Is anyone here on a bisphosphanate for bone strengthening? My medical team has recommended it but I'm not keen. I've just got my teeth checked and my dentist recommends two extractions before I start on the drugs.
Any advice much appreciated. And that's me celebrating my 50th birthday recently.
It's controversial before castration resistance. Given that you're an avid cyclist, I'd suspect a DEXA scan would show high bone mineral density. Why not be guided by your DEXA scan?
Thank you. I will pursue this. I presume there is no rush to start the tablets as this is all long term medication? My dentist didn't know
There is no need for bisphosphonates at all unless your BMD is low. Get a DEXA scan first.
I had never heard that. I had zometa (w/Celebrex) while still hormone sensitive. Why is it controversial?
Schwah
Because the benefit in terms of preventing fractures has been proven for mCRPC but not for mHSPC. ADT depletes BMD over time. It is unclear that there is any benefit in men who do not have osteoporosis.
This is apart from the survival benefit for the combo of Zometa and Celebrex in newly diagnosed metastatic men.
Im not convinced sitting down and spinning your legs around would be beneficial for BMD.
trainingpeaks.com/blog/why-....
Very silly article to anyone who has ridden seriously. I know I spent as much time standing as sitting.
Yeah, it makes little sense to me. Certainly running, being an impact exercise, could be expected to stress the hips more, but still--and some of us older guys like to grind the big gears.
There is generally a feeling out there in the ether that cycling does not benefit bone density. The reason is that it is not "weight bearing" exercise. Some have inferred that cyclists actually have lower bone density than sedentary subjects, which I don't pretend to understand. Cyclists are sometimes advised to incorporate resistance training for this reason.
Still, I'm sure there is fairly large individual variation; YMMV
If you have castration resistant cancer and bone metastases or if you are on ADT and have osteoporosis (T value in DEXA > -2.5) caused by the treatment, the administration of zoledronic acid or denosumab reduce the incidence of skeletal events (fractures, pain etc). These drugs are particularly important if you are going to be treated with Xofigo (Ra 223).
When was your last DEXA scan? Do you know your DEXA T value?
I don't think I've ever had one and I don't know my DEXA T value
Everybody on ADT and powerful anti androgens should have DEXA scans, initial as a baseline and later (in general every 2 years depending on the basal value) to see if severe osteopenia or osteoporosis is present.
Perhaps is the time to request a DEXA scan and based on the results decide if bone agents are necessary, unless your cancer is considered castration resistant and there are bone metastases. In mCRPC with bone metastases , bone agents can reduce the incidence of skeletal events.
I have bone metastases although my PSA is now a comfortable 0.08. I presume I am not castrate resistant. I have never fully understood this term. I presume it means that my cancer is still responding to ADT treatment.
Castrate resistant means that the PSA is increasing of the cancer progressing radiological when the testosterone is below 50.
In your situation is difficult to say since you are in enzalutamide and castration resistant cancer responds to enzalutamide.
I would get a DEXA and decide treatment with bone agents based in the T score and the FRAX score. I would assume the cancer is castration sensitive given the very low PSA.
Happy Birthday and best wishes to you from Chicagoland. We were celebrating my son’s 50th birthday last night. No opinion on the drug.
Thank you
Hi, have you had a DEXA bone density scan? That will determine what kind of meds may be necessary to offset the bone loss from ADT.My DEXA from last Summer shows that I'm osteopenic.
BMD (Bone Mineral Density) CHANGE from DXA on 08/06/18:
4.3% AP Spine L1_L4
5.7% Femur NECK Left
-2.2% Femur TOTAL HIP Left
-5.9% Femur NECK Right
-5.1% Femur TOTAL HIP Right
-0.7% Forearm RADIUS 33 Left
Lowest T_Score: -1.5 Normal = T-score of -1.0 or higher
Low bone mass = T-score between -1.0 and -2.4
Osteoporosis = T-score -2.5 or lower
Treatment Recommendations:
All Patients: Calcium 1,200 mg/daily; vitamin D 1,000 IU/daily;
Weight-bearing and muscle-building exercise; Counsel to stop smoking.
