Did a baseline Dexa scan report for dad who is 83 and with bone mets.
Some areas like femur say osteoporosis. He does have mets there.
Have started his ADT from today with relugolix.
Worried about this dexa report.
Would love to hear any inputs from those who had a similar situation.
After clearance from a dentist, he should discuss Zometa or Xgeva. Alendronate is possible too, and is less likely to have adverse side effects with longterm use, but it is weaker. His bloodwork should include calcium and Vitamin D.
Thanks Allen.🙏🏻
His vitamin D was 40 and calcium is in range when checked last month. I was giving 4000 IU of vitamin D daily since long which I have increased to 8000 IU. Also been giving vitamin K2 since long. Should I add calcium tablets even if the calcium blood test is normal ?
Will look into the alendronate. Between zometa and xgeva , do you have any preference. Which one has lesser side effects. I see many on board say they have had no issues while some say they did.
He has started the relugolix yesterday. Have the MO appointment in two weeks. Can I discuss it with him then you think or does this need to be done sooner. He already has a Prescription for xgeva and another for zometa. Not for alendronate.
Apart from avoiding falls , anything else he should avoid doing ? He does some stationary exercise bike and some stretching exercises
Thanks again.
Stop giving him drugs he doesn't need!
I am confused. Do you mean the vitamin D and k2 ?
If his levels are fine, stop giving him those drugs.
Ok. Will do.
Please can you give your opinion on these -
1) Do you have any preference. Between zometa and xgeva ? (Will ask about the alendronate too ) Which one has lesser side effects. I see many on board say they have had no issues while some say they did.
2) He has started the relugolix yesterday. Have the MO appointment in two weeks. Can I discuss it with him then you think or does this need to be done sooner. He already has a Prescription for xgeva and another for zometa. Not for alendronate.
3) Apart from avoiding falls , anything else he should avoid doing ? He does some stationary exercise bike and some stretching exercises
Thanks 🙏🏻
1) No difference between those two. Alendronate has less SEs.
3) I thought he's too frail for chemo. How is he able to exercise on a bike? What is his Charlson Comorbidity Index or Frailty Index.
I don’t know about that index. What kind of doctor would do that ?
The doctors said oh at this old and frail age we don’t consider chemo.
He is in general good health and was walking an hour daily till last month ( has stopped since a month due to the left leg little Pain) and does some stationary cycling and stretching.
Allen , do you think it’s ok to get dad doing some resistance training to strengthen legs , before taking the bone injections ?
It isn't late to realize that you may end up in the role of the sorcerer's apprentice in 1940 Disney's Fantasia.
Did not understand
Classic Disney movie where Mickey Mouse tries to fix things to see things worsen after every attempt. In your case, you were advised to start your dad on ADT, now they tell you to give him extra drugs to protect him from osteoporosis worsening, then something else to protect him from that and the vicious cycle goes on and on. IMO this Disney Studios' animated clip, bearing a timeless truth, is their best creation ever. You can view it in YouTube, if you haven't, but I doubt there is anyone on earth that hasn't.
If he can ride a stationary bike he can strength train. The biking is of very limited benefit for his osteoporosis.
A trainer who knows how to work with Pca patients can assist him with a weight lifting program. They exist and can be found. Obviously not heavy lifting, but something he can slowly get stronger with. It can literally work miracles. This is better for both his osteoporosis and overall health than anything in his control.
What is/are the best resistance exercise(s) for Mets in vertebrae? Ribs? Thanks!
You probably need to consult a professional for a referral to an PT who deal with medical back, etc issues and have your reports with you. This not advice to handled by a forum.
I just went through this with my wife. Her GP recommended someone or you consult with a orthopedic doctor who deals with this type of issue.
Good luck!
I'm not having any pain or other issues. I was just asking about specific resistance exercises that best work those areas.
to me resistance training is critical. He starts out weak and you are taking testosterone away. If he does resistance training he will be able to hold on to his current strength. If not he will get weaker and start falling where he will break a hip and at his age he has a 30% chance of dying from a broken hip. The resistance training might help his bones too but that is less important once he is on the bone meds.
you mean he can do resistance training also with the osteoporosis?
Obviously the condition of the bone that is being stressed by the exercise must be considered. I don't know what you can find on Google or youtube, but you should give it a try by searching. of course, finding a local specialist is the best...if affordable for you. Hip, spine, and wrist comprise the top 3 fracture points. I would think muscle strength is a key to maintaining decent balance.If strong enuf, he could do squats. He can hold somethingto maintain stabilty during that exercise. The worst to let atrophy are the leg muscles.
I follow a senior fitness trainer on Instagram who seems good. His handle is @growyoungfitness.
Rather than taking more drugs that have side effects, why not do all-natural, transdermal estradiol (TDE) therapy, to add-back the estradiol lost due to Lupron/Orgovyx ADT?
Estradiol is the main hormone that fights osteoporosis. This plot shows the change in Bone Mineral Density (g/cm2) comparing Lupron ADT to Estradiol Patches (from the PATCH Phase-II study). Men on Lupron (or Orgovyx) lose bone density over 2 years, compared to men who gained bone density on Estradiol patches, for the same time period. TDE has many other benefits, including greatly reducing or eliminating hot flashes, improving blood glucose level, and lowering cholesterol and lipids.
Your Dad is beginning his ADT treatment already severely osteoporotic. He needs strong treatment to prevent further bone loss. It would be very bad if he fractured his hip or vertebra, which can happen spontaneously without a fall.
Bob in New Mexico
Yes, I know men who have been taking estradiol patches/gels for over 20 years. It's really an old therapy that's experiencing a resurgence of interest because of the PATCH trial in the UK.
My PCP prescribed estradiol gel for me, which I am currently taking. You will find most MO's and Urologists won't prescribe it for prostate cancer, though, because it's not currently SoC.
If you send me an email request to janebob99@lobo.net, I will send you a some of the best papers.
Bob
Sent mail
Goodness. Before you subject your dad to Estradiol, look here:
DOES MEDICARE COVER DEXA SCANS FOR MEN WITH PROSTATE CANCER
PSMA scan shows rib met
PSMA scan shows lung nodules 
Bone scans show no change in mets, but PSA rising
Lupron and osteoporosis
