus, and/or supraspinatus tendon) have occurred [ 1 - 3 , 8 ].…”

“…The initial management included discontinuation of the aromatase inhibitors. The two patients with ruptured tendons required surgical treatment; however, the woman with severe tendinopathy and no rupture had complete resolution of her symptoms within one month after replacing her drug and conservative treatment with corticosteroids [ 8 ].…”

Current Advances on the Regeneration of Musculoskeletal Interfaces

“…These therapies can induce, for example, chondrocytes senescence and bone differentiation leading to osteoarthritis 40 . Furthermore, numerous other drugs are associated with the development of tendinopathies or muscle rupture 41,42 .…”