Great pic!
Btw, my#1 son still in London after attending Cambridge years ago, visited him in 2017. He used to live in Angel/Islington area
Randy in CA
I know Angel/Islington area well
I second Tall_Allen on this. You should definitely take a DEXA scan to determine the status of your bone density.
Contrary to the once popular belief, drinking milk with calcium in it apparently has done nothing to reduce osteoporosis. Might have to do with its enzymes being burnt during pasteurization or some such thing.
Blood tests are not a good indication because it reports the levels of calcium in your blood,. It doesn't do you any good if the calcium doesn't get in your bones. 
So a DEXA scan is a much better way to determine how your bones are doing.
To protect your bone density on ADT, many oncologist prescribe Calcium and Vitamin D but I don't think many, if any, ever think to recommend other supplements such as Magnesium. Your ratio of Calcium to Magnesium should not be higher that 2 to 1.
I supplement myself with 1000mg of Calcium per day, and I take between 400mg and 800mg of Magnesium too. I also take Vitamin D3, C, and K2 in MK-7 form.
And apparently, Potassium is an important mineral for bone health as well : ncbi.nlm.nih.gov/pmc/articl...
Best wishes and hope this helps!
I had a Dexa scan and it showed mild Osteopenia in my femoral necks. My MO was against bone strengthening drugs and actually felt my bone density would recover after being off ADT. I would note that it seems to be widely accepted that road bikers are prone to lower bone density as opposed to mtn bikers or runners due to more time in the saddle.
Thank you for all the replies. And so swiftly too. I have not had a DEXA scan. I had a full body bone scan when diagnosed to see the tumour spread but I presume that is a different scan. I will attempt to ask for one.
Yes they are different scans. Dexa is a light x-ray and they only scan your pelvis area. It only takes a few minutes and I did not need to disrobe. My biggest issue was probably the 2 years of prednisone. It was a recommnedation by others on this forum and I saw the value right away for if/when I go back on ADT and to serve as a baseline. I will check it again in 2 years. As your off ADT now I would also see it of less value for you unless of course you would like it as a baseline as well.
PS The frustrating thing about all this is that otherwise my dentist said that all my teeth looked ok. I had neglected seeing a dentist for the past 18 months and had assumed I needed a few things done. Other than one tooth that possibly needs a filling, they're looking pretty much ok.
Seems somewhat unusual if you were checked and OK 18 months ago that extractions would be recommended now. Do you know why? Decay? Perio disease?
Steve (DDS)
I have internal resorption in one back molar that has a root canal. I also have possible internal resorption in one of my front teeth (also a root canal). My back molar is my last one that I can use to chew and I don't want to lose my front tooth for obvious reasons.
That's unusual. Generally a well-done root canal treatment will prevent internal resorption, since there should be no cellularity or blood supply internally. (External resorption is another story. Also, if there was already internal resorption going on at the time the root canal treatment was done, it becomes more difficult to seal the tooth effectively). If the front tooth is not too far gone root canal treatment is certainly a consideration.
I don't know too much about dentistry in the UK; would recommend you consult with an endodontist if possible. If you can upload radiographs anywhere, I'd take a look.
Thank you. I will try to get them. Your feedback is much appreciated!
My research doctor has me on xgeva. It's a stronger form a prolia.
Hi London cyclist. A belated happy birthday to you. Hope it was a good one. Did your medical team give a reason for recommending bone strengthening? My Oncologist was against it but I have not had a Dexa scan either.
They just simply said over the phone that they recommend it due to the hormone treatment. I will be investigating this much further. How are you?
For your medical team to recommend bone strengthening agents without knowing your baseline bone density is not a responsible move.
