Is there a degree of osteoporosis (based on T-score) that would prohibit you from the utilization of an AI in a strong HR+ early stage breast cancer?

Tamoxifen is often underutilized in many patients who otherwise have a narrow benefit/risk ratio from an AI. It is more preserving and more tolerated, and should be used more readily in the majority of patients with lower risk disease.

Using a sequence of tamoxifen and an AI is also very reasonable as an approach when the preserving effect of tamoxifen is needed to balance the estrogen deprivation consequences of an AI, be it the daily quality of life issues, or the long term consequences of est...

This is a nuanced question that requires a nuanced answer. There isn’t necessarily a clear T-score or FRAX that would prohibit me from using an AI, but I would weigh the following factors:

• What is the patient's risk tolerance for fractures vs cancer recurrence?
• Are they followed by a bone health expert who can assist me and the patient?
• Do they have known fractures?
• Are they willing to receive a bisphosphonate? Or are they already on adequate therapy and still have osteoporosis?
• What is the ris...