What Prostate Cancer Survivors Need to Know About Osteoporosis

January 2012

The Impact of Prostate Cancer

The National Cancer Institute reports that next to skin cancer, prostate cancer is the most common type of cancer among American men. The cancer usually grows very slowly, however, and most men who are diagnosed with prostate cancer live for many years. Still, prostate cancer can be serious and, in some cases, life-threatening.

All men are at risk for prostate cancer, but most men diagnosed with it are age 65 or older. And as men get older, their risk for developing another disease, osteoporosis, increases. Osteoporosis is of particular concern for men with prostate cancer. Recent research has found a strong link between hormone deprivation therapy, which is one of the treatments for prostate cancer, and osteoporosis. Hormone deprivation therapy is also called androgen deprivation therapy because it deprives cancer cells of the male hormones (called androgens) that the cancer needs to grow.

Facts About Osteoporosis

Osteoporosis is a condition in which bones become weaker, less dense, and more likely to break. Many people—even some doctors—think of osteoporosis as a women’s disease, but millions of men develop it, too. Men who break bones are less likely than women to be treated for bone disease, even though treatment can help prevent broken bones in the future.

Besides taking hormone deprivation therapy for prostate cancer, other risk factors for developing osteoporosis include:

  • being thin or having a small frame
  • having a family history of the disease
  • using certain medications, such as glucocorticoids
  • not getting enough calcium
  • not getting enough physical activity
  • smoking
  • drinking too much alcohol

Osteoporosis is a silent disease because it can weaken bones over the years without causing symptoms. For men coping with prostate cancer, weak bones may not seem very important. But weak bones can cause problems because they break easily, and broken bones often initiate a downward health spiral. Twenty percent of seniors who break a hip die within 1 year, and survival rates are lower for men than for women. But it is never too late to improve your bone health: osteoporosis can be treated and prevented.

The Link Between Prostate Cancer and Osteoporosis

Studies show that men who receive hormone deprivation therapy for prostate cancer have an increased risk of developing osteoporosis and broken bones. Hormones such as testosterone protect against bone loss. So, once these hormones are blocked, bone becomes less dense and breaks more easily.

Hormone deprivation therapy is one of several treatment options available to men with prostate cancer. Traditionally, it has been used mainly to treat prostate cancer that has spread to other parts of the body. But because men are more likely today to be diagnosed in the early stages of prostate cancer, more of them are opting to be treated with hormone deprivation therapy earlier in the course of the disease.

Osteoporosis Management Strategies

Several strategies can reduce a man’s risk for osteoporosis, or lessen its effects if he already has it.

Nutrition. Some studies have suggested a link between a high-fat diet and prostate cancer. However, it is not yet clear which foods or supplements may play a role in reducing the risk of prostate cancer. As far as bone health is concerned, a well-balanced diet rich in calcium and vitamin D is important. Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Taking dietary supplements or multivitamins also can help ensure that you meet your body’s daily calcium requirement.

However, some evidence suggests that high calcium intake might be associated with the development of prostate cancer. But the studies that produced these findings are not definitive. In fact, other studies have shown a weak relationship, no relationship at all, or the opposite relationship between calcium and prostate cancer. At this point, researchers can only say that the relationship between calcium and prostate cancer risk remains unclear. Currently, it is recommended that men age 19 to 70 consume 1,000 mg (milligrams) of calcium per day, and those over age 70 consume 1,200 mg per day.

Vitamin D plays an important role in calcium absorption and bone health. Some individuals may require vitamin D supplements to achieve the recommended intake of 600 to 800 IU (International Units) each day.

Exercise. Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best exercise for bones is weight-bearing exercise that forces you to work against gravity. Some examples include walking, climbing stairs, dancing, and weight training. Regular exercise, such as walking, may help prevent bone loss and provide many other health benefits, such as reducing pain, relieving stress, and making cancer treatment easier to handle.

Healthy lifestyle. Smoking is toxic to bones as well as the heart and lungs. In addition, smokers may absorb less calcium from their diets. Studies also have found that heavy drinking hurts your overall health, weakens your bones, and increases your risk of broken bones. Moderate drinking—for most men, this means not more than two alcoholic drinks per day—has not been shown to hurt your bones.

Bone mineral density test. A bone mineral density (BMD) test is the best way to determine your bone health. BMD tests can identify osteoporosis, determine your risk for fractures (broken bones), and measure your response to osteoporosis treatment. The most widely recognized BMD test is called a dual-energy x-ray absorptiometry (DXA) test. The test is painless—a bit like having an x-ray, but with much less exposure to radiation—and can measure bone density at your hip and spine.

Men being treated for prostate cancer with hormone deprivation therapy should discuss with their doctor whether BMD testing is a good idea. Don’t wait for your doctor to bring up your bone health with you. A new study shows that many men on hormone deprivation therapy for prostate cancer are not being screened or treated for osteoporosis, even when they have other risk factors for the condition.

Medication. There is no cure for osteoporosis, but medications are approved by the Food and Drug Administration for men with the disease. Although no medications have been approved specifically to treat men with bone problems caused by hormone deprivation therapy for prostate cancer, studies of several medications are underway for this purpose.

Resources

For more information on osteoporosis, visit:

NIH Osteoporosis and Related Bone Diseases ~ National Resource Center

Website: http://www.bones.nih.gov
Phone: 202-223-0344
Toll free: 800-624-BONE (2663)

For more information on prostate cancer, visit:

National Cancer Institute

Website: http://www.cancer.gov

For information on studies sponsored by the National Institutes of Health, visit the following websites:

Clinical Trials at NIH

Website: http://clinicaltrials.gov

Centers for Disease Control and Prevention’s National Center for Health Statistics

Website: http://www.cdc.gov/nchs

For Your Information

This publication contains information about medications used to treat the health condition discussed here. When this publication was produced, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released.

For updates and for any questions about any medications you are taking, please contact:

U.S. Food and Drug Administration

Website: http://www.fda.gov
Toll free: 888–INFO–FDA (888–463–6332)

For updates and questions about statistics, please contact:

Centers for Disease Control and Prevention’s National Center for Health Statistics

Website: http://www.cdc.gov/nchs
Toll free: 800–232–4636

NIH Osteoporosis and Related Bone Diseases ~ National Resource Center

2 AMS Circle
Bethesda,  MD 20892-0001
Phone: 202-223-0344
Toll Free: 800-624-BONE (2663)
TTY: 202-466-4315
Fax: 202-293-2356
Email: NIHBoneInfo@mail.nih.gov
Website: http://www.bones.nih.gov

The NIH Osteoporosis and Related Bone Diseases ~ National Resource Center provides patients, health professionals, and the public with an important link to resources and information on metabolic bone diseases. The mission of NIH ORBD~NRC is to expand awareness and enhance knowledge and understanding of the prevention, early detection, and treatment of these diseases as well as strategies for coping with them.

The NIH Osteoporosis and Related Bone Diseases ~ National Resource Center is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases with contributions from:

The National Institutes of Health (NIH) is a component of the U.S. Department of Health and Human Services (DHHS).

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