Spinal osteoporosis after 10 months on ADT

drew, you might ask about Forteo (teriparatide). It often prescribed during ADT to counteract bone loss. I haven't had prostate cancer.

I was on Fosamax For the first six years I was on ADT. I kept my bones strong and prevented me from having osteoporosis. After six years, I switched over to Zometa and had it for two years and it has kept my bones strong since then.

There’s also Xgeva (denosumab) which some people get instead of Zometa. It is a little higher chance of osteonecrosis

All of these drugs can return you to a better bone health.

You can also switch to estrodiol patches instead of Lupron. That keeps your testosterone just as low, but has fewer hot flashes and Can restore your bone health.

Lots of options to talk to your doctor about.

@gently and @jeffmarc, thanks so much for your thoughts. I also plan to ask my doctor, who is very expert on these things, why I didn't have a baseline bone scan at the start of treatment, as I was shocked at how fast the osteoporosis happened. My PSA is 0.006 so at least that is going well.

@gently thank you for this!

@drew2021
I am so sorry to hear that : ( .

Just wanted to say that I read that the MOST of bone loss happens in the first 6 mos of ADT and than it slows down somewhat, so it can definitely happen in a year : (((.

Were you at least advised to take Vit. D and calcium on a daily bases and practice weight training and do "step" exercise ? All of that supposedly slows down bone loss during ADT.

I think that it is really irresponsible NOT to order bone scan for a patient before the start of ADT treatment : (((, especially if it is going to be longer than 6 mos.

@surftohealth88 Thank you. I exercise 4-5 times a week, resistance training and cardio, and I do take calcium and vitamin D, 500 mg and 2000 IU respectively. I agree it was irresponsible not to have ordered me a bone scan at the start. I had no idea or I would have requested it.

@drew2021
If I may just suggest doing some exercises that involve small bouncing moves (like going up and down one step , or using small trampoline, or doing small bunny jumps ). Studies were done mostly for women and osteoporosis but now there were done for men on ADT also (Australia) and the same effect was noticed - those kind of small "bounces" cause bone to regrow. Somehow those small "impact" moves cause bones to grow stronger.

Now that you have weakened spine : ((( , please ask you doctor (or even better PT therapist) if those kind of exercises are too much for your spine. If they are not, than it might be worth trying them.

Wishing you all the best and super fast reversal of you a bone loss 🍀

@drew2021
if you have risk of bone mets, Prolia or one of the bisphosphonates might be a better choice.
Otherwise, I'd press for Forteo. It builds the best bone. It is usually a 2 year course which times nicely with your use of ADT. You might also ask for bone markers CTX and P1NP to understand how the medication is working for you.
Jeff is the expert here. I only have osteoporosis.

My orthopedic doc and urologist/oncologist now accept the below:
Ortho advised only needing Ca in the normal range but taking large supplements of C and D3. Both at least 6,000 IU per day.
Reason is, the D3 and C activate the body's ability to use the Ca for bones. Excess Ca just gets washed out by the kidneys - which can also raise risk of kidney stones.
I'm also on Prolia twice a year for life due to osteoporosis.
At first, onco kept advising Ca but after the above explanation he ok'ed moderate/normal Ca if any and encouraged D3 in particular.
This was all triggered by 5 compression fractured Thoracic vertebrae (those were a "12" pain on the 1 - 10 scale) a year and 1/2 after finishing 2 years of Lupron.
Be sure to consult a orthopedic surgeon of high repute if using any ADT.

PS: my hospital has a "protocol" that DEXA bone scans don't evaluate the spine; only one leg and on arm. So my osteoporosis was a nasty surprise. If I ever get another DEXA it will be at another provider.

grandpun, thank you for the warning. I'm sorry you had this painful times five surprise a year and a half after Lupron.
Dexa only evaluates the lumbar spine, because of the ribs, but a lumbar evaluation would have warned you.
https://www.medicare.gov/coverage/bone-mass-measurements