American Board of Internal Medicine (ABIM) Certification Practice Exam

When should bisphosphonate treatment be initiated for patients on aromatase inhibitors?

1. If T score is below -1.0

2. If T score is below -2.0

3. If T score is below -2.5

4. If T score is below -3.0

The correct answer is: If T score is below -2.5

Bisphosphonate treatment should be initiated for patients on aromatase inhibitors if the T score is below -2.5. This threshold signifies osteoporosis, a condition where bone mineral density is significantly reduced, leading to an increased risk of fractures. Aromatase inhibitors, frequently used in the management of hormone receptor-positive breast cancer, can cause a decrease in estrogen levels, which negatively affects bone density and can increase the risk of osteoporosis. Initiating bisphosphonate therapy at this level (T score below -2.5) is crucial for providing appropriate management in hopes of reducing fracture risk and preserving bone health in these patients. This recommended approach aligns with guidelines for osteoporosis treatment, where the diagnosis is typically established at a T score of -2.5 or lower, thus advocating for proactive intervention to mitigate complications associated with reduced bone density.