Research Paper: Guidelines for screening, lifestyle, etc.

peggy_j

This research paper contains recommendation for when and how often to screen, lifestyle factors, etc. It's a consensus paper. I had posted it in the topic on bone loss in pre-meno women taking tamox, but...these guidelines can be helpful for anyone. I received this paper from my endocrinologist, the head of the UCSF Osteoporosis clinic.

Management of cancer treatment-induced bone loss in early breast and prostate cancer -- a consensus paper of the Belgian Bone Club.

http://www.ncbi.nlm.nih.gov/pubmed/17690930

(from page 1447, Specific Recommendations)

Our approach is summarized in Table 1. We recommend
that all women starting medical castration therapy or AI
therapy and all men starting ADT should be assessed for
their risk of osteoporosis and undergo BMD measurement
by DXA. Professional guidelines recommend only highrisk
breast cancer patients with T-score between −1 and
−2.5 to undergo monitoring on an annual basis for changes
in BMD. However, the prevalence of CTIBL in the setting
of adjuvant therapy for breast or prostate cancer suggests
that all patients should be monitored for bone loss.
Currently, DXA is the most reliable method for assessing
BMD [39]. The role of markers of bone resorption, such as
the cross-linked N-telopeptide of type I collagen (NTX) or
the C-telopeptide (CTX), should be investigated to assess
their ability to predict bone loss in cancer patients receiving
AIs or ADT. Bone loss increases fracture risk and has longterm
implications with respect to function and quality of
life. Despite the growing recognition of this problem
[39, 79], there are currently no therapies specifically
approved for preventing CTIBL in patients who are
receiving adjuvant therapy for breast or prostate cancer.
Since cancer therapy-associated bone loss is largely
preventable, an aggressive approach to preserve bone health
should be implemented. Attention should be paid to bone
health through lifestyle modifications including smoking
cessation, moderation of alcohol consumption and regular
weight-bearing exercise. Supplemental vitamin D (400–
800 IU per day) and supplemental calcium to maintain a
calcium intake of 1200–1500 mg per day are also recommended.
Patients with existing osteopenia and osteoporosis
should be evaluated for conditions which further deteriorate
skeletal health, such as vitamin D deficiency, hyperparathyroidism,
hyperthyroidism and hypercalciuria. Preserving
BMD should be an important part of cancer therapy and not
simply considered as supportive care when a fracture occurs.
Although available drugs for treating osteoporosis have
not been considered yet for reimbursement in the specific
indications of prevention and treatment of CTIBL, existing
professional guidelines already recommend bisphosphonate

therapy, along with annual BMD testing, only for those
subjects with T scores ≤−2.5 (or −2.0 according to the
National Osteoporosis Foundation guidelines). Treatment
for bone loss is also indicated when the patient experiences
a fragility fracture. It is unknown whether osteopenic
patients should be treated as well. Double-blind placebocontrolled
trials in osteopenic patients using monthly oral
ibandronate and weekly risedronate are ongoing. In the
meantime, we recommend that patients with T-scores
between −1 and −2.5 be considered for treatment with
bisphosphonates if other risk factor(s) for fractures are
present. Besides BMD, several risk factors for osteoporotic
fractures independent of BMD have been identified. They
include older age, a prior history of fracture, a family
history of hip fracture, previous and/or current use of
systemic corticosteroids, a low body mass index, premature
menopause, current smoking and a high intake of alcohol. It
has been proposed that the contribution of these risk factors
should be integrated to calculate a 10-year risk of fracture
probability, similarly to the absolute risk approach already
successfully applied in the management of coronary heart
disease. However, the use of multiple risk factors has to be
applied cautiously until interrelationships are determined
and validated [80]. The decision to initiate therapy must
also be based on the degree of osteopenia. We thus propose
a selective approach based on BMD and the presence of
major risk factors other than AI therapy in osteopenic
patients (Table 1). Our recommendations are in agreement
with other recently proposed guidelines [81, 82]. In women
with risk factors, Chien and Goss thus recommend to start
bisphosphonates if their T-score is −1.5 or below [82].