Bone health on ADT: checks to ask your doctor about
This article is general education, not medical advice. Talk to your treating team about your situation. Disclaimer.
Testosterone helps keep bones strong. On ADT, bones gradually lose density, which raises fracture risk the longer treatment goes on.
What guidelines recommend
Bone health guidance from expert groups shares common themes (Canadian Urological Association; ASCO-endorsed guideline; Meet-URO/AIOM consensus):
- A baseline bone density scan (DXA) and fracture-risk assessment for men starting longer-term ADT.
- Repeat scans, often every 1–2 years depending on your risk.
- Enough calcium and vitamin D, from diet first and supplements if needed.
- Bone-protecting medicines (such as denosumab or a bisphosphonate) for men at higher risk. This is your doctor’s decision.
Exact schedules vary by country and by person.
What you can do
- Resistance and impact exercise, where safe for you, helped preserve spine bone density in trials (Newton et al. 2019; Taaffe et al. 2019). See Exercise on ADT.
- Reduce your fall risk: good lighting, clear floors, and balance exercises.
- Limit alcohol and stop smoking.
Heart and metabolism checks too
ADT can raise weight, cholesterol and blood sugar. Expert consensus suggests regular checks of blood pressure, glucose/HbA1c, cholesterol and weight, at least yearly and more often if you have risk factors (Hong Kong consensus, Frontiers in Oncology 2024; CUA ADT guideline).
Ask your doctor: “Have I had a bone density scan? When are my next bone, cholesterol and blood sugar checks due?”
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