when do I need a bone density test?

Good question. I think with women with BC, they typically do a DEXA scan prior to starting AIs so you have a baseline there. Here are some guidelines from this website (I'm sorry, I don't know how reputable this site is) 

 http://www.medicinenet.com/script/main/art.asp?articlekey=41585

 In premenopausal women, estrogen produced in the body maintains bone density. Following the onset of menopause, bone loss increases each year and can result in a total loss of 25%-30% of bone density in the first five to ten years after menopause. Your doctor can help you decide when and if you need a bone density test. In general, this testing is recommended for women 65 and older along with younger postmenopausal women who have further risk factors for osteoporosis, including:

A history of bone fractures as an adult or having a close relative with a history of bone fractures
Smoking
Vitamin D deficiency, which can occur as a result of certain medical conditions
Excessive alcohol or caffeine consumption
Weight loss or low body weight; small-boned body frame
Early menopause or late onset of menstrual periods
Physical inactivity
Taking a medication [such as prednisone or phenytoin, (Dilantin)] known to cause bone loss
Low estrogen levels
Hyperparathyroidism
Hyperthyroidism

(end of website info) 

As someone posted elsewhere, DEXA scans emit some radiation but much less than a chest Xray and are generally not recommended more than once every two years. FWIW, my ONC's attitude towards all tests is "what will we do differently based on the results of this test?" If the answer is to tweak your diet or exercise, one option is to do that anyway. (though if you're asking, you probably are already taking some of those steps). But just an FYI that everyone has a different opinion on the value of getting a "baseline" measurement.

I had a baseline bone density about 6 or 7 years ago and just had a repeat at the begining of this month and now have to see my GP to talk about results.  My first one before BC was good.  It scares me a bit.  I know that the treatments we've had are hard on the bones.  It won't hurt to have one.

I got a baseline DEXA when I entered menopause.  I had osteopenia, so a follow up every 2 years.   I had a series of them when I was diagnosed with BC.   The dexa a year after treatment still showed osteopenia.

It would be a good idea to get a baseline DEXA scan.  At the local BC survivor conference a gynecology professor from Hopkins told us that tamoxifen is associated with bone loss in premenopausal women.

Follow cyclepath's advice about getting the DEXA scan in the same facility.  The facility I use provides a report that shows the previous results tht makes trends easier to spot.  It also ended up doing conversions for earlier scans on equipment that reported results differently. 

Take care,

Meg 

Get a baseline.   Then get another one every year.   You need to keep close tabls on your bone density while on hormonal therapy.   It's a cheap, non-invasive test.   There is no reason to not get it.

lalisa wrote:

 my Gyn is more of a worrier, always wanting tests, but then the tests seem to lead to more questions rather than answers.

I hear you. It's frustrating and stressful. I just went through this (pelvic bloating->US->uterine biopsy). When the tests show anything unusual they want to order more tests. Stressful.

One advantage of getting a baseline now is that you can measure your rate of change, which is important. FWIW, I asked for a DEXA scan prior to any Tx (I have a rare bone disease that makes me prone to osteoperosis and wanted to make sure there wouldn't be a problem with rads). In my case, my hips are slightly osteopenic, and my spine is slightly better than avg for my age. I consulted with the head of an osteoposis clinic and he wasn't that concerned, said everyone's anatomy is different so it could just be that I was born this way. He reviewed and tweaked my diet/supplements/exercise which is typically the most "treatment" they do prior to a Dx of osteoporosis. (I posted his comments in a separate thread below, if you're curious)

Fearless_One wrote:

Get a baseline.   Then get another one every year.   You need to keep close tabls on your bone density while on hormonal therapy.   It's a cheap, non-invasive test.   There is no reason to not get it.

I believe the standard recommendation is once every two years. I had considered getting them once a year but both my MO and endocrinologist pointed out that there is some radiation exposure and recommend getting another in two years to see where I stand then. I don't believe it's standard treatment to get them every year unless a problem is seen.

I am 65 and dx this year at the start with stage IV.My gyn ordered bone density test for me,then I got dx of stage IV,and asked onc about it. She said maybe later. Let the gyn know and she agreed

Told to start vit d and calcium at time of dx. Vit d level in normal range at the start,which I thought was odd since I live in northeast,and NEVER go in the sun.But I do drink a vit d fortified milk daily

cycle-path ~ I heard that as well.  Bone density is slow to change, and it is the rate of loss that is important.  That's why I wanted to get the baseline being on Tamoxifen and facing possible AI's/ovarian suppression in another 5 years.

I have yearly Dexa scans,

My baseline showed osteopenia, this was six months without a period due to chemo aged 40.

1 yr follow up after being on Arimidex showed 11% decrease in BMD now osteoporosis, stopped Arimidex commenced 6 monthly Zometa, period also returned, not on hormone therapy.

Dexa at 2 yr mark showed no change still osteoporosis.

My Onc described my rapid BMD loss as alarming on the AI and despite the zometa, being premenopausal and exercising a lot it's going to take a long time to see an increase.

rgiuff, You could probably use your DEXA from three years ago as a baseline, if you don't mind just using a ballpark figure.  It should be close enough.  Tamox. bone loss or bone gain is not a huge percentage either way.  Definitely get one again after a year or two on an AI.  My reasoning stems from this type of info. I have read:

ATAC Trial

As an FYI, I was at my GYNO's office today. There was a chart with recommended tests. They recommend a baseline DEXA scan at 65.  Much too late, I believe, for anyone going through BC Tx that could impact our bones. But my guess is that these bone issues may not be on the radar for many of the docs, so it's up to us to ask for them.

My onc ordered baseline DEXA when I finished chemo and started AI's (I was 50)...as long as I was on AI's, I had DEXA annually....when I stopped AI's it went to every other year....I just had one last month....first in 2 1/4 years and my spine decline 7% and 13% in 5+ years since baseline...I haven't been on AI's for 2 years....and I stopped my Actonel when I stopped AI's....bad choice....I need to talk to my PCP and go back on something since I am now osteoporosis......and no side effects...so don't wait to you see side effects to have a DEXA....I've had mine done at the same place....I think I've had 5 now....not sure if I'll go back to annual since the decline or every other year....I started seeing a "BHRT" doc and she put me on 10,000IU Vit D per day....plus calcium, magnesium and Vit K plus an assortment of other vits and supplements...