Osteopenia Supplements that work?

I believe there is a lot of variation in what happens to individuals taking vitamin D-3 supplements. Some take daily doses of 2000 IUs, others take 5000 IUs while some - in admittedly rare occurrences - take 10,000 IUs.

The only way to really know is to have a blood test to check on your vitamin D level. I believe LabCorp will perform this test for $50 to $75. The goal is to obtain a "healthy" level measured in units of nanograms per milliliter (ng/mL).

Example: I take 5000 IUs daily and my vitamin D level is 60 ng/mL. But I also have a friend at my health club who takes 2000 IUs daily. His vitamin D level is slightly higher at 65 ng/mL.

As mentioned in another post on hormone blocking therapy bone health, I have collected advice primarily from Nurses (PAs, RNs, APNs). Doctors have rarely focused discussions with me on non-medicine bone issues unless directly asked.

First: Vitamins:
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1. Calcium Citrate (not carbonate)
2. Magnesium Glycinate
3. Vitamin D3

The amounts of these vitamins varies; there are many opinions. I'd suggest starting with a good (mostly vegetable) diet, looking at the the recommend amounts from the bottle labels, asking your nurses or doctors for more detailed advice, and looking at this web site. Opinions vary; bodies vary, results vary.

Second: MOVE:
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Exercise your bones with weights, floor exercises, FAST walking (especially up and down hills). It helps to have a willing partner for walking because on rainy, hot, or cold days having a scheduled walk with a partner helps one to get moving. BUT, don't walk on snow and ice; falls for people like us are dangerous.

As always YMMV (your mileage may vary). But if ever there was a time to focus, do smart things, and move, it is NOW.

@rlplaut
Unfortunately, this is not enough if you are on ADT. You really need to get bones strengthen ears like Fosamax, Xgeva or Zometa To have long-term bone strength.

This was not my opinion a bone doctor that is a prostate cancer specialist Send this at a conference about six months ago. He was pretty emphatic about the fact that people need those drugs to keep their bones healthy while on ADT.

What you have outlined helps but is not enough.

@jeffmarc Hi Jeff, these are forms of bisphosphonate drugs. If your DEXA scan shows you have osteoporosis, then perhaps they are appropriate.

If not (scan shows Osteopenia or better) then it’s safer to focus on vitamins and exercise and diet.

Bisphophonates are very strong drugs with some “interesting” side effects. Goggle is a valuable tool here.

Doctors like writing scripts for these drugs and they may be right for your specific condition, but get that DEXA scan first and then be an informed patient.

@rlplaut Same experience here. I didn't have a bone-density scan 4 years ago because I was in medical crisis and they were focused on saving my life and mobility, but earlier this year my oncologist noted the gap and ordered a baseline. At the time, I wa 3½ years into ADT+Apalutamide, 18 months of which I'd spent with extremely limited mobility (starting out immobile in a hospital bed).

The scan showed only very mild osteopenia, only a little worse than you'd expect for an average 60-year-old male without prostate cancer and a serious spinal injury, so, as you mentioned, he saw no point adding more polypharmacy complications to my life.

We'll do a follow-up scan in a couple more years and see if it has changed at all then. If it gets worse, then yes, bone-strengthening meds may be in my future.

@rlplaut
As I said, this was not my advice

This was not my opinion a bone doctor that is a prostate cancer specialist said this at a conference about six months ago. He was pretty emphatic about the fact that people need those drugs to keep their bones healthy while on ADT.

ADT can very quickly, deteriorate your bones, That’s why the doctor said this.

I was on Fosamax for six years, Had no real side effects from it, but it did make my bones a lot stronger. I am on Zometa now, Had infusions every three months for about the last year and a half. Never had any side effects from it at all

@jeffmarc I agree that bone-density loss is a serious risk for all of us on ADT and requires some kind of proactive approach, but I wonder if that doctor's perception of it also owes something to selection bias.

As an orthopedist rather than an oncologist, he'll see mainly the cases where prostate-cancer patients on ADT *are* having serious bone-density issues (especially those who are relatively elderly and inactive); the ones who are doing better would be less likely to show up in his office.

@jeffmarc Hi Jeff, Thank you for the good news about your experience with Fosamax. If my upcomming DEXA shows osteoporosis and I need to go with a bisphosphonate, your input will be important to me.

@rlplaut
You don’t wanna wait for osteoporosis. If you get a report of osteopenia, then you need to get on a bone strengthening drug.

Many common medications can deplete bone mineral other than ADT. Proton pump inhibitors , for example, are offenders. I was diagnosed with osteoporosis on a bone density DEXA scan nearly 2 years ago and have been on a bisphosphonate since. I take Caltrate/D once daily and Vitamin D2 2000 IU daily (as well as occasional Tums, calcium carbonate). I just started ADT, receiving my first Lupron injection 3 weeks ago. I will be due for a follow up DEXA in December marking 2 years since my first DEXA.

A bone density is the best measure of bone health although imperfect. In the absence of a fracture history, a low bone density fails to fully assess the quality of bone matrix.

Everyone deserves an evaluation of their bone health and fracture risk, but I am not sure that everyone on ADT requires bisphosphonate intervention.

Bisphosphonates are not without side effects, but the most notorious association (osteoporosis of the mandible) is infrequent. After treatment of >5 years on bisphosphonates there are reports of atypical stress fractures of the femur, so most providers would recommend limiting the use of bisphosphonates to a 5-year interval and then considering alternative pharmacologic approaches if the bone density remains low.