Bone and joint pain
- Medical Review: Margret Rosenzweig, PhD, CRNP-C, AOCNP, FAAN
Bone and joint pain are common side effects of some breast cancer treatments, including hormonal therapy and chemotherapy.
Sometimes, bone and joint pain happens because breast cancer has spread to the bones.
It’s normal to be concerned about any kind of pain after a breast cancer diagnosis. Below, we’ll explain how to tell if pain is in your bones or your joints, which treatments can cause this pain, and what you can do about it.
Bone pain versus joint pain
It isn’t always easy to tell if you’re having bone or joint pain. Here are some ways to tell the difference:
Bone pain
Think about where the pain is. For example, bones of the:
- Spine
- Pelvis
- Ribs
- Long bones in the arms/legs
Think about what the pain feels like. Bone pain can range from a slightly uncomfortable dull ache to severe, ongoing pain that needs to be treated with medicine.
Think about what increases the pain. For example, pain may increase when lying down. Some people report that pain increases at night.
Joint pain
Think about where the pain is. This may include:
- Hips
- Knees
- Ankles
- Elbows
- Wrists
- Hands
- Fingers
- Shoulders
- Lower back
Think about what the pain feels like. For example:
- Stiffness
- Muscle pain
- Hand weakness when trying to grip things
Think about what increases the pain. Some people may feel pain when waking up or after being still for a while. Does movement make this better or worse? Bone pain often worsens, joint pain may feel better.
Treatment versus bone metastasis pain
Bone and joint pain can happen for different reasons:
- Bone and joint pain can be a side effect of breast cancer treatment.
- Bone pain can sometimes mean that breast cancer has spread to the bone (bone metastasis).
- Both bone and joint pain can be part of the normal course of aging.
Bone or joint pain due to breast cancer treatment
- May have started around the same time, or soon after, you started the treatment.
- Is likely to occur on both sides of the body. For example, in both wrists.
- May get worse when starting the treatment and get better when stopping it.
- May get better with exercise.
Bone or joint pain due to breast cancer that has spread to the bone
- May come and go.
- May be worse at night.
- May get better at first when you move. Later, the pain may be constant and may get worse during activity.
If you have bone pain, your doctor may suggest a bone scan to check for cancer that has spread to the bone.
Treatments that cause bone & joint pain
Breast cancer treatments that lower or block estrogen can cause bone and joint pain. This is because estrogen keeps joints flexible, reduces inflammation, promotes bone building, protects bones from breaking down, and sends pain-blocking signals to the brain.
When estrogen is lowered or blocked, it can interfere with these benefits.
Other treatments may cause bone and joint pain for different reasons. For instance, immunotherapy may cause the immune system to change healthy tissue.
Here are common treatments that can cause bone and joint pain:
Hormonal therapy
Hormonal therapy is used regularly to treat hormone receptor-positive breast cancer. One possible side effect of these medicines is bone and joint pain. Here are the different hormonal therapies that can cause bone and joint pain:
- Aromatase inhibitors: It is common for people who take aromatase inhibitors to feel aches or pains in their joints, bones, and muscles. This also might feel like general stiffness. Aromatase inhibitors include anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara).
- Tamoxifen:
- Tamoxifen is less likely to cause bone fractures than aromatase inhibitors.
- Joint pain is less common with tamoxifen than it is with aromatase inhibitors, but it can still happen.
- Tamoxifen can have different effects on bone, depending on a woman’s menopausal status:
- In premenopausal women (women who are still having monthly periods), tamoxifen can cause bone loss (and possibly pain).
- In postmenopausal women, tamoxifen has the opposite effect and may help strengthen bones.
- Selective estrogen receptor degraders (SERDs): SERDs are hormonal therapies that include the oral medicines elacestrant (Orserdu), imlunestrant (Inluriyo), and fulvestrant (Faslodex, an injection). These medicines block estrogen. As a result, they can cause bone and joint pain.
- GnRH agonists: GnRH agonists are medicines that suppress the ovaries to lower estrogen that helps hormone receptor-positive breast cancer grow. They are commonly used to improve the effectiveness of other hormonal and/or targeted therapies in pre- and perimenopausal women with hormone receptor-positive breast cancer. GnRH agonists temporarily shut down the ovaries and reduce the production of estrogen. They can also cause bone and joint pain.
Aromatase inhibitors and GnRH agonists can also cause bone loss. This can lead to osteoporosis, which is when the bones become fragile and have a higher risk of fracture. Still, there are ways to reduce the risk. Visit Bone loss and Bone health to learn more.
