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CME: Preventing and mitigating skeletal-related events in breast cancer

Activity Description / Statement of Need:

In this online, self-learning activity:

Each year, more than 290,000 cases of breast cancer are diagnosed, making it the leading cause of cancer among females in the United States. Although earlier screening and more effective treatment options have improved outcomes among people with breast cancer, more than 43,000 people die from this type of cancer each year. Throughout the course of breast cancer management, bone health remains an important consideration. In early breast cancer, chemotherapy-induced ovarian failure and endocrine therapy can contribute to BMD loss and subsequent osteoporosis and fracture. In advanced breast cancer, about 70% of all patients will experience bone metastases, placing patients at risk for SREs. In fact, breast cancer is associated with the highest risk of SREs among all tumor types.

Maintaining bone health in patients with breast cancer requires routine monitoring and proactive management to minimize the risk of BMD loss, osteoporosis, and SREs. Guidelines therefore recommend that patients with non-metastatic breast cancer initiating aromatase inhibitors or other treatment that causes bone loss undergo dual-energy X-ray absorptiometry (DXA) scans to assess baseline BMD. Furthermore, patients at risk for osteoporosis should receive regular follow-up DXA scans to monitor for BMD loss. This represents an opportunity for ongoing education about the need for monitoring to ensure maintenance of optimal bone health.

Target Audience:

The following healthcare professionals: medical and radiation oncologists, primary care physicians, and endocrinologists; physician assistants, nurse practitioners, and pharmacists who treat breast cancer; and any other healthcare professionals who commonly care for patients with breast cancer.

Commercial Support Disclosure: This program is supported by an educational grant from AMGEN.

This activity is free of charge.

Release Date: October 27, 2022 -- Expiration Date: October 27, 2024

Faculty: Azeez Farooki, MD


Cursory Refresher of Breast Cancer and Bone Health

  • Epidemiology
    • Early disease
    • Advanced disease
    • Periods of highest risk for fractures and SREs
  • Importance of bone health
    • Burden of bone loss in early breast cancer
      • Osteoporosis
      • Future fractures
    • Effects of skeletal metastases
      • Pain
      • Quality of life

Guideline Recommendations for the Maintenance of Bone Health

  • Current guidelines
    • NCCN
    • ASCO
    • ESMO
  • Monitoring bone health and bone metastases
    • Whole-body MRI, CT, and PET/CT
    • Role of DXA scan
  • Preventing and/or managing bone disease
    • Treatment options
      • Bisphosphonates
      • Denosumab
    • Indications in early breast cancer
      • Osteoporosis and fracture prevention
      • Delay of bone metastases and progression
    • Indications in metastatic breast cancer
      • Delay time to SREs
      • Effect on survival
    • Safety
    • Selection of agents
      • Consideration of dosing, route of administration
      • Consideration of renal disease
  • Patient cases and clinical pearls

Summary, conclusions, and best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Describe the benefits of bone-modifying therapy for patients with early or advanced breast cancer.
  • Recall the relative efficacy and safety of presently available agents used for bone health and fracture prevention in patients with breast cancer.
  • Identify candidates for different bone-modifying therapies using the most recent guideline recommendations.
  • Using details in a patient case, recommend an appropriate pharmacotherapeutic treatment plan for the purpose of preventing SREs in patients with breast cancer.


ACCME Activity #202344315

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: ScientiaCME designates this educational activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.


ABIM MOC Recognition Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.75 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

ABIM MOC Credit Type: Medical Knowledge

Physicians: For maintenance of certification (MOC) points, you must enter your board certification ID # and birth date correctly.  It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive MOC points for this activity. By providing this data, you acknowledge that it will be shared with ACCME and the applicable certifying board. Please note: Not all activities on this site provide MOC points. If this activity does not specify that it provides MOC points in this section, then it does NOT provide MOC points. This activity provides MOC points only for ABIM.


ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 0.75 contact hours (0.075 CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. ACPE #0574-0000-22-058-H01-P. This is an Knowledge (K)-type activity. 

PharmacistsYou must enter your NABP # and birth date correctly so that proof of participation can be posted to your NABP CPE profile. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive CPE credit for this activity.

Nurse Practitioners (NPs): The American Academy of Nurse Practitioners accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME. ScientiaCME will provide NPs who successfully complete each activity with a certificate of participation indicating that the activity was designated for AMA PRA Category 1 Credit(s)™.

Physician Assistants: The American Academy of Physician Assistants accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.

Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review by ScientiaCME.

Faculty Disclosure: Azeez Farooki, MD, Memorial Sloan-Kettering Cancer Center, Division of Endocrinology, has received financial compensation for consulting work for Novartis and is a stockholder of Johnson and Johnson.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.

Faculty will NOT discuss off-label uses.

All relevant financial relationships have been mitigated.

ScientiaCME adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Commercial Support Disclosure: This program is supported by an educational grant from AMGEN.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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