American Board of Internal Medicine (ABIM) Certification Practice Exam

What is used to reduce skeletal-related events in patients with bone metastases?

1. Zoledronic acid infused every three months

2. Calcium supplements taken daily

3. Radiation therapy once a month

4. Denosumab injections monthly

The correct answer is: Zoledronic acid infused every three months

Zoledronic acid is a bisphosphonate that has been shown to significantly reduce skeletal-related events in patients with bone metastases, such as pathologic fractures, spinal cord compression, and the need for radiation or surgery to the bone. The infusion every three months is a standard dosing schedule that has been proven effective in clinical studies for managing skeletal complications associated with various cancers that metastasize to bone, including breast cancer and prostate cancer. By inhibiting osteoclastic activity, zoledronic acid helps to stabilize bone resorption, thus minimizing the likelihood of these detrimental skeletal events. Calcium supplements, while important for overall bone health, do not directly address the prevention of skeletal-related events in patients with active bone metastatic disease. They are usually part of general management but are insufficient on their own in this context. Radiation therapy is effective for palliating pain caused by bone metastases and can address specific areas of bone involvement, but it does not have the same widespread preventive effect on skeletal-related events as zoledronic acid. Denosumab is also a medication used to prevent skeletal-related events and is effective in many cases, but it is administered monthly, which means that in this specific question, the context suggests that the less frequent dosing of