Joint pain and falls among women with breast cancer on aromatase inhibitors

  • Coby Basal
  • Emily Vertosick
  • Theresa A. Gillis
  • Qing Li
  • Ting Bao
  • Andrew Vickers
  • Jun J. MaoEmail author
Original Article



Arthralgia is common among women with breast cancer on adjuvant aromatase inhibitor (AI) therapy. Pain is associated with falls in the general population; however, little is known about the relationship between arthralgia and falls among AI users. Our objective was to determine whether joint pain severity and interference predict future falls.


We conducted a prospective cohort study of postmenopausal women with stage I-III estrogen receptor-positive breast cancer who were prescribed a third-generation AI. Arthralgia symptoms were measured at baseline using a modified version of the Brief Pain Inventory. Fall occurrence was obtained at 24-month follow-up.


Among 667 participants (median age 63 years, interquartile range 57–69 years), 232 (35%, 95% CI 31 to 39%) reported falls 12–24 months after baseline. Among women who fell, 65 (28%) reported seeking medical assistance. After controlling for multiple fall risk factors, we found significant non-linear associations between baseline joint pain severity and risk of falls (p = 0.001). Women with joint pain severity scores ≥ 4 had a more than twofold increase in fall risk compared to those without pain (41% vs. 20%). We observed a similar relationship for pain interference and fall risk (p < 0.001). Fewer than half of participants reported having been asked about falls in the past 12 months by their primary care physician (44%) or oncologist (36%).


Joint pain increases the risk of falls among women with breast cancer on adjuvant AI therapy. Health care providers should evaluate and manage arthralgia symptoms and implement fall-prevention strategies for those who are at increased risk.


Breast cancer Aromatase inhibitors Fall risk Arthralgia Joint pain Falls 


Author contributions

Coby Basal, BA: conceptualization, data curation, investigation, methodology, writing—original draft, and writing—review and editing. Emily Vertosick, MPH: data curation, methodology, formal analysis, visualization, writing—original draft, and writing—review and editing. Theresa A. Gillis, MD: conceptualization, investigation, writing—original draft, and writing—review and editing. Qing Li, MS: conceptualization, data curation, formal analysis, methodology, writing—original draft, and writing—review and editing. Ting Bao, MD, DABMA, MS: conceptualization, investigation, writing—original draft, and writing—review and editing. Andrew Vickers, PhD: conceptualization, data curation, methodology formal analysis, investigation, visualization, writing—original draft, and writing—review and editing. Jun J. Mao, MD, MSCE: conceptualization, data curation, funding acquisition, investigation, methodology, writing—original draft, and writing—review and editing.


This work was supported in part by grants from the National Cancer Institute at the National Institutes of Health (grant numbers R01 CA158243, P30-CA008748) and by the Byrne Fund and the Translational Research and Integrative Medicine Fund, both at Memorial Sloan Kettering Cancer Center.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involving human participants and/or animals

The Institutional Review Board of the University of Pennsylvania approved the study protocol. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.NeurologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.Bendheim Integrative Medicine CenterNew YorkUSA

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