When to stop taking calcium after stopping Lupron?

[SooHwa99]

I was wondering when it was OK to stop taking calcium supplements after stopping Lupron? I have no issues with taking D3K2, but I am concerned that there are some current studies that show that this actually has no effect on bone density and actually at large doses can cause problems with prostate cancer.

[pjoshea13]

There are many issues with the way calcium is used. For bone loss, the assumption is that one can top-up with calcium without addressing the cause of mineral loss. With ADT, if there was no bone loss before, one must first assume that estradiol [E2] may have fallen below 12 pg/mL - this can be checked. The solution is a low-dose E2 patch.

Excessive doses of calcium suppress the production of active vitamin D. The kidneys will not convert 25-D (calcidiol) to 1,25-D (calcitriol) when they are busy ditching calcium. (The same goes for phosphorus & phosphates.)

But the most worrying thing is the impact of a high calcium:magnesium ratio. This has an effect on prostate health - but, importantly, on the heart:

From December:

"This study demonstrated that a moderate Ca-Mg ratio (range: 3.91-4.70) had the lowest mortality risk, and that low serum Mg and high Ca-Mg ratio were independent risk factors of mortality in CAD patients."

pubmed.ncbi.nlm.nih.gov/318...

Here's an oldie:

healthunlocked.com/advanced...

Best, -Patrick

[SooHwa99 in reply to pjoshea13]

So my RO had it added to my treatment plan while on ADT. Vitamin D and calcium supplements to avoid osteopenia/osteoporosis during treatment.

I guess my real question should have been at what point do you look at the level of testosterone in a patient and feel it is adequate for them to stop supplementing with calcium. From what I understand it takes some time for testosterone to come back after a course of ADT. Approximately the same time one was on a course of ADT? Is there a risk of stopping before one knows what one's testosterone level is and if so what level of testosterone would be acceptable for stopping calcium supplementation?

[pjoshea13 in reply to SooHwa99]

I would say that for bone health, you should monitor estradiol [E2]. As testosterone [T] rises, E2 should also rise. When E2 is > ~12 pg/mL, you can stop worrying. This will be at a T level that will vary between individuals.

The T cut-off for hypogonadism is 350 ng.dL. It can take a while to get there, but you could assume the you have E2 sufficiency at that point.

-Patrick

[Tall_Allen]

Why are you taking calcium supplements? Why are you taking Vitamin D supplements? I assume the answer is because your blood levels are low. If that is the case, just take enough to correct for it.

[SooHwa99 in reply to Tall_Allen]

My RO had it added in addition to vitamin D as part of my Lupron treatment to avoid osteopenia/osteoporosis. My blood levels have been WNL while on both supplements.

[Tall_Allen in reply to SooHwa99]

No advantage in prophylactic treatment. Get a DEXA scan. If you have osteopenia or osteoporosis, you can take a bone strengthening agent, otherwise, it's a poor idea to take something for a condition you don't have.

[SooHwa99 in reply to Tall_Allen]

I had a DEXA Scan prior to starting treatment and was prescribed calcium and vitamin D to avoid any issues with osteopenia/osteoporosis. This seems to be a pretty common protocol for those on ADT in the States.

My main question now is when to stop. I had my last Lupron shot the beginning of April, but my testosterone level was undetectable shortly there after. I am just wondering should I stop now or wait until my testosterone comes back up a bit.

[Tall_Allen in reply to SooHwa99]

You should not be taking any drugs for a condition you don't have. It is poor practice.

Our best evidence to date shows that neither drug has any effect on bone health if serum levels are already normal. In fact, men taking high doses of Vitamin D cause lower bone mineral density. Calcium supplementation has been associated with prostate cancer.

pcnrv.blogspot.com/2018/07/...

So since you should not have been taking those drugs in the first place, it is definitely safe to stop.

[SooHwa99 in reply to Tall_Allen]

I just don't understand why physicians are recommending this regime for patients on ADT. Clearly there is no financial gain as most of have to purchase the supplements ourselves.

I am fully aware that physicians get very little training in nutrition, etc, but with the potential to cause harm by taking large doses of calcium is concerning.

I had messaged my RO and she said since I finished my last Lupron the beginning of April that I could stop taking the calcium.

Why did I have to ask? I would have kept taking it until my next appointment in August if I hadn't wondered about it.

[Tall_Allen in reply to SooHwa99]

Many doctors don't keep up.

[j-o-h-n]

Chocolate chip ice cream (two scoops).

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 05/11/2020 6:13 PM DST

[ctflatlander]

Na8l, I'm 76 been on ADT almost 2 1/2 yrs. calcium 1200 mg along with 3000 iu vit D daily. Unfortunately dexa scan now shows ostopenia low levels in forearm,lumbar and hip. Nutrition, gym work has not kept it at bay. This is what you were expecting. Bob

[VioS]

My MO recommended same thing calcium 1000 mg with 2000 IU of Vitamin D3 daily once I am starting ADT for bone strength he says...I haven't checked my calcium levels yet this year but lsat year and previously everything was good .Should I try to get the calcium only from the food or at least take some Ca but not as much as suggested?I guess I need a blood test from my physician to see were I am while on ADT.