Dexa Scan Query

[Rodeoz15]

Hi everyone,

So I got my 75 year old father (who is on ADT since 4 months) a DEXA scan and the T scores were as follows:

Spine (L1-L4) ( minus 2.6) - he has had a spine surgey 6 years back at L4-L5.

Femur Neck (Right) (3.5)

Femur Neck (Left) (minus 3.7)

Total Femur Left (1.5)

Total Femur Right (minus 3.3)

Right forearm ( minus 4.1)

The doctor I am consulting did not really recommend a DEXA and had suggested to continue taking Calcium and Vitamin D tablets. I got it done nonetheless because I wanted to confirm if a bone fortification treatment (Zoledronic acid?) is needed.

Please could you let me know if just Ca and VitD supplements will be fine and we switch to something else only if the baseline gets worse. I understand from the report that the baseline itself is quite bad and there is a great risk of fracture.

He has Stage 4 PCa with extensive bone mets. Responding well to ADT so far (Leuprolide and Abiraterone). Should I take a second opinion from another doc?

Many thanks,

A

[Tall_Allen]

No, Ca and VitD supplements are not enough. That is full-blown osteoporosis and he needs a bone strengthening agent. The risk is the bones may fracture and he may suffer crippling spinal compression. He should be getting monthly Zometa injections (or Xgeva). He may have to take Ca and Vit D with it, but those drugs alone do nothing to help BMD if his levels are normal - that is a myth.

Also discuss adding Celebrex along with Zometa.

[Pleroma in reply to Tall_Allen]

Agreed with Tall_Allen. He will get rapid bone density loss on Lupron + Abiraterone.

I cannot believe your doctor is so uninformed.

[Rodeoz15 in reply to Pleroma]

Thank you!

[Dett in reply to Tall_Allen]

TA, is Zometa preferable to Prolia for men with PC? Husband was recently prescribed Prolia.

[Tall_Allen in reply to Dett]

Prolia is only for men without metastases.

[michael00 in reply to Tall_Allen]

I have bone mets and got prolia. After a couple years it changed bone density results from osteopenia to normal density. So i have now atopped using prolia.

[Skeeter03 in reply to Tall_Allen]

I have a single sacral metastasis and was started 2 days ago on xgeva. Should I be changed over to Zometa.

[Tall_Allen in reply to Skeeter03]

No. Xgeva is fine.

[Skeeter03 in reply to Tall_Allen]

Thanks

[Rodeoz15 in reply to Tall_Allen]

Thank you. This is very helpful to know.

[Schwah in reply to Tall_Allen]

At what reading for the lowest number do you think one should add bone strengthening agents. My worst is -1.7 with one -1.5 both in hips. Everything else is positive.

[Tall_Allen in reply to Schwah]

-2.5

[Schwah in reply to Tall_Allen]

Thx TA

[Poowater in reply to Tall_Allen]

Agree.

[London441]

Let me get this straight: You’re on Lupron and your doctor ‘did not really recommend a DEXA’ and told you to just keep taking vitamin D and calcium only? What kind of doctor does this?

One that doesn’t know that Lupron attacks bone density. Or worse, doesn’t believe it and thinks he knows better. This is no good.

If he had at least thrown weight bearing exercise into his supplement advice it would make a little sense, since that is the only proven treatment other than the bone strengthening drugs you mentioned.

Your dad needs both.

[Rodeoz15 in reply to London441]

Thanks. Agreed. We were only advised a repeat CT scan 6 months after starting ADT. I will consult another doctor with his Dexa report.

[Hidden]

Hey Rodeoz15! He should be on zometa for bone mets . Great job advocating for him . My dad had this too . It sucked to see him weakened greatly by it all . Then his heart went . Cherish you father . Quality time is best . Love him a lot . 🙏❤️

[Rodeoz15 in reply to Hidden]

Thank you!

[Poowater]

Always get a second opinion. Doctors encourage that.