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Breast Cancer — SCE Medical Oncology MCQ

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HardBreast CancerBreast CancerSCE Medical Oncology

A postmenopausal woman beginning adjuvant anastrozole has a lumbar-spine T-score of −2.8, normal corrected calcium and eGFR 74 mL/min/1.73 m². There is no metastatic bone disease. Which bone-health plan fits UK guidance?

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Correct answer: B — Arrange dental review and start an osteoporosis-dose bisphosphonate with calcium and vitamin-D optimisation

Explanation lettering: D = shown as A · E = shown as B · A = shown as D · B = shown as E

E is correct. A T-score of −2.8 establishes osteoporosis and meets the UK treatment-induced bone-loss pathway for antiresorptive treatment. Dental health, renal function, calcium and vitamin-D status are assessed before an oral or intravenous osteoporosis-dose bisphosphonate is selected. Denosumab 120 mg every four weeks and monthly zoledronic acid are metastatic skeletal-event regimens, not routine osteoporosis schedules. Supplements alone do not provide sufficient fracture protection at this T-score. Strontium ranelate is not the routine first-line agent because of its restricted safety profile. If denosumab 60 mg six-monthly is chosen instead, an exit strategy is needed to avoid rebound vertebral fracture risk.

Reference: NICE NG101 breast-cancer treatment-induced bone loss recommendations: https://www.nice.org.uk/guidance/ng101/chapter/Recommendations