Osteoporosis and How Is It Related to Hormone Therapy (ADT)?

Osteoporosis is a general loss of bone mass that can lead to fractures. (A related condition, osteopenia refers to bone density that is lower than normal peak density but not low enough to be classified as osteoporosis.)  ADT increases a man’s risk of developing osteopenia or osteoporosis. The longer a man remains on ADT, the greater our risk for loss of bone mass (bone mineral density). (Citation: Michael G. Oefelein, Vincent Ricchuiti, et.aL, J of Urology; Volume 166, Issue 5, Pages 1724-1728 November 2001)

In normal bone, two types of cells called osteoclasts and osteoblasts work together to rebuild and strengthen bone:

  • osteoclasts that destroy old bone
  • osteoblasts that build new bone.

ADT and prostate cancer causes an imbalance between these two cell types resulting in more bone being destroyed than rebuilt, leading to weakening and thinning of the affected bone.

Make sure that you do have a regular bone density test if you are on ADT, no matter the schedule.

This can cause pain and means that the bone can fracture or break more easily.  Men may not even know they have osteoporosis or experience any significant problems with this condition until a fracture occurs. When osteoporosis is present, fractures of the spine are common and may occur while merely bending, lifting, standing, sudden movements, or from other minimal stress. Pain results from the collapse of the small bones of the spine that may have been weakened by osteoporosis. More severe spinal fractures can cause paralysis. Early diagnosis and treatment can prevent these potentially disabling injuries.

How is Osteoporosis Diagnosed?

Early diagnosis is helpful for men on ADT. You can be tested for osteoporosis by having your bone mineral density (BMD) evaluated by a dual energy x-ray absorptiometry (DEXA) scan. DEXA readings can be overly optimistic (i.e., indicate g