You may not need it at all! Never take drugs unless you need them. I did 18 months of ADT and lost some density, but my baseline was very good and I didn’t lose that much.
I had Dexa scans along the way. The numbers are great to know! They help you navigate your treatments and even type of exercise. Cycling is obviously good,. However, weight lifting is a must if you want to keep what you’ve got, even though the drugs do help.
Whether it’s determined at some point that you have osteopenia/osteoporosis or not, knowing your numbers is very helpful. Don’t hesitate to impress upon your team that getting these scans are important to you and why.
Hi, I’m a distance runner and keen gym goer, When I had my dexa scan it showed deterioration, exercise slowed the osteoporosis but couldn’t totally stop it. There are potential problems in the long term but you can take a year off and delay that.
When I was put on Lupron, My MO added calcitrol to my drugs. Is this why?
I am on a bisphosphonate called Alendronate (70 mg). I have been on it for about 3 months now. I started it after a fall on a bicycle ride last June where I fractured my pelvis. Prior to the fall I had been an avid fitness bicycle ride; in 2020 I rode 3300 miles.
I spent 27 months on ADT (Lupron and Casodex), but have been off it for quite a while - since October 2014. I have had several bone density scans, starting from when I was on ADT. They have shown some osteopenia (just a less severe version of osteoporosis) , especially in femur and pelvis, for years. I talked to a bone specialist Physician's Assistant who said that cycling does not help increase bone density; weight-bearing exercises are needed.
I have not had any side effects from the Alendronate so far, though I have not had any dental work done since starting it. The PA talked about staying on it for anywhere from 6 months to a max of 5 years. I will say the fractured pelvis was no fun. I had surgery to have a 12 cm (over 4.7 inches) screw inserted. I spent two months using a walker confined to the first floor of my house. My son set up a bed in the living room for me to sleep in during that time.
Thank you. It's interesting to read your story. I wish you all the best.
Was on Xgeva for three years had to be taken off due to jawbone problems it caused. I needed oral surgery twice to have dead bone removed. My Dr. Doubled my Calcium dosage for around six months until levels stayed normal. I'm glad I'm off it the oral surgery twice wasn't a pleasant experience. I was finally able to have dental work completed. Leo
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Xgeva was suggested to me in 2019 when I first began ADT. I took a DEXA scan and proved to my oncologist that it was not necessary in my case. Recently, I began getting quarterly Xgeva injections when I started Cabazitaxel in September of 2021.
I don't know why I didn't get another DEXA scan this time. I probably will get one soon. Anecdotally, I have heard a few people say that Xgeva can be toxic. I believe there are a few cases where the results can be opposite of those intended and the medication facilitates a spontaneous fracture. That is from 3 conversations, and one article on possible side effects, so don't take that as more than a couple of people talking.
I will do more research, since I haven't felt great since December 22 when I got my Xgeva injection at the same time as my monthly Firmagon injection.
I have decided that I will not get two treatments on the same day again. For me, it always seems to intensify the side effects, which normally don't bother me. The worst reaction for me was when I had Cabazitaxel and Firmagon on the same day, which actually caused a fever and flu-like symptoms for 24 hours.
That is a long-winded way of saying that I agree with Tall_Allen that you should verify that it is needed to prevent a bigger problem before risking some other problems.
Philly
Hey londoncyclistt48!
Bone density is increased by weight bearing exercises, resistance exercises, running or brisk walking on a surface which transmits the shock of contact when the foot contacts the surface through the skeletal system.
This is termed by personal trainers as, Form follows function".
Exercising on an elliptical eliminates this repeated surface contact and the amount of resistance when cycling may be beneficial to extent of effort involved and the cyclist's body weight. It will only be the resistance provided by the cyclist's body weight that will stimulate the deposit of minerals used by the body in the skeletal system as the feet are on pedals and have no impact on a surface.
