Helping Men Maintain Strong Bones When Using Androgen Deprivation (ADT) During Prostate Cancer Treatment

By Dr. David Samadi

For men dealing with advanced prostate cancer, bone health is an essential concern, especially if the cancer has spread to the bones. Add to that the use of androgen deprivation therapy (ADT), a commonly used standard treatment for prostate cancer — and the risk of bone loss becomes even more significant. ADT, by reducing testosterone levels, can contribute to thinning bones, increasing the risk of fractures and other bone-related issues. 

Here’s a deeper dive into how ADT affects bone health and what you can do to protect your bones during treatment.

The Impact of ADT on Bone Health

The American Cancer Society estimates that in 2025, 313,780 men will be diagnosed with prostate cancer, a disease that thrives on androgens (hormones like testosterone) in order to grow. The overwhelming majority of these men will survive (98-99%) the disease. Some men, however, may be recommended by their healthcare provider to consider androgen deprivation therapy. 

ADT’s job is to lower testosterone levels in the body by reducing the levels of androgens helping slow the growth of prostate cancer cells that rely on these hormones to live. ADT is given either through medications or surgical options. These medications can include LHRH analogs (like Lupron), LHRH antagonists (like Firmagon), or antiandrogens (such as Xtandi, Erleada, and Nubeqa).

ADT is a highly effective method for treating prostate cancer, especially in its advanced stages. While it does come with some unintended consequences, the effectiveness of ADT in treating prostate cancer should give you confidence in your treatment plan.

Tips for Maintaining Bone Health While on ADT

While bone health can be at risk during ADT, several steps can be taken to minimize the impact and maintain strong bones throughout treatment.

1. Ensure Adequate Calcium and Vitamin D Intake

Calcium and vitamin D are essential for ensuring adequate bone health. Rich food sources include dairy products, leafy green vegetables, and fortified cereals. If necessary, talk to your doctor about calcium and vitamin D supplements to ensure you’re meeting your daily needs.

2. Consider Medications to Protect Your Bones

Your healthcare provider may recommend medications specifically designed to protect your bones, such as Prolia, Fosamax, or Zometa. These medications can help prevent further bone loss and reduce the risk of fractures. Regular supplementation with calcium and vitamin D3 may also be advised. Always consult with your doctor to determine the right approach for you.

3. Stay Active with Weight-Bearing Exercises

Regular physical activity is key to maintaining bone strength. Weight-bearing exercises like walking, jogging, and weightlifting can help improve bone density. Activities involving quick movements — like racquetball, basketball, or soccer — can also strengthen bones, particularly in the lower torso.

4. Talk to Your Doctor About Bone Density Tests

Monitoring your bone health is crucial. Bone density tests, often called DEXA scans, are a great tool for assessing the mineral density of your bones. These tests can help detect osteopenia or osteoporosis early, allowing you and your healthcare team to advise on proactive steps to manage your bone health.

5. Avoid Smoking and Limit Alcohol Consumption

Smoking can impair calcium absorption, which can weaken bones over time. Nicotine also interferes with the production of bone-forming cells, further increasing the risk of bone loss. Alcohol has a similar effect by hindering bone formation and speeding up bone breakdown. Reducing or eliminating both smoking and excessive alcohol consumption can have significant benefits for your bone health.

The Role of Bone Imaging in Prostate Cancer Treatment

For men undergoing ADT, regular bone monitoring is essential. A bone density test is the best way to track bone health and detect early signs of osteopenia or osteoporosis. These tests use X-ray imaging to measure bone density and provide a clear picture of bone health over time.

A bone density scan results can help your doctor determine if you need additional treatments to protect your bones, and they can guide decisions on lifestyle changes or medication adjustments.

Conclusion

While prostate cancer treatment is primarily focused on managing and eradicating the disease, it’s equally important to prioritize overall health — including bone health. Men undergoing androgen deprivation therapy (ADT) should work closely with their healthcare team to monitor and protect their bones, ensuring they remain strong and resilient throughout treatment.

For men over 40, regular prostate cancer screenings are highly recommended. And for those on ADT, maintaining bone health should be a key part of the care plan. By being taking control of your health, you can lower your risk of fractures and maintain a strong, healthy body as you navigate your cancer treatment.

 

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of two books, Prostate Cancer, Now What? A Practical Guide to Diagnosis, Treatment, and Recovery, and The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.

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