# Bone health on aromatase inhibitors, ovarian suppression and androgen deprivation therapy

Source: https://onco.cc/protocols/bone-health-on-hormone-therapy/  
OnCo record `bone-health-on-hormone-therapy` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Some hormone treatments for breast and prostate cancer thin the bones and raise the chance of a fracture. When you start an aromatase inhibitor or treatment that stops the ovaries working, a bone density scan is offered; on prostate hormone therapy your fracture risk may be checked. Exercise, a good diet and not smoking help, and bone-strengthening medicine is offered if the bones are thin.

## Summary

Aromatase inhibitors, treatment-induced menopause, ovarian suppression and androgen deprivation therapy (ADT) accelerate bone loss. NICE NG101 offers a baseline DEXA scan to women with invasive breast cancer not receiving adjuvant bisphosphonates who start an aromatase inhibitor, have treatment-induced menopause or start ovarian suppression, and not to those on tamoxifen alone; bisphosphonates are offered to those identified by the 2008 UK expert group algorithms. Men with breast cancer starting testicular suppression with an aromatase inhibitor also have bone density assessed (NG101, 2025). Separately, adjuvant bisphosphonates for postmenopausal women with node-positive disease are offered to reduce recurrence, and also protect bone.

For prostate cancer on ADT, NICE NG131 advises against routine bisphosphonates to prevent osteoporosis, suggests considering fracture risk assessment in line with NICE's osteoporosis guidance, offers bisphosphonates to those with osteoporosis and suggests denosumab if bisphosphonates are not suitable. ASCO (2019) asks clinicians to assess fracture risk with established tools, to measure bone density where the risk is substantial, to advise nutrition, exercise and lifestyle for everyone, and, where a drug is needed, to use bisphosphonates or denosumab at osteoporosis doses. Before starting a bone-modifying drug, see the protocol on dental assessment and jaw osteonecrosis.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: bone density scan on aromatase inhibitor; DEXA on hormone therapy; cancer treatment-induced bone loss; osteoporosis on androgen deprivation therapy; bone protection on letrozole or anastrozole
- Tags: protocol; bone-health; survivorship

## Connected records

- drugs: [Anastrozole](https://onco.cc/drugs/anastrozole/), [Denosumab](https://onco.cc/drugs/denosumab/), [Exemestane](https://onco.cc/drugs/exemestane/), [Goserelin / leuprolide (ovarian function suppression)](https://onco.cc/drugs/goserelin/), [Letrozole (and other aromatase inhibitors)](https://onco.cc/drugs/letrozole/), [Zoledronic acid](https://onco.cc/drugs/zoledronic-acid/)
- cancers: [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Androgen deprivation & AR pathway inhibitors](https://onco.cc/technologies/androgen-deprivation/), [Bone-modifying agents (bisphosphonates, denosumab)](https://onco.cc/technologies/bone-modifying-agents/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/)
- terms: [Androgen deprivation therapy (ADT)](https://onco.cc/terms/adt/), [Aromatase inhibitor](https://onco.cc/terms/aromatase-inhibitor/), [Treatment-induced bone loss](https://onco.cc/terms/treatment-induced-bone-loss/)
- protocols: [Hot flushes on breast cancer endocrine therapy and prostate cancer hormone therapy: non-hormonal options](https://onco.cc/protocols/hot-flushes-on-endocrine-therapy-non-hormonal-options/)

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