I first became aware of vibration plates six years ago. They were being used in the Sarasota, Florida area to increase the bone density of elderly people that were unable to exercise. It was found that standing on the plates also hastened recovery from surgical operations--imagine that! Guess where the plates became popular? In the NFL trainer's rooms as one example. Not only did using the plates help speed recovery from injury but also from hard workouts. Many players bought their own vibration plates to use at home. Gym Source began selling the vibration plates. The plates were quite expensive at that time, not so much now. They are available at the big "A".
Back to weight bearing exercises. If you can do back squats even with a light weight, particularly breathing back squats with high repetition that will stimulate your body to deposit calcium and magnesium in your skeletal system. Lifting weights and resistance exercises are very helpful if proper form used to prevent injury. Proper form is especially important when doing squats and deadlifts but the benefits are gratifying if one can do these exercises even with relatively light weight but increased reps. A few sessions with a good personal trainer is money well spent.
It has been said that if one wants bones like chalk eat calcium. If one wants bones like ivory eat calcium and magnesium. There are many good sources of these nutrients in vegetables.
Currumpaw
Vibration plates would appear to be a very easy way to work out but is it just another gimmick ? I have heard some concern that vibration plates could adversely effect cancer lesions on bone. Any comments?
Hey alperk,
Type the below into your search bar.
______________________________________________________________________________________________
Studies of vibration plates accelerating cancer lesions growth on bone
______________________________________________________________________________________________
Currumpaw
My Dexa scan showed osteopenia. Had prolia injections every 6 months for 2 years. Newer dexa scan showed normal density so they took me off prolia.
Congrats on 50, londoncyclist! I agree with Tall_Allen and think a DEXA scan is a great idea, especially since you are so young and vigorous . It is simple and adds information that you and your doctors can address directly.
I was put on the bone strengthener Xgeva (demosunab, not a bisphosphonate) upon PCa diagnosis 5+ years ago (at that time I was not castrate resistant, so why, I dunno). It wasn't until I had the "awesome" opportunity to have dental issues in summer 2020 that I got an Xgeva vacation that I am still on. It turned out that I've always had side effects with Xgeva ; my joint pain was considerable and I had routine headaches. I was simply putting these down to ADT/Zytiga, and it reminded me that side effects can be associated with any of the meds I am on.
In 2021, I had a DEXA scan performed, and even though I was castrate-resistant and off Xgeva for nearly a year, the scan revealed good bone density (about -1.0 for my age at the time - 53, I am now 54). I have since had the continuing discussion with my MO on whether to go back on Xgeva or a bisphosphonate.
Statistically, I know it is a matter of "when" rather than "if" I go back on these, but I've enjoyed the freedom - if only for a couple of years. Good luck. - Joe M.
I find the best bone-strengthening exercise to be jumping off a height, landning on the heel of one foot at a time. I do 30 times on each, in different directions, after a protocol on this. The shock to the bone is greater than from weight-bearing exercises.
What is a bone density test?
A bone density test, DEXA, measures the mineral content of the bones in certain areas of the skeleton. It’s a way to measure bone loss as you age. Healthcare providers sometimes call these tests bone densitometry tests, or DXA.
What is a DEXA scan?
A DEXA scan is a type of medical imaging test. It uses very low levels of x-rays to measure how dense your bones are. DEXA stands for “dual-energy X-ray absorptiometry.”
Medical experts consider DEXA scans to be the most useful, easy, and inexpensive test for helping to diagnose osteoporosis. The test is quick and painless.
Good Luck, Good Health and Good Humor.
j-o-h-n Wednesday 01/26/2022 2:30 PM EST
I always thought of the loss of bone density as a LONG-term effect of ADT, not an immediate one, but yes, existing loss will be rapidly accelerated as soon as one starts ADT, and the biggest loss rates actually can come in the first year of ADT. So, many docs want to start these bone meds right away, to nip the problem in the bud. But wouldn't that make sense mostly for men who are "old," either chronologically or physiologically?
