From the Research
For men with a history of prostate cancer, particularly those on androgen deprivation therapy (ADT), DEXA scans are typically recommended every 1-2 years to monitor bone mineral density changes. Men starting ADT should have a baseline DEXA scan before beginning treatment or within the first 3-6 months. The recommendation for regular DEXA scans is based on the fact that ADT significantly increases the risk of bone loss and fractures by reducing testosterone levels, which normally help maintain bone density 1. Some key points to consider:
- The prevalence of osteoporosis rises significantly during ADT, from 10% at the start of treatment to 22% after 2 years 1.
- Osteoporotic fractures are a significant concern, with 6 patients experiencing clinical vertebral fractures and 2 patients experiencing hip fractures in one study 1.
- Bisphosphonates, denosumab, and selective estrogen receptor modulators (SERMs) have been shown to be effective in preventing bone mineral density loss in men with prostate cancer taking ADT 2.
- Exercise programs may have a role as an adjunct for holistic care, but are insufficient in isolation to prevent bone loss 2.
- The use of calcium and vitamin D supplementation may not be sufficient to prevent loss of bone mineral density in men undergoing ADT, and high levels of dietary calcium and calcium supplement use have been associated with higher risks for cardiovascular disease and advanced prostate cancer 3. Given the potential risks and benefits, regular DEXA scans every 1-2 years are recommended for men with a history of prostate cancer, particularly those on ADT, to monitor bone mineral density changes and prevent osteoporotic fractures.