I rarely comment on this web site. I have advanced high risk PCa, treated 2022-2024 with RT, ADT and abiraterone. In late 2022 I had a DEXA scan showing osteoporesis. There were no prior scans so I can't definitively say I did or did not have it before PCa treatment.

There is zero doubt very low Testosterone leads to 5-6 fold higher BMD loss rates. If you have a pre-existing BMD loss going on due to age and biology, there is no data about how much worse that makes low T BMD loss.

My MO put me on Prolia every six months and in late 2024 my DEXA results were normal. I am not on ADT now, but my T for sure has not gone above supracastrate levels after about 1 year off ADT. It will be interesting what my 2026 DEXA scan shows. I take all the supplements that are supposed to help with BMD, exercise a lot, etc.

So for those worried about Prolia et al SE's, my understanding is they are non-fatal and very treatable. OTOH, if your body already had a prior bone loss issue (IE most of us), and you add LT ADT to the mix, you risk bad bone breaks in your 80's which have been shown to be FAR more dangerous than Prolia et al SE's. Fatal for most men in about 1 year, very painful very poor QOL for that year.

IMO the best that supplements and exercise can do for folks with low T is stabilize bone density numbers. If osteoporetic, odds are that will remain so.