Treatment algorithms proposed by the Expert Group
The choice of endocrine therapy should be based on the characteristics and prognosis of the underlying breast cancer, rather than pre-existing bone health, provided that appropriate monitoring and treatment of bone loss can be ensured.
Two algorithms for the management of bone loss in early breast cancer are proposed.
Algorithm 1: Women who experience premature menopause due to chemotherapy or ovarian suppression, ablation or removal.
Algorithm 2: Postmenopausal women receiving treatment with aromatase inhibitors.
There are no specific monitoring or treatment requirements for:
• women who continue to menstruate after treatment for early
breast cancer; or
• postmenopausal women above 45 years of age who do not require endocrine treatment or who are receiving tamoxifen therapy.
Any patient, regardless of age, with a baseline T-score of <–2 should be assessed for other causes of osteoporosis, based on erythrocyte sedimentation rate (ESR), full blood count (FBC), bone and liver function tests (calcium, phosphate, alkaline phosphatase, albumin, aspartate aminotransferase [AST] / γ-glutamyl transferase [γGT]), serum creatinine and thyroid function tests, and the serum protein electrophoretic strip.
The choice of endocrine therapy should be based on the characteristics and prognosis of the underlying breast cancer, rather than pre-existing bone health, provided that appropriate monitoring and treatment of bone loss can be ensured.
Two algorithms for the management of bone loss in early breast cancer are proposed.
Algorithm 1: Women who experience premature menopause due to chemotherapy or ovarian suppression, ablation or removal.
Algorithm 2: Postmenopausal women receiving treatment with aromatase inhibitors.
There are no specific monitoring or treatment requirements for:
• women who continue to menstruate after treatment for early
breast cancer; or
• postmenopausal women above 45 years of age who do not require endocrine treatment or who are receiving tamoxifen therapy.
Any patient, regardless of age, with a baseline T-score of <–2 should be assessed for other causes of osteoporosis, based on erythrocyte sedimentation rate (ESR), full blood count (FBC), bone and liver function tests (calcium, phosphate, alkaline phosphatase, albumin, aspartate aminotransferase [AST] / γ-glutamyl transferase [γGT]), serum creatinine and thyroid function tests, and the serum protein electrophoretic strip.
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