Fig. 2.

Proposed therapeutic approach to cancer patients with bone loss induced by hormone deprivation therapy. Non-pharmacological measures include the following: regular exercise, calcium 1200 mg/day and vitamin D 800–1000 IU/day or supplements to reach 25(OH)Vit D levels > 50–75 nmol/L (20–30 ng/ml,) if necessary, smoking and alcohol cessation and training to avoid falls. Pharmacological measures are indicated when T-score < -1.5 or < -2 depending on the number of aforementioned clinical risk factors and clinical guideline followed. In addition, dorsolumbar X-ray may be necessary if axial pain appears or a vertebral fracture is suspected. Pharmacological treatment is mandatory in any of the three scenarios mentioned if a prevalent major osteoporotic fracture is confirmed. DXA dual energy X-ray absorptiometry, FRAX Fracture Risk Assessment Tool, MOF major osteoporotic fracture, yrs years