Our bones are living matter. They are constantly dying and regenerating. As we grow older we need to maintain strength in our bones through use. Weight-bearing exercise and brisk walking or swimming are particularly important to avoid osteoporosis, a deterioration of bone tissue which can lead to fractures. Unfortunately this deterioration is made worse by:
- certain hormone treatments for locally advanced and advanced prostate cancer (e.g. Zoladex) designed to lower testosterone levels
- metastasis of the cancer to the bones in the advanced stages, particularly to the ribs, hips and spine.
If it is not offered, you should ask for a Bone Mineral Density test (BMD) or DEXA (short for dual energy X-ray absorbtiometry) scan at the start of long-term hormone treatment to establish a baseline. This should be repeated every 24 months. The doctor will get the results, which will come in the form of T-scores:
- between 0 and –1.0 is normal
- between –1.0 and –2.5 indicates low bone mass (osteopoenia)
- below –2.5 indicates osteoporosis.
Calcium and Vitamin D
Calcium intake is one of the keys to maintaining good bone health. If you are avoiding dairy products, calcium may be found in many other foods: green fruit, vegetables, soya milk and baked beans.
Note: Too much salt, caffeine or alcohol will deplete your calcium
Vitamin D3 is vital to help fix calcium in your body. It can be obtained naturally via careful and limited exposure to sunlight, and in oily fish and supplements. Most men in the UK are deficient in Vitamin D3, due to inadequate sunlight in the winter months, and precautions against sunburn in the summer. So some men could find Vitamin D3 in tablet form helpful in the fight against prostate cancer, alongside other treatments.
Many osteoporosis treatments combine calcium and vitamin D3 in tablet form. Bisphosphonates such as Zoledronic acid (Zometa) are usually prescribed for osteoporosis. Denosumab, given by injection, is yet to be approved by NICE for prostate cancer. It is recommended that all patients receiving these drugs consult their dentist, as they can affect the jaw and teeth.