Need advice on dexa scan result saying moderately low

[Soumen79]

hi

i am a 42, fighting pca since March 2021, initial psa 189.6, mets across skeletal system, immediate bilateral oritectomy , 10 chemo and abi took my psa to <0.006.

but my dexa scan shows moderately low bone density with T score -1.3 in femur neck.

my doc is inclined to continue with shelcal hd having Ingredients:

Calcium Carbonate (1250mg)

Elemental Calcium (500mg)

Vitamin D3 (500IU)

Dosage - twice daily

i have question to all wise minds here

1. I noted adverse link between calcium supplement and pca and hence cut down the dosage to once daily - should i go back to twice daily?

2. If serum calcium level is within range,can I not fear the link between ca supplement and pca?

3. Will sunlight be of any help?I do my 40 min workout in morning at outdoor only.

4. Any other diet intervention?any other suggestions

thank you all for reading this far.

with regards

soumen

[Magnus1964]

For what it's worth I take calcium caltrate 1200 and D3 1000 once per day. I think that should be enough. Any more and your just passing it.

[Soumen79 in reply to Magnus1964]

Thank you Magnus, take my regards and my wish of best health for you.

[Seasid]

My oncologist recommended only sunshine. (I live In Sydney) If you are not on the bone strengthening medication you don't need all of this calcium supplements. Can you start deadlifting one time per week? I am doing one set only in one week. We need time to recover. Maybe even more than a week time.

[Soumen79 in reply to Seasid]

When recommending sunshine did your mo mention any timeline?What is the medical reasoning behind this notion of calcium supplement of no help if bone strengthening agent is not taken?

I do bit of weight lifting but with very less weight.

Thank you so much for your reply!!

[Seasid in reply to Soumen79]

You need to do deadlifting with 30% of your 1RP maximum. I am currently doing with 55kg one set, 20 repetition. Repeat in one week or even 10 days when you fully recover. I rather not take calcium supplements. I am in a bad shape now after 4 years of ADT. You probably need longer exposure to the sunshine if you get dark. That is why my goal is not to get too dark.

[Tall_Allen]

Calcium supplements do nothing to increase bone mineral density, and are associated with increased cancer progression, cardiovascular and kidney problems. There is no reason for you to take any calcium supplements if your serum values are adequate. Same with Vitamin D - supplement only if your serum values are low. Send these to your doctor:

aacrjournals.org/cebp/artic...

ncbi.nlm.nih.gov/pmc/articl...

If weight lifting alone isn't increasing your BMD, you can discuss using an estrogen patch (with tamoxifen to prevent gynecomastia), or adding alendronate.

[Jost-58 in reply to Tall_Allen]

I take calcium supplements as tablets. Do you think I should stop using them or is there any circumstances when they are needed?.

[Tall_Allen in reply to Jost-58]

Only if your serum values are low.

[garyjp9 in reply to Tall_Allen]

TA, it sounds like Seasid (below) thinks that one should take calcium supps if you are on bone strengthening meds, even if your serum Ca levels are normal. Do you agree?

[Tall_Allen in reply to garyjp9]

I agree with the doctors/researchers who wrote this:

"Studies seeking to show whether these supplements do increase the efficacy of osteoporotic treatment or decrease adverse events (that is, hypocalcaemia) are lacking. In either case, screening for vitamin D deficiency and seeking its correction should be warranted before the initiation of anti-resorptive treatment [e.g., Zometa or Xgeva]. Moreover, in a recent mendelian randomisation study investigating the role of vitamin D in maintaining bone mineral density, increased levels of vitamin D had no effect on bone mineral density measured by [DEXA scan]. However, increased 25-hydroxy-vitamin D was associated with a slight reduction in heel bone mineral density estimated by ultrasonography. These results are consistent with our mendelian randomisation findings of no causal effect of vitamin D levels on fracture."

ncbi.nlm.nih.gov/pmc/articl...

[Seasid in reply to Jost-58]

If you are on bone strengthening medication.

[Soumen79 in reply to Tall_Allen]

Thank you TA, is these two medication (estrogen patch and alendronate safe for metastatic prostate cancer progression?

[Tall_Allen in reply to Soumen79]

Yes

[Soumen79 in reply to Tall_Allen]

Thank you TA.One more question, is it fact that generally bone damage takes place in greater extent in the first year of adt and in subsequent years things (bone loss) stabilizes?

[Tall_Allen in reply to Soumen79]

Loss of BMD is progressive with ADT.

[Soumen79 in reply to Tall_Allen]

Ohh.

[Soumen79]

Nice to know this for a fact. Thank you sir ☺️