American Board of Internal Medicine (ABIM) Certification Practice Exam

What monitoring is recommended for patients taking aromatase inhibitors?

1. Chest X-ray

2. Bone density

3. Liver function tests

4. Cardiac stress tests

The correct answer is: Bone density

The recommendation for monitoring bone density in patients taking aromatase inhibitors stems from the well-documented adverse effects these medications can have on bone health. Aromatase inhibitors, commonly used in hormone receptor-positive breast cancer treatment, lead to decreased estrogen levels. Since estrogen plays a crucial role in maintaining bone density, the reduction in estrogen caused by aromatase inhibitors can increase the risk of osteoporosis and bone fractures. Monitoring bone density is particularly important in patients who may already be at risk due to age, prior steroid use, or other risk factors for osteoporosis. Regular bone density assessments allow for early identification of bone loss, enabling timely intervention with lifestyle modifications or pharmacological treatments such as bisphosphonates or other osteoporosis-preventive strategies. While other monitoring approaches, like liver function tests and cardiac stress tests, might be relevant in different clinical contexts, they are not specifically indicated for patients on aromatase inhibitors. Chest X-rays generally have no direct connection to the monitoring needs associated with aromatase inhibitor therapy. Therefore, regular monitoring of bone density is the recommended practice in this scenario to maintain bone health and minimize the risk of complications.