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. Author manuscript; available in PMC: 2011 Mar 2.
Published in final edited form as: J Natl Compr Canc Netw. 2009 Jun;7(Suppl 3):S1–S35. doi: 10.6004/jnccn.2009.0076

Figure 2.

Figure 2

Algorithm for management of bone health of cancer patients in the United States.

Abbreviations: 25(OH), serum hydroxy; BMD, bone mineral density; DEXA, dual-energy x-ray absorptiometry; FRAX™, Fracture Risk Assessment Algorithm.

*See section on “Screening and Detection of Osteoporosis” for FRAX™ algorithm.

†See section on “Update on Treatment Options for Osteoporosis” for lifestyle modifications and calcium and vitamin D repletion.

‡See section on “Update on Treatment Options for Osteoporosis” to correct vitamin D deficiency.

§In selected cases, longer or shorter intervals may be considered. If a major change in patient risk factors or a major intervention occurs, repeating DEXA scan at one year is reasonable.

Note: In addition to monitoring changes in BMD, the oncologist should obtain a lateral thoracic and lumbar x-ray of the spine to determine if vertebral compression deformities are present if there is: 1) a historical height loss > 4 cm (1.6 in) or a prospective height loss > 2 cm (0.8 in), or 2) complaint of acute back pain. Consider referral to a bone health specialist if loss of vertebral height > 20% is present.