Bone health is very important in men with hypogonadism or prostate cancer. Men are frequently overlooked when it comes to evaluating bone density.

Osteoporosis is a silent disease that causes the skeletal bones to weaken and break with or without a fall or trauma. The majority of men and health care providers view osteoporosis as solely a “woman’s disease after menopause”. Around age 65, men and women lose bone mass at the same rate.

If a man has low testosterone or is on medication to lower their testosterone level due to prostate cancer, his risk is increased at any age. Alcohol abuse and smoking decreases bone density. Some diseases such as hyperparathyroidism, inflammatory bowel disease can cause loss of bone density. Prolonged bed rest or immobilization of some part of the body can also result in significant bone loss.

We are dedicated to maintaining healthy bones for men. We perform DEXA scans in our office which is a bone density study to determine if the bone thickness is normal, osteopenic or osteoporotic. Based on the results of the DEXA scan, medication may be recommended to strengthen your bones.

Bone metastases are very common in prostate cancer. This occurs when the prostate cancer travels to various bones in the body and starts to grow in that area. Prostate cancer cells are attracted to the bone because of a good blood supply. This is still prostate cancer and not bone cancer. Bone metastases put you at risk for:

• Pathological fractures (broken bones due to prostate cancer) can occur without any fall or trauma and may be painful and difficult to heal.
• Surgery to the bone to stabilize an area that is at high risk for breaking.
• Radiation to areas where bone metastases are causing moderate to severe pain.
• Spinal cord compression due to prostate cancer growing in the spinal bones and causing pressure on the spinal cord. This can compress the spinal cord nerves causing numbness, weakness or possibly paralysis.

The hormone medications themselves that are used to treat this advanced prostate cancer further weaken bones. So it is important to treat poor bone strength to decrease the likelihood of fractures.

Treatments

Medications are used to strengthen the bone and include denosumab (Prolia or Xgeva) injections or Zometa oral bisphosphonate pills.

Things you can do to maintain bone strength

Weight bearing exercise is encouraged, however men should avoid high risk activities such as climbing on ladders, getting up on their roof, high impact sports which could increase the risk of breaking a bone. Walking, going up and down stairs, jogging, dancing are all weight bearing exercises. Avoid smoking or quit smoking and reduce alcohol intake. Ensure an adequate daily intake of Vitamin D, typically around 800 IU daily. Ensure a daily calcium intake of 1200 mg daily, it is best to obtain through your foods.