Bone Health Alert: Why Men with Prostate Cancer Need Osteoporosis Screening

Why brittle bones aren’t just a woman’s problem – Orange County Register

Critical Information for Men on Hormone Therapy

If you're being treated with androgen deprivation therapy (ADT) for prostate cancer, here's something your oncologist should be discussing with you: your bone health. A growing body of evidence shows that men—especially those on ADT—face serious but often overlooked risks of osteoporosis and life-threatening fractures.

The Hidden Danger for Prostate Cancer Patients

While osteoporosis has long been considered a "women's disease," the reality is starkly different for men with prostate cancer. About 1 in 5 men over age 50 will suffer an osteoporotic fracture in their remaining years, and men who do break a hip face worse outcomes than women, with 25% to 30% dying within a year.

For men on ADT, the risk is even higher. Prostate cancer drugs are among the medications that significantly damage bone density. ADT works by lowering testosterone levels, but testosterone is crucial for maintaining bone strength. The result: accelerated bone loss that can lead to debilitating fractures.

A Sobering Comparison

A 50-year-old man is more likely to die from complications of a major osteoporotic fracture than from prostate cancer itself. These major fractures include breaks to the wrist, hip, femur, humerus, pelvis, or vertebra—injuries that can rob you of independence and quality of life.

The Screening Gap

Here's the frustrating part: despite the known risks, a recent study of veterans ages 65 to 85 found that only 2% of men in the control group had undergone bone-density screening. Researchers called this rate "shockingly low" and "abysmal."

The problem stems partly from conflicting guidelines. While professional organizations like the Endocrine Society and the American Society for Bone and Mineral Research recommend screening for men 50 and older with risk factors (and all men over 70), the U.S. Preventive Services Task Force has deemed the evidence "insufficient". This means Medicare and many insurers won't cover screening for men who haven't already had a fracture.

What Your Oncologist Should Be Doing

If you're starting or currently on ADT, your oncologist should:

1. Discuss bone health risks before beginning treatment
2. Order a baseline DXA scan (bone density test) to assess your starting point
3. Monitor your bone density regularly during treatment
4. Prescribe preventive medication if you have osteopenia (bone loss) or osteoporosis
5. Recommend lifestyle interventions including weight-bearing exercise, calcium and vitamin D supplementation, smoking cessation, and limiting alcohol

Treatment Options That Work

When screening reveals bone loss, several effective treatments are available:

• Oral medications: Fosamax or Actonel
• Intravenous infusions: Reclast (once yearly)
• Daily self-injections: Forteo or Tymlos
• Twice-yearly injections: Prolia

A recent study showed that when men were offered screening with proper support and education, 49% agreed to be tested. Half of those tested had osteoporosis or osteopenia, and most started appropriate treatment. After 18 months, bone density increased for those in the intervention group.

Take Action: What You Can Do

Don't wait for a fracture to address bone health. Here's what you should do:

If you're about to start ADT: Request a baseline DXA scan before beginning treatment.

If you're currently on ADT: Ask your oncologist, "Have we checked my bone density? Should I have a DXA scan?"

If your doctor says insurance won't cover it: DXA scans are widely available for $100 to $300 out-of-pocket—a small price compared to the cost of a hip fracture.

Know your additional risk factors: Falls, family history of hip fractures, smoking, excessive alcohol use, rheumatoid arthritis, hyperthyroidism, Parkinson's disease, or use of steroids all increase your risk.

The Bottom Line

Two-thirds of older people who suffer hip fractures will not regain their prior mobility. But this outcome isn't inevitable. Bone density screening and treatment can prevent fractures and preserve your quality of life.

As one expert put it, with proper testing and treatment, "a man could see a clear-cut improvement in mortality and, more importantly, his quality of life."

Don't let outdated thinking about osteoporosis being a "woman's disease" put your health at risk. Advocate for yourself, ask questions, and insist on appropriate bone health screening as part of your prostate cancer care.

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Sources

1. Span, P. (2025). Why brittle bones aren't just a woman's problem. KFF Health News. Distributed by Tribune Content Agency. Available at: https://www.ocregister.com [Article discusses recent VA study on osteoporosis screening in men]

2. Colón-Emeric, C., et al. (2025). Bone health service intervention for male veterans. JAMA Internal Medicine. [Study of 3,000 veterans ages 65-85 showing effectiveness of systematic screening and treatment approach]

3. Bauer, D. (2025). Commentary on male osteoporosis screening. JAMA Internal Medicine. [Accompanying commentary discussing implications for clinical practice]

4. American Society for Bone and Mineral Research. Clinical practice guidelines for osteoporosis screening in men. https://www.asbmr.org

5. Endocrine Society. Guidelines for osteoporosis screening and treatment in men. https://www.endocrine.org

6. U.S. Preventive Services Task Force. Screening for osteoporosis in men: Recommendation statement. https://www.uspreventiveservicestaskforce.org

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Note: This article is for informational purposes only and does not constitute medical advice. Always consult with your healthcare provider about screening and treatment decisions appropriate for your individual situation.