Osteopenia Supplements that work?

I’ve talked about this a lot. A bone doctor that was at a recent prostate cancer conference specifically said that people on ADT should be on Bone strengtheners.

I took Fosamax for the first six years on ADT. Followed by Zometa infusions. Last time I had a DEXA scan, I was in pretty good shape. That really is what you need to talk to your doctor about.

I would not taken any of the prescription based ones, those have a lot of problems as I have heard from many others (brittle bones breaking and so on), but no personal experience.

Instead one can easily find these: Vitamin D3 with K2 supplement, strontium supplement like strontium citrate, boron, biosil (silica), maybe a little magnesium if you handle it, and a little calcium - but sometimes taking it isn't needed understand the parathyroid can rob bone if it is lacking but many have too much in diet so it is very individual on that. Don't bother with the articles from 5 or 8 years ago where they mistook data on strontium as you need it to build bone, newer articles say the data that poo-pah'ed strontium was in error and retracted that article or at least one article, you will need it to build bone is the long and short of that.

jime51, if you plan on stopping ADT, recovering testosterone can restore bone loss.
One value of antiresorptive osteoporosis medications is that they can prevent or slow bone metastasis. If the cancer genetics indicate that it is likely to metastasize, a patient would be given these drugs. They do have side effects in some people.
If you will be continuing ADT you'd be better off taking an osteoporosis medication.

My doc had me on Prosteon, it's available directly from the manufacturer, I think there's no prescription required.

Prosteon is a dietary supplement formulated to support bone health, particularly for men undergoing androgen deprivation therapy (ADT) for prostate cancer. It helps maintain bone mineral density and prevent osteoporosis, a common side effect of ADT, by providing key nutrients like calcium, vitamin D3, magnesium, vitamin K2 (as MK-7), and boron.

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.

My husband's medical oncologist and the Kwon team at Mayo Rochester all advised him to have Xgeva injections, which he has every three months.

Something interesting I heard about using Xgeva for bone strengthening. It’s only used for a certain amount of time and apparently using Zometa once after the Xgeva Infusions end can lock in the benefit that Xgeva Provides.

This was discussed in a weekly ancan.org Advanced prostate cancer meeting. Len, who is one of the moderators/leaders is the one who brought up the subject. He took advantage of this “feature”.

Thanks, Jeff. I will ask the Indianapolis medical oncologist about this when we see him next month. He is the one overseeing the Xgeva injections.

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.

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