Long term ADT bone loss mitigation tips?

[jackwfrench]

My post RP BCR was diagnosed 8 months ago when they said, "you will be on ADT the rest of your life". I am on Lupron and abiraterone 4 months now. I am taking 1000mg of calcium per day and 2000IU of D3 per day. If I am lucky enough to last years, what else can I do to prevent the loss of bone? Thanks -

[Tall_Allen]

What were the results of your DXA scan? Weight bearing exercise may mitigate BMD loss somewhat.

[jackwfrench in reply to Tall_Allen]

No I did not get one yet - he talks about that not coming for a while per Hopkins SOC. I have been doing weight lifting throughout and commit going forward, but just for the standard exercises - it's difficult to ensure weight bearing activity on all the various bones.

[Tall_Allen in reply to jackwfrench]

Walking and jogging improve most bones in the axial skeleton. Good idea to get a baseline DXA - it's cheap and easy - why not?

[jackwfrench in reply to Tall_Allen]

I will ask again, and if not maybe my primary care guy will order it.

Yes I just recently started feeling good enough to jog again as part of my cardio. Thx.

[London441 in reply to jackwfrench]

You should know your baseline. You don’t have to ask anyone, just go get it.

It’s your lower half that needs the most attention. What do you do for it?

[jackwfrench in reply to London441]

35 minutes med-high intensity leg based cardio 4x/week-recently inserted some jogging as part of it, plus weights 2x/week. Yeah gonna get one.

[London441 in reply to jackwfrench]

Good. MO’s do not always order them as they should, PCP’s are worse. They often follow a protocol of every 2 years etc. Not applicable to us.

[Mgtd in reply to jackwfrench]

What resistance exercises are you doing? Are you working ALL muscle groups. 2X a week MAY not be enough to do that.

Suggest you consult with a professional trainer to establish a complete body program.

If you spent sometime observing those doing resistance training in the gym you may notice that a lot of guys really only work the upper body - arms, chest, abs, etc.

Ever notice in your time in the gym how many guys have great upper body development and weak lower bodies. For bone maintenance you need a complete routine.

[jackwfrench in reply to Mgtd]

My PT has me doing upper and lower, I’ll discuss missing muscle groups with her. I heard rowing gets 85% of your muscle groups, may integrate that. Thx

[addicted2cycling in reply to jackwfrench]

jackwfrench wrote -- " ... I will ask again ... "

FYI - it's YOUR BODY with hopefully many years to come so DEMAND a DXA!!!

I used to walk marathons but problematic knees make walking NOT ENJOYABLE and yet I still park the car as far away from grocery store entrance as I can. Thankfully they don't prevent me from bicycling 👍👍

[KocoPr in reply to jackwfrench]

Hi Jack. I went through my PC. That’s who you want to order it.

[KocoPr]

Add K2 to that D3 and not sure if you need calcium supplements. In any event here is one of many articles on this subject.

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

The Synergistic Interplay between Vitamins D and K for Bone and Cardiovascular Health: A Narrative Review.

[Tall_Allen in reply to KocoPr]

"Based on the current body of evidence, there is not enough evidence to recommend combined vitamin D and K supplementation for the prevention and treatment of osteoporosis. "

[dhccpa in reply to Tall_Allen]

Interesting! I wondered when you were going to weigh in on K2.

[KocoPr in reply to Tall_Allen]

I believe you TA, but would we ever get a randomized control trial for this? I haven’t found any on vitamin K2?

I have seen studies on vit D and K1 but what does K1 have to do with moving calcium from blood to bone? It’s seems these studies are made to fail sometimes.

I really hate to be a skeptic about our health system but it is built on money/influence so all of us cancer warriors are stuck with researchers vitro cell lines and vivo trials on non humans. We have no choice but to try other methods of counteracting these side effects, or fighting our cancers.

[Tall_Allen in reply to KocoPr]

Since supplementing Vitamin D has been proven to have no effect on bone mineral density and pulls calcium out of bone in high doses, it makes no sense to me to take a drug whose only possible benefit is to prevent that side effect - just refrain from Vitamin D supplementation when serum levels are normal!

Here's a trial that included men. It found: "There was no difference in 3-yr change in femoral neck BMD between the vitamin K- and non-vitamin-K-supplemented groups (P = 0.94) (Fig. 2A​2A).). Likewise, there were no differences in 3-yr change in lumbar spine or whole-body BMD between the two groups (P = 0.98 and 0.81, respectively) (Fig. 2​2,, B and C)."

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

In this Japanese trial, the authors found a BMD increase of 4.92±7.89% in post-menopausal women and claim it was significant. It isn't. A standard deviation of ±7.89% means that the BMD got worse with the same assurance that it got better: 1.96 standard deviations give 95% confidence that the true value is between -10.54% and +20.38%

maturitas.org/article/S0378...

You aren't "stuck" with believing non-clinical data. You are just deluding yourself into believing things are true because you would like it to be true. Acting on flawed info may be injurious to your health.

[Derf4223]

Prolia (based on DEXA scan results) aka denosumab

[Nusch in reply to Derf4223]

Ne careful with Prolia. Once on, you can’t get off again, at least without losing the bone mass you gained. Lots of side effects for many, not for all.

[Derf4223 in reply to Nusch]

ccjm.org/content/87/6/339

[maley2711]

You are 73? Then SOC for men 70+ !!! GP should order DXA...as well as any of your PCa Docs IMO. At 72 and with PCa, Kaiser did not t balk at offering DXA for me.

[Horse12888]

Since it appears that intermittent ADT is not inferior to continuous, it's hard to understand why ANYONE is on continuous. What precisely this has to do with bone loss, I have no idea.

[Derf4223]

Magnesium and K2, both taken at separate times from Calcium and D3. may help with bone. I had a DEXA scan and it showed I was osteopenic, My MO said I basically had no chance of not losing bone without something like Prolia. I will learn later this year how my bones are doing at my next DEXA scan.

[janebob99]

Someone mentioned Zoledronic Acid (Zometa, Recast), which is a bisphosphonate, that prevents bone loss (but doesn't grow bone). This is a once a year infusion. Also, a hormone-like drug like Forteo can actually grow bone. But, it's expensive.