From the Guidelines
Yes, a bone density scan can be performed during chemotherapy and radiation therapy, but it is generally recommended to wait until after treatment is completed, typically 2 or more years after therapy, due to the potential harms from radiation exposure and the cost of the scan 1.
Key Considerations
- The decision to perform a bone density scan during chemotherapy and radiation therapy should be made on a case-by-case basis, taking into account the individual's risk factors and medical history 1.
- Radiation therapy, particularly to the brain or spinal cord, can increase the risk of weak bones and fractures, making bone density screening important for long-term follow-up 1.
- Chemotherapy and hormonal deprivation can also negatively affect bone health, increasing the risk of bone loss and fractures 1.
Radiation Exposure
- The radiation dose from a single bone density scan is considered negligible, but cumulative radiation exposure from multiple scans and cancer treatments should be taken into account 1.
Cost and Insurance
- The cost of a bone density scan may not be covered by health insurance, but a letter of medical necessity from a healthcare provider can help justify the expense 1.
Timing of Scan
- Bone mineral density screening is recommended at entry into long-term follow-up, typically 2 or more years after completion of therapy, and at 25 years of age for individuals treated with radiotherapy to the brain or spinal cord, or total body irradiation 1.
From the Research
Bone Density Scans During Chemotherapy and Radiation Therapy
- Bone density scans can be performed during chemotherapy and radiation therapy to monitor bone loss, which is a common side effect of these treatments 2, 3, 4, 5.
- Studies have shown that chemotherapy and radiation therapy can cause significant bone loss in patients with cancer, particularly in those with gynecologic cancer 3, 4, 5.
- The use of diagnostic computed tomography scans and dual-energy x-ray absorptiometry scans can help measure volumetric bone mineral density (vBMD) and areal bone mineral density (BMD) in patients undergoing chemotherapy and radiation therapy 3, 4, 5.
- Research suggests that bone loss can occur immediately after treatment and may persist or worsen over time, highlighting the importance of pre- and post-treatment monitoring of bone loss in these patients 3, 4, 5.
- However, one study found no significant change in vertebral bone density attributable to radiation treatment, suggesting that increased fracture rates after radiation may be due to factors other than bone density 6.
Monitoring Bone Loss
- Regular bone density screenings are recommended for patients undergoing chemotherapy and radiation therapy to monitor bone loss and prevent or minimize its effects 2, 3, 4, 5.
- Agents such as denosumab and bisphosphonates may be effective in preventing chemotherapy- and radiotherapy-induced bone loss in cancer patients 2.
- Treatment and patient-related factors other than radiation therapy may contribute to declines in bone mineral density after treatment for cervical cancer, highlighting the need for routine bone density screening and post-radiation therapy with hormones in selected patients 4.