Bone-Modifying Agents in Cancer — RACP Adult Medicine MCQ

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EasyMedical OncologyBone-Modifying Agents in CancerRACP Adult Medicine

A 55-year-old woman with metastatic breast cancer develops new bone pain. A bone scan shows multiple areas of increased uptake. Her calcium is normal. She is commenced on zoledronic acid for bone protection. How frequently should zoledronic acid be administered for metastatic bone disease?

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Correct answer: D — Monthly (4 mg IV every 4 weeks)

For metastatic bone disease, zoledronic acid 4 mg IV is given every 3–4 weeks (monthly is standard). This reduces skeletal-related events (pathological fractures, spinal cord compression, need for radiation/surgery). After 1–2 years, de-escalation to every 12 weeks may be considered based on the OPTIMIZE-2 and CALGB 70604 trials, which showed non-inferiority. Dental assessment before commencement and calcium/vitamin D supplementation are essential. Renal function must be monitored.

Reference: Cancer Council Australia – 2024 – Breast Cancer Guidelines; eTG – 2025 – Oncology