Has your doctor suggested dosing for Calcium and Vitamin D during ADT?

This is a problem. Your doctor should not only know that you’re supposed to be on calcium, but they should be directing you to be on calcium.

If they are not then it sounds like they are not a GU Oncologist they’re just a medical oncologist and don’t keep up with what is supposed to be done.

I would completely question my medical team if this was left out of the instructions. It might make sense to go somewhere else, so that you have the proper expertise directing your prostate cancer treatment.

You should ask your doctor why this was not recommended when it is a standard for the industry

Thank you.

I don't remember when I started the calcium.

I was told to split the dose to twice a day. I was taking Citracal. Now I get a sort of equivalent from the VA - 315 mg calcium citrate, 200 unit D - 2 of these, twice a day.

I've wondered about the bone strengtheners (the anabolic treatments - not to be confused with anabolic steroids).

A friend who has a different cancer and is taking heavy duty infusions for it gets one of those, I think.

I will ask about all of this when I get a consult. Meanwhile, I'll try spreading the four pills across three times a day, as you suggest.

Costco sells calcium citrate With magnesium and vitamin D. They are 250 mg pills of calcium. Of course, if you get them free from the VA keep doing it.

Bone strengtheners like Zometa (zoledronic acid) and Fosamax (alendronate) are not anabolic. They belong to a class of drugs called bisphosphonates and work by an antiresorptive mechanism, meaning they slow or stop the breakdown of existing bone.

Thanks Jeff, I have an appointment on Monday and will definitely bring this up. My MO specializes in GU and she keeps up with all the latest info, and she is the Dr that prescribed my ADT. So yeah, kinda strange. I’ll let you know what she says.

My oncologist prescribed 1200 mg calcium and 125 mcg D3 daily and 70 mg Alendronate Sodium once a week. You lose both bone and muscle when your testosterone goes down (the point of ADT) and your red blood cell count also drops. EXERCISE!!!!

Thanks for reminding us of the 500mg absorption limit. Is there are reason or benefit for taking calcium citrate as opposed to calcium carbonate? And thanks for the reminder of bone strengtheners. Given my BCR, I'm bracing myself for the eventual ADT.

I have a pharmacist specialist that calls me every six months from my medical team. The first thing she told me was stop taking the calcium I was taking and start taking calcium citrate. It works much better with the drugs we are on.

Now for some technical reasons.

Calcium citrate's main benefits over other forms, like calcium carbonate, are its better absorption regardless of stomach acid levels (making it ideal for older adults or those on certain medications) and its inability to increase kidney stone risk. It is also absorbed well with or without food and may be less likely to cause gastrointestinal side effects like gas and bloating.

Here is a link to more information
https://ods.od.nih.gov/factsheets/Calcium-Consumer/#:~:text=Check%20the%20Supplement%20Facts%20label,form%20of%20calcium%20you%20take.

My 69 yo husband just started calcium citrate (helps absorption) and D3; next blood test will show if normal range of Ca. His first radiation/hormone is this week (prostatectomy 4 years ago) He will also start resistance/weight/balance training this week to retain bone density. Deossification can result from the hormone treatment as he goes through manopause. He has to stop his daily multivitamin because some of the ingredients decrease the efficacy of treatment. He started Cialis to increase blood flow down there; I read one research paper that ED meds weren't effective for decreasing damage from radiation, however the study was limited. Most damage is due to scarring and hypoxia (less O2) so it seems logical if you increase blood flow and oxygen that at least the hypoxia might be lessened. BTW, if someone has osteoporosis from hormone treatment there are a number of ways to stop/reverse that (ben there, done that).

The question is, how much (if any) supplemental Vitamin D is needed?

I guessed a good starting point was 1000 IU of vitamin D3 every other day. And a multivitamin in between D days.

Luckily I made a good guess...

After a few months of supplemental vitamin D, my blood test was 42 (20-50 is normal).

And I continued the supplemental vitamin D for the year I was on ADT (Orgovyx).

Unfortunately, vitamin D is not routinely included in my blood tests. So I had to specially request it.

Caution: Do not mega-dose vitamin D or you risk toxic side effects.

After my RARP & on ADT, my bone density fell to just over the osteopenia line. My doctor recommended calcium supplements, but since I like milk, I now drink 24oz of low-fat milk daily, & that raised my bone density just enough to come back over the line to normal.

Your mileage may vary.