Aromatase Inhibitors
Common brand names: Anastrozole (Arimidex), Letrozole (Femara), Exemestane (Aromasin)
Three nutrients listed against this medication. The most severe is marked critical.
At a glance
One of the three is marked well documented. The other two carry their own evidence levels.
At a glance
- Vitamin D3 + Calcium (Bone Matrix)Critical · Well documented
- CoQ10Moderate · Mechanism only, no human trial
- MagnesiumMild · Traditionally cited, limited evidence
Color shows how serious each listed effect is. The label beside it shows how strong the evidence is. The cards below explain each one and show its evidence.
Nutrients it can lower
Mechanism, Aromatase inhibitors eliminate estrogen, which is critical to bone mineral density. Without estrogen, osteoclast activity dramatically accelerates bone loss.
Common signs, Accelerated bone loss, osteoporosis, fractures, joint pain
Eastell et al. (J Clin Oncol, 2008; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 18309940): five-year bone-density results from the ATAC trial: anastrozole produced continued lumbar spine and hip bone loss over five years, while tamoxifen did not.
A DEXA scan is done at baseline and annually. Calcium 1,000 to 1,200 mg from food plus supplement, with vitamin D3, is the intake in common use and is not from a trial cited on this row. No 25(OH)D concentration target is established: the cited trial reports bone density, not a vitamin D threshold.
Mechanism, Fatigue is the most common complaint on aromatase inhibitors and has been attributed in part to mitochondrial impairment. The supporting oxidative-stress data come from other breast-cancer drug classes rather than from aromatase inhibitors themselves, so the link to CoQ10 here is inferred.
Common signs, Fatigue (primary complaint), cardiac risk, muscle weakness
Conklin (Integr Cancer Ther, 2004): a review of chemotherapy-associated oxidative stress covering antineoplastic agents generally, not aromatase inhibitors. No human study shows CoQ10 depletion on aromatase inhibitors.
CoQ10 was used at 200–300 mg daily, of particular interest after anthracycline chemotherapy; this is discussed with the oncologist.
Mechanism, Proposed mechanism, not measured: estrogen supports magnesium retention by the kidney, so estrogen suppression by an aromatase inhibitor has been suggested to increase magnesium loss. Magnesium has been suggested for aromatase-inhibitor joint pain, which is a treatment question, not a depletion. Aromatase inhibitors have not been shown to deplete magnesium.
Common signs, Joint pain (arthralgia, most common AI side effect), muscle cramps, insomnia
Magnesium supplementation may ease aromatase-inhibitor joint pain (augmentation); AIs are not shown to deplete magnesium.
Magnesium 300–400 mg daily is a range in common use, not from a trial cited on this row. The row's own evidence describes magnesium as augmentation for joint pain, and aromatase inhibitors are not shown to deplete it.
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Disclosure
These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
Grades move when new trials publish. A free monthly email lists every grade EBL moved, with the reason and the trial behind it: the sign-up is on the Evidence Log →