What is your approach to adjuvant hormone therapy for HR+ breast cancer in post-menopausal women with pre-existing osteoporosis?

Pre-existing osteoporosis, I assume secondary causes of osteoporosis and vitamin D3 deficiency have been ruled out, and she is on antiresorptive medications. In this case, I would use tamoxifen. In postmenopausal osteoporosis, tamoxifen mitigates bone loss but does prevent fractures. Suppose there a...

It depends upon the patient's risk of breast cancer recurrence. Fortunately, we have effective treatment options for osteoporosis (oral and IV bisphosphonates and denosumab), but if she develops metastatic breast cancer she has a terminal (though treatable) illness. So, in a patient with osteoporosi...