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CME: Oncology Patients at High Risk of Bone Fracture: Advances in Pharmacotherapy


Activity Description / Statement of Need:

In this online CME self-learning program:


The use of androgen deprivation therapy for prostate cancer has greatly increased in the last 15 years because statistics have shown it has about a 25% better 10 year mortality outcome when compared to observation alone. It has been associated with reductions in morbidity and metastases and increased survival rates when combined with radiation both in more advanced stages of the disease and in disease confined to the prostate. Adjuvant aromatase inhibitor (AI) therapy is a common treatment in postmenopausal women with hormone receptor positive breast cancer. Bone fractures are of particular concern in these patents, given their association with increased mortality in prostate cancer and breast cancer patients. Studies have shown that about 19.4% of men who received androgen deprivation therapy experienced a fracture, and 5.2% of them required hospitalization.


Patients taking AIs or androgen deprivation therapy have benefited from vitamin D, calcium, and bisphosphonate therapy. Denosumab, used in patients receiving AIs has been shown to significantly increase lumbar spine BMD by 7.6% from baseline versus placebo.Increases were observed as early as 1 month from beginning of therapy and were not influenced by duration of AI therapy.Increases in BMD can also be seen in the hip, total body, and femoral neck.




Faculty introduction, disclosures

Introduction content: cursory refresher and review of oncology patients at high risk of bone fracture [Learning objective #1]

  • Epidemiology
  • Defining clinical features
  • Risk factors
  • Statistics
  • Guidance on screening criteria in oncology patients at high risk of bone fracture
  • Patient cases

Treatment options [Learning objectives #2, 3, 4, & 5]

  • Goal of treatments
    • A review of present pharmacotherapy; the roles of:
    • RANKL inhibitors
    • Bisphosphonates
    • Barriers to optimal care in oncology patients at high risk of bone fracture

Summary, conclusions, and best practice recap

Target Audience:

The following healthcare professionals: oncologists, primary care physicians, and endocrinologists; physician assistants, nurse practitioners, nurses, and pharmacists who practice in oncology, endocrinology and internal medicine; and any other healthcare professionals who commonly care for patients with breast cancer or prostate cancer.

This program is supported by educational grants from AMGEN.

Release Date: November 17, 2017 -- Expiration Date: November 17, 2019

Faculty: Azeez Farooki, MD


Learning Objectives

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

  • Apply screening criteria to a patient receiving AI therapy or androgen deprivation therapy
  • Describe the criteria for initiation of pharmacotherapy in a patient receiving aromatase inhibitor (AI) therapy or androgen deprivation therapy and apply them to a patient case
  • Identify present pharmacotherapeutic treatments for management of a patient receiving AI therapy or androgen deprivation therapy, and describe their mechanisms of action and place in therapy
  • Describe the challenges associated with treating patients receiving AI or androgen deprivation therapies, focus specifically on the risks (e.g., adverse drug reactions, drug interactions, et cetera) of the agents and apply the information in optimizing patient care in a patient case



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 ScientiaCME.


Faculty Disclosure:  Dr. Azeez Farooki, MD, Associate Clinical Member Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, New York  has worked as a consultant for Amgen.

Disclosures of Peer Reviewer: Brooke Crawford, MD has no relevant financial disclosures.

Disclosures of Peer Reviewer: Eric Goldberg, MD has no relevant financial disclosures.

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


Commercial Support Disclosure: This program is supported by educational grants 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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