ADT serves to MAKE you older, more quickly, but many of us are pretty young to start with. So the immediate bone-loss impact of ADT is more readily absorbed by us.
Surely the rate of loss varies from man to man, and younger men that have not already experienced much bone loss can probably "afford" the early hit of ADT. So I personally (as a NON-expert, to be clear) don't see a definitive reason to always start these bone meds so early in the course of ADT unless you already are losing bone density for some other reason (age, vitamin D deficiency, heavy smoking, alcoholism, etc) OR it turns out that ADT is really is doing a number on you... both of which scenarios, as others noted, can and SHOULD be measured with scans.
And while everyone here mentions DEXA scans, I have read that it may not pick up all changes. From a blog on scans: "The way that we test for bone loss to make sure that someone doesn't already have pre-existing osteoporosis is a scan called the bone density scan of which there are two types. One, the most common one, is called a DEXA scan. It’s a simple imaging study that checks the hip; it’s not very accurate for the back. And another study called a QCT which is very accurate for the back, but is not as widely available. "
Considering some studies show greatest early-on bone loss from ADT can be to the spine, I think I might want the QCT over the DEXA?
Most importantly, it often seems to be overlooked that the loss of bone density from ADT results from the loss of estrogen (which men derive from testosterone), so one possible strategy to reduce rates of bone loss is to add some back, generally with the use of low-dose E2 patches. I mean, why wouldn't we address the actual CAUSE of the bone loss, if possible, rather than treat the symptoms with meds as if the loss is inevitable?
Also important for ALL men who want to slow bone loss, whether from aging or from ADT: back strengthening and weight-bearing exercises.
As an aside...
[In addition to just plain "getting old," there are other ways to lose bone as well as by ADT. For example: "Glucocorticoid therapy is the most common cause of secondary iatrogenic osteoporosis. The bone loss occurs predominantly due to a decrease in bone formation, although increased bone resorption also occurs. Glucocorticoids induce osteoblast apoptosis and increase osteoclast survival and activity."
Presumably, the very low doses of prednisone we take along with our Zytiga are not huge factors in this process... but if PC metastasis to the bone is primarily osteoblastic, and steroids reduce osteoblasts, are steroids helpful there? Anybody here have more info on that?]
I'd get a new dentist!
Hello londoncyclist,It’s a personal decision for sure. I started alondronate in February of 2020 and don’t regret it. I’m still responding to ADT (zytiga and Eligard). When I started adt 5 years ago, dexa scans started showing rapid bone density loss (femur, pelvis, and neck/spine were checked) with high fracture risk and osteopenia. This, despite a job where I stand/bend and walk a lot (I’m a middle school teacher) walking 10-15,000 steps a day, and moderate weight bearing exercise the whole time. My dexa scan in 2/20 (one year after alondrenate) showed a decline in loss and my dexa scan in 2/22 showed no loss in pelvis and slight bone gain in back/neck. I do have concerns about long term issues but I strongly believe I avoided other serious short term consequences. Maintaining my high level of activity as long as possible is critical for my physical and mental well being! You’ll make the right choice for you! Happy cycling. ✌️ DougNOLA.
I am also a cyclist and recently celebrated my 50th birthday. I have added strength training and light running to my exercise regime to help counter the effects of the ADT on bone loss (it is common for some cyclists to develop osteopenia since the activity lacks impact to maintain bone strength). I do not know about the drug, but I definitely encourage adding weight training and perhaps running (besides, strength training can make you a faster cyclist).
I have now had my DEXA scan. Waiting for my next routine appointment to discuss results. Thank you for all the advice given above. Very informative.
ex volleyball player and bodybuilder, I have thick bones, but I have been put on zometa even if HS not only to prevent osteoporosis but because it makes it harder for bone metastasis to spread it seems.
Them bones them bones !
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