These guidelines are kindly supplied by the West Anglia Cancer Network and are a guideline to standard practice - They are likely to differ from hospital to hospital or between individual oncologist and the circumstances of individual patients but are illustrated here as an example of typical recommendations for patients taking aromatase inhibitor drugs in the UK. All patients taking aromatase inhibitors should be given lifestyle advice on exercise, smoking and diet.

Baseline DEXA scanning - Indications

Post menopausal taking an Aromatase Inhibitor (anastrazole, letrozole, exemestane) 

 Postmenopausal women who have received chemotherapy not on tamoxifen.

Pre-menopausal women who are taking tamoxifen.

Premature menopause (<45 years)

Premature menopause induced by Zoladex, chemotherapy or oophorectomy.

Co-morbidities long term steroids, hypothyroidism, chronic renal failure.

Men taking long term Zoladex

Having a dexa scan

A DEXA scan is a painless test that measures the density of bones. DEXA stands for dual energy x-rays absorptiometry. There are two different types of DEXA scanning devices, central and peripheral. Central DEXA devices are large machines that can measure bone density in the centre of your skeleton, such as your hip and spine. Peripheral DEXA devices are smaller, portable machines that are used to measure bone density on the periphery of your skeleton, such as your wrist, heel or finger.

During a DEXA scan, you will be asked to lie on your back on a couch and to keep still while the scan is being taken. The scan usually takes between 10 and 20 minutes, depending on which part of your body is being examined, and whether a central or peripheral scanner is being used.

In order to check for osteoporosis, the doctor commonly scans the lower back bones (vertebrae) and hips. The forearm may also be scanned, because it has a different level of calcium content from other body parts.

No preparation for the test is required and, depending on which part of your body is being scanned, you may be able to remain fully dressed, in clothes without metal fastenings. It is a painless procedure and you can go straight home afterwards.

The information from the scanner is sent to a computer which calculates a score for the density of your bone. A low score indicates that the bone is less dense than it should be, and is more likely to break. If a DEXA scan shows that you have osteoporosis, you may be given advice and treatment to help strengthen your bones.

  * Z score (age adjusted) if < -2 refer patient to endocrine physician to investigate for endocrine abnormalities.

Other comments:-

·       Oral Bisphosphonate prescribing; eg Risedronate 35mg or Aledronate 70mg PO once weekly. Always co-prescribe a calcium/vitamin D supplement such as Adacal-D₃ one per day.

·       Weekly bisphosphonate dosing is effective, better tolerated than daily (avoids daily insult to oesophagus) with better compliance. 

·       Dosing instructions are critical and should be reinforced at follow-up visit: take first thing in the morning, follow by drink of water, sit upright for 30 minutes, do not take lying down and do not eat or drink for 30 minutes after taking the tablet.. 

·       DEXA response to bisphosphonates is virtually universal (failure of response is a sign of non-compliance), so no need to rescan until end of five year course (more valuable to spend time ensuring compliance at each follow up visit).

·       Bisphosphonates are absolutely contraindicated in pregnancy so make sure younger patients are aware of this and taking appropriate precautions, even if apparently menopausal. A 6 month washout period is needed after risedronate if attempting to conceive (which is the same as the recommended tamoxifen washout period).

·       Patients who cannot tolerate oral bisphosphonates and have T scores less than -2.5 should be given monthly pamidronate infusions for five years.  Other intravenous preparations as they become licensed may become preferable. 

Patients who have moderate to severe renal failure should only take Bonefos only under strict supervision. Care should be taken with Bonefos if it is taken with non-steroidal anti-inflammatory drugs.

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.