For pt with osteopenia and frax score less than 20%, or hip fracture risk less than 3% do we need to do bisphosphonates / denosumab in breast cancer pt on aromatase inhibitor? How do you approach this on osteopenia on pt on aromatase inhibitor?
I typically treat patients with more severe osteopenia (e.g. T< 2.0) with bisphosphonates or denosumab when they are on aromatase inhibitor. Likelihood of progressing to osteoporosis if mild osteopenia (T-1-2) is low. Also use BTAs if high risk disease as there is evidence of an antirelapse effect in postmenopausal patients receiving adjunctive bone agents.
Also, do you absolutely need dental clearance for once yearly dose of zoledronic acid?
I don't worry about that. Unless the patient is having active teeth issues, and/or requires extraction or root canal treatments within a short time, I see no need to get clearance. The risk of ONJ from yearly or Q 6 month bisphosphonate/denosumab is exceedingly low.
