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 ...

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 ex...