Risk-reducing ovary removal
For some women at high risk of breast cancer or recurrence (a return of the cancer), surgical removal of both ovaries, also called an oophorectomy, can reduce that risk. But it can also cause side effects such as joint and bone pain.
The ovaries are the main organs in women that make estrogen. When the ovaries are removed, estrogen levels go way down. Low estrogen can lead to bone and joint pain. Ovary removal can also lead to bone loss and increase the risk of osteoporosis. Visit Bone loss and Bone health to learn more.
Chemotherapy
Some types of chemotherapy can cause bone and joint pain.
Taxanes can cause bone and joint pain:
- Taxanes commonly used in breast cancer are paclitaxel (Taxol), docetaxel (Taxotere), and nab-paclitaxel (Abraxane).
- Pain generally starts in the first few days after receiving these medicines and lasts about a week.
Some chemotherapies, such as cyclophosphamide (Cytoxan), cisplatin (Platinol), and doxorubicin (Adriamycin), can damage ovaries and reduce estrogen. This can cause:
- Bone and joint pain
- Bone loss and possibly increase the risk of osteoporosis
If your care team has recommended chemotherapy, talk with them about potential bone and joint side effects and how to manage them.
Learn more about Bone loss and Bone health.
Targeted therapy
Some targeted therapies can cause bone and/or joint pain. These include some, but not all:
- CDK 4/6 inhibitors (abemaciclib (Verzenio), ribociclib (Kisqali), and palbociclib (Ibrance))
- Antibody-drug conjugates such as ado-trastuzumab emtansine (Kadcyla), trastuzumab deruxtecan (Enhertu), and sacituzumab govitecan (Trodelvy)
- PARP inhibitors such as olaparib (Lynparza)
Some targeted therapies can trigger the immune system to change healthy tissue. This can lead to bone or joint pain.
Visit Targeted therapy to learn more.
Immunotherapy
Immunotherapy is treatment that uses the body’s immune system to find and kill cancer cells.
Pembrolizumab (Keytruda) is FDA-approved to treat triple-negative breast cancer. Pembrolizumab is the only immunotherapy currently approved to treat breast cancer. This treatment can trigger the immune system to change healthy tissue. This can cause inflammation that may in turn cause bone and joint pain.
Learn more about pembrolizumab.
Treatments for low white blood cell counts
Some chemotherapy medicines can cause neutropenia, which is a low white blood cell count. Doctors may treat this problem with growth factor medicines. These are medicines that help increase white blood cells, the cells that fight infection. Examples are:
- Filgrastim (Neupogen)
- Pegfilgrastim (Neulasta)
These medicines help increase white blood cells. But they can cause bone and joint pain because they:
- Help the bone marrow to quickly produce more blood cells
- Cause bone marrow inflammation
- Lead to expansion of the bone marrow
- Stimulate nerves
Medicines that protect bones
Medicines that protect against bone loss, breakdown, and fracture can also cause bone and joint pain.
These medicines include:
- Bisphosphonates, such as alendronate (Fosamax) and zoledronic acid (Reclast and Zometa)
- Denosumab (Prolia and Xgeva)
These treatments may be recommended if you are taking breast cancer medicines that increase the risk of bone loss or if you have been diagnosed with metastatic breast cancer that has spread to the bones.
These medicines may cause bone or joint pain for different reasons:
- They can cause an inflammatory reaction in the body.
- While these medicines reduce bone loss, in some cases, they can also suppress bone repair. This can lead to fractures and pain.
A very rare but serious side effect of these medicines is osteonecrosis of the jaw (ONJ). This can cause jaw pain and other symptoms. There are ways to reduce the risk of ONJ, and ways to treat it if it does happen.
Learn more about medicines to protect the bones, including how to reduce the risk of ONJ, on the Medicines to protect bones page.
Metastatic breast cancer and bone pain
If you have been diagnosed with metastatic breast cancer, bone pain can be a side effect of your treatment or a sign that the cancer has spread to the bones. The spine, pelvis, ribs, and long bones in the arms and legs are common places for breast cancer to spread.
When breast cancer spreads into the bone, it interferes with the bone’s normal growth, causing pain and thinning, which can increase the risk for bone breaks or fractures. This can also be very painful.
Learn more on our Metastatic breast cancer to the bones page.
Managing bone and joint pain
You should never have to cope with untreated pain. Talk to your cancer care team. They will help figure out the cause of your joint or bone pain and offer possible solutions.
