Osteopenia Supplements that work?

Xgeva, another brand name for denosumab (other brand name Prolia) is thought to control bone metastasis better than the bisphosphonates like zometa.

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.

The problem is that Xgeva has a higher percent of osteonecrosis of jaw than Zometa. That causes bones in the jaw to deteriorate and die. Not a real common problem, but more common with Xgeva.

I don’t know why your doctor is prescribing this, but it is not approved for use with ADT. Using a real drug like Fosamax, Xgeva or Zometa Is much better for someone on ADT.

Toremifene (Prosteon) is not currently an approved treatment for the prevention of osteoporosis or bone loss in men on ADT in many regions

GTx, Inc. submitted a New Drug Application (NDA) for toremifene (brand name Acapodene) 80 mg for fracture prevention in men on ADT. Despite positive Phase III trial results, the FDA issued a Complete Response Letter in November 2009, declining to approve it for this indication. Toremifene (brand name Fareston) is only approved in the U.S. for metastatic breast cancer in postmenopausal women.

In the European Union, toremifene (brand name Fareston) is approved for the treatment of hormone-dependent metastatic breast cancer in postmenopausal women, but not for preventing osteoporosis in men on ADT.

The same is true for Canada.

I am a retired orthopaedic surgeon who also is dealing with residual/recurrent/ongoing prostate cancer. The main things to do for osteopenia at this point are: 1) check your Vit D blood level. A surprising number of random tests show low or borderline low Vitamin D levels. 2) Take extra calcium daily. I use TUMS and take 2000-3000 mg a day. The literature varies a lot on how much to take but if you don't have a calcium problem such as calcific kidney stones, there is no danger from taking that much. 3) Make sure you put daily stress on your bones. Walking is good for the lower extremities. Pushups are good for upper extremities. If you cannot do real pushups, you can do "baby pushups" on your knees instead of on your toes. You can also work out on various machines in gyms and suit those to your abilities but do it regularly. Also stress your spine with exercises such as sit-ups, crunches, etc. Should your osteoporosis progress to the point that you experience fractures, there are drugs to reportedly increase bone mass but they work very slowly on bone mass even though the fracture rates are reported to decrease more rapidly. Best to do the 3 things above to avoid problems.

Question for the group. I've only been on ADT since 6/2025, but it appears this may be a long-term treatment. Which doctor do I push for bone density testing and follow-up? PCP, urology, radiation oncology, urologic oncology, cardiac oncology or do I need to find another doctor to add to the list?

And...thanks to the jime51 for bringing this up.

ETA: Never mind...just got an email that DXA scan has been ordered for the week after IGRT ends.

Question for the group. I've only been on ADT since 6/2025, but it appears this may be a long-term treatment. Which doctor do I push for bone density testing and follow-up? PCP, urology, radiation oncology, urologic oncology, cardiac oncology or do I need to find another doctor to add to the list?

And...thanks to the jime51 for bringing this up.

ETA: Never mind...just got an email that DXA scan has been ordered for the week after IGRT ends.