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A cautionary tale for those on ADT: Lupron and Osteoporosis
I offer this as a cautionary tale for those on ADT; specifically Lupron.
I have/had osteoporosis of only the thoracic spine after taking Lupron.
Here’s a time line of experiences.
RALP 01/2022. Positive margins; then Lupron 22.5, quarterly shot from 3/2022 till last shot 01/2024.
PSA negligible since then.
Also had DEXA scans; all showed I was 70% to the good: 12/2022, 10/2024, 2/15/25
(Note: some hospitals Protocol calls for scans to only front view of 1 arm and 1 leg - that missed my spinal problem)
Starting mid-09/2025 I had chronic back pain that I attributed to too much walking and a sprained foot for a 10-day period. So probably muscle pain and I got PT my back starting ~ 10/01/25.
Early November pain got severe. Went to an orthopedic specialist. X-ray then was read (incorrectly FWIW) as no spine problem, I ‘should’ get PT; which I was already doing.
Later, pain got really, like blacking out severe.
12/04/25 Found a great orthopedic Dr. He read earlier X-ray as suspicious trouble in spine's thoracic region. An MRI showed T-5, 7, 9 compression fractured. Surgery (kyphoplasty) corrected those.
2 weeks later found T-6 & 8 had just fractured; repaired those.
Since then it’s a long recovery to fight the osteoporosis with Vitamins C & D3 at 6k IU per day and starting Prolia injections.
My orthopedist discounts use of Ca supplements. He says we get plenty of that in food. But C & D3 activate the Ca we have to strengthen the bones. Additional, Ca could encourage kidney stones.
I had been taking increased Ca before his counsel and on 12/26 and 12/27 had sharp pain episodes on my left side. A CT scan showed a stone in left kidney that I passed naturally on 12/28.
My oncologist wouldn’t attribute my fractures to Lupron nor would he not. I guess it’s possible but not common.
So talk to your oncologist AND at least PCP if not orthopedic doctor about osteoporosis risk in any bones.
Good luck my buddies!
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Grandpun, thanks for the warning.
"BMD has a close correlation with serum testosterone levels in men. Moreover, testosterone levels immediately decrease because of androgen deprivation therapy (ADT) for prostate cancer, resulting in a decrease of BMD and osteoporosis. In addition, estradiol (E2) converted from testosterone by aromatase is deeply related to BMD maintenance. A relative decrease in estrogen level due to ADT also poses a risk for BMD loss [10,11]. In general, BMD decreases by about 2%–8% in 1 year after the commencement of ADT [12]. Furthermore, ADT increases the risk of decreased BMD at five- to tenfold compared to prostate cancer patients with normal testosterone levels. A meta-analysis demonstrated that 9%–53% of osteoporosis incidence was caused by ADT [13]" https://pmc.ncbi.nlm.nih.gov/articles/PMC7867125/
A DXA (DEXA) scan before ADT is a good idea. Following with a DXA one year after starting ADT. Radiation affects bone marrow cells and can also have a negative effect on bone mineral density.
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1 ReactionThe problems you encountered are almost definitely caused by Lupron. It’s a documented fact that the bones get weaker on ADT.
When I was started on Lupron, I was also started on Fosamax a bone strengthener. Took that for six years and then I started on Zometa infusions every three months. Another bone strengthener that has kept my bone strong, even when I have fallen nothing has broken.
It’s really too bad that not everyone that has put on ADT gets a bone strengtheners.
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8 Reactions@jeffmarc
I agree with you.
FWIW, I was on prolia but only while on Lupron.
Since my side effects have reduced but some continue, maybe Lupron isn't out of my system. Even after a full 2 years have passed since my last Lupron shot.
YES, guys, get those bone strengtheners as long as the side effects of ADT persist. If insurance doesn't cover them, then take lots of vitamin D3 and C (I'm taking 6,000 IU per day). Ask your doctor/s till you get a WELL CONSIDERED answer!
@grandpun
Actually, Lupron has a very short half-life, 3 to 6 hours. If you get a three month shot, As an example, It literally disappears within days of three months.
The problem is that testosterone just doesn’t come back quickly and for some people it doesn’t ever come back. If you’re on Lupron you’re going to wait at least six months to a year for your testosterone to get to a level where you don’t have the side effects from the Lupron. In many cases it takes even longer, 18 months to 2 years to get to 250 or above. There are exceptions, but most people really wait a long time.
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4 Reactions@jeffmarc
Yeah Jeff, this hits on the fine line between the presence of Lupron vs it's effects.
Chart attached shows 3-month interval injections but suppression of T is relatively constant due to the "steady state release" of Lupron in the bloodstream based on the concentration when it's administered. (Details here. Item 12.3 :
https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/020517s036_019732s041lbl.pdf)
Lupron may be largely out of one's system but its effects, particularly to testosterone suppression as in mine and other's cases, continue. Possibly for much longer. My GU/oncologist also says this persistence of side effects increases with age. I was 76 when Lupron was started, 78 when concluded; I may be dealing with this for a while longer.
Thanks for your comments.
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2 Reactions@grandpun
Not sure you’ve read it, but I was on Lupron For six years and switched to Orgovyx For nine months when I stopped taking it. In seven months by testosterone went from undetectable to 50. I was 77 at the time. My testosterone was going up 25% a month.
My oncologist didn’t want me to stay off of ADT so I had to go back on Orgovyx. It wasn’t real fast, but after all those years, it was coming back pretty steadily.
The problem is everybody’s different with this recovery of testosterone. I’ve run into people that never had it come back And some of the online meetings I’ve attended. They are not happy and in most cases their doctors don’t want to give them testosterone injections.
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5 Reactions@grandpun FortiBone Collagen Peptides also show measurable clinical improvement in bone density
Phil
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1 Reaction@jeffmarc
If so many men never recover their testosterone after Lupron treatment, why do doctors keep administering it. If your testosterone never returns why keep beating a dead horse. I only had 4 months of Lupron, but my testosterone is still < 8 after 6 months. I had awful side effects until this seventh month but maybe my testosterone is coming back at age 83 but my nonexistent libido and no erections indicate otherwise.
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