Talking with your care team
Bone and joint pain are very common with some breast cancer treatments, so it’s important to let your care team know if you are having these side effects.
How to describe the pain to your team:
- Write down which symptoms you have and how long you’ve had them.
- If you are taking one of the medicines listed above that may cause bone or joint pain, let your care team know if the pain started around the time you began taking the medicine.
- Rate your discomfort on a scale of 1 (no pain) to 10 (the worst pain you have ever felt).
- Note whether the bone pain comes or goes or is constant.
- Be as specific as possible and let your team know how much bone pain impacts your life.
If bone and joint pain from hormonal therapy is severe and ongoing:
- It may be possible to switch you to a different medicine. For example, aromatase inhibitors work in similar ways, but you may have different side effects than someone else taking the same aromatase inhibitor. Some people report pain relief after switching the type of hormonal therapy they are taking.
- Always let your doctor know about any side effects you are having—including bone and joint pain.
Complementary therapies and things you can do at home
There are many ways to manage bone and joint pain that don’t involve taking medicine. Talk with your care team and ask about a referral to a specialist who can help with ways to control pain. For example:
- Complementary therapy practitioners
- Exercise trainer or physical therapist focusing on people being treated for breast cancer
Complementary and integrative medicine refers to treatments that work in addition to—not instead of—traditional cancer treatments. Examples of complementary and integrative practices that may help with pain due to cancer include:
- Acupuncture can be helpful for joint pain caused by aromatase inhibitors.
- Exercise. Always talk to your doctor before beginning any exercise program. Types of exercise that may ease bone and joint pain:
- Exercise in a pool
- Pilates
- Aerobic and resistance exercise
- Maintaining a healthy weight. Extra pounds put stress on your joints and bones.
- Massage
- Meditation
- Yoga
- Stretching
- Hypnosis
- Music and art therapy
Medicines for bone and joint pain
Several types of medicines can be used to help manage bone and joint pain. Medicines can be taken by mouth, by injection, or applied to the skin. Before using any of these medicines, talk to your care team to make sure that a medicine is right for you.
Medicines for bone pain
There are medicines that may reduce bone pain due to bone loss such as:
- Bisphosphonates
- Denosumab (Prolia and Xgeva)
These medicines and others, such as opioids, can also reduce bone pain associated with metastatic breast cancer in the bones. Learn more on the Medicines to protect bones page.
If you have bone metastases, your care team may suggest:
- Radiation therapy
- Radiofrequency ablation, or destruction of normal tissue, which involves passing an electric current through tissue to destroy a nerve and block the pain signal.
- Surgery to relieve pain and shrink areas of cancer.
For severe pain, opioids, such as oxycodone or morphine, may be recommended.
Medicines for joint pain
The following medicines may be helpful for joint pain:
- Duloxetine (Cymbalta), an antidepressant, was shown in a clinical trial to improve joint pain and stiffness in people taking an aromatase inhibitor. If you are taking tamoxifen, it’s important to know that duloxetine may interfere with how well tamoxifen works. Learn more on the tamoxifen page.
- Anticonvulsants such as gabapentin and pregabalin block pain signals in the brain and may be useful for joint pain.
- Muscle relaxants such as diazepam, lorazepam, and metaxalone decrease muscle spasms and can be helpful for bone and joint pain.
- Over-the-counter medicines such as:
- Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and the COX-2 inhibitor, celecoxib (Celebrex)
- Acetaminophen (Tylenol)
If your pain is due to taking an aromatase inhibitor, ask your doctor about switching to a different aromatase inhibitor or to tamoxifen.
Other options for bone and joint pain that are applied on top of the skin are:
- Medicated patches
- Ointments and creams
- Hot or cold packs on affected areas
If pain is severe, ask your care team about opioids, such as oxycodone or morphine.
Ask your doctor for suggestions that may help your pain. Your care team will work with you to find the best treatment and to minimize joint and bone discomfort.
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Reviewed and updated: December 18, 2025
Reviewed by: Margret Rosenzweig, PhD, CRNP-C, AOCNP, FAAN
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Living Beyond Breast Cancer is a national nonprofit organization that seeks to create a world that understands there is more than one way to have breast cancer. To fulfill its mission of providing trusted information and a community of support to those impacted by the disease, Living Beyond Breast Cancer offers on-demand emotional, practical, and evidence-based content. For over 30 years, the organization has remained committed to creating a culture of acceptance — where sharing the diversity of the lived experience of breast cancer fosters self-advocacy and hope. For more information, learn more about our programs and services.