Indications for screening - one or more of the following:
(1) age >= 65 years
(2) age 60 to 64 years with one or more risk factors
(2a) family history of osteoporosis
(2b) body weight < 70 kilograms
(2c) history of spontaneous or low-impact fracture
(2d) other medications or conditions associated with osteoporosis or osteomalacia)
(3) postmenopausal woman being treated with an aromatase inhibitor
(4) women receiving therapy resulting in premature menopause (ovarian castration)
Screening of bone density may consist of a DEXA scan of the hip (with or without spine) or a comparable method.
Management recommendations for all women with breast cancer:
(1) Appropriate intake of dietary calcium and vitamin D.
(2) Make lifestyle choices that promote bone health (exercise, body weight, etc).
(3) Avoiding medications associated with osteoporosis if possible.
(4) Monitor annually for risk factors affecting bone health.
Additional recommendations based on T-score if high risk
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T Score
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Recommendation
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> -1
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Repeat bone mineral density annually.
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-1 to -2.4
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Repeat bone mineral density annually. Consider drug therapy for certain high risk individuals.
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<= -2.5
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Repeat bone mineral density annually. Start a medication to increase bone density such as a bisphosphonate (alendronate, zoledronate, risedronate) or the selective estrogen receptor modulation raloxifene (ONLY if NOT taking tamoxifen or an aromatase inhibitor)
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