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Recommendation
Bone mineral density assessment
Consider imaging with dual energy x-ray (DEXA) to measure bone mineral density in patients with breast cancer treated with chemotherapy and/or endocrine therapy.
It is recommended that primary care clinicians
(a) should refer post‐menopausal breast cancer survivors for a baseline DEXA scan (Level of evidence = 0); and
(b) should refer for repeat DEXA scans every 2 y for women taking an aromatase inhibitor, premenopausal women taking tamoxifen and/or a GnRH agonist, and women who have chemotherapy‐induced, premature menopause (Level of evidence = 0).
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How this guidance was developed
This recommendation was adapted from the ACS/ASCO 2016 guidelines (US). The source recommendation was based on a systematic review of the evidence conducted to April 2015 and was not graded by the source guideline authors. The source recommendation was simplified by removing details of the treatment regimens, and by making the recommendation less directive by replacing ‘refer’ to ‘consider’ as a DEXA scan is not recommended for all patients treated with chemotherapy and/or endocrine therapy and to reflect the Australian health care context (MBS items). This recommendation was also informed by several other source recommendations on this topic across guidelines, noting inconsistency across guidelines as to who should have the scans and the frequency of scans. An algorithm for determining who should receive a DEXA, as referred to by NICE and several other guidelines, is noted.
Related guidance by topic
Bone mineral density assessment
Recommendation
Consider imaging with dual energy x-ray (DEXA) to measure bone mineral density in patients with breast cancer treated with chemotherapy and/or endocrine therapy.
Principles in action
Discuss out of pocket costs
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Supportive care
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Care coordination
Useful Links
This recommendation was adapted from the ACS/ASCO 2016 guidelines (US). The source recommendation was based on a systematic review of the evidence conducted to April 2015 and was not graded by the source guideline authors. The source recommendation was simplified by removing details of the treatment regimens, and by making the recommendation less directive by replacing ‘refer’ to ‘consider’ as a DEXA scan is not recommended for all patients treated with chemotherapy and/or endocrine therapy and to reflect the Australian health care context (MBS items). This recommendation was also informed by several other source recommendations on this topic across guidelines, noting inconsistency across guidelines as to who should have the scans and the frequency of scans. An algorithm for determining who should receive a DEXA, as referred to by NICE and several other guidelines, is noted.
Related guidance by topic
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