Bone problems and osteoporosis in prostate cancer

Bone loss (osteoporosis) and ageing

Getting older can also cause your bones to get thinner and weaker. Thinner bones are more at risk of breaking (fracturing). This bone thinning is called osteoporosis.

Tests for bone loss

Your doctor will assess if you are at high risk of bone loss. Getting older and having cancer treatment can increase the risk of bone loss. You'll have a bone density scan (also called a DEXA or DXA scan) if you are at high risk. 

Find out more about having a bone density scan

Reducing the risk of bone loss

There are different things you can do to reduce your risk of bone loss. These include:

• making sure your diet has enough calcium and vitamin D

• avoiding caffeine, alcohol and smoking

• exercising regularly 

• taking medicines called ​bisphosphonates​  

Calcium and vitamin D 

Adults should generally have 700mg of calcium a day. People with osteoporosis should aim for 1000mg a day.

Dairy products such as milk, cheese and yoghurt contain calcium. Some foods have added calcium. Check food labels to see how much calcium they contain. Milk substitutes such as soya or rice milk usually do not contain as much calcium as dairy products.

You can also get calcium from:

• green vegetables (cabbage, broccoli and okra)

• soya products including tofu

• tinned fish with bones like sardines, salmon and pilchards

• nuts and dried fruit

• fortified breakfast cereals 

• bread and foods made from flour 

• tap water 

Calcium supplements are available. Dietitians recommend that you do not have more than 1500mg of calcium. This total calcium could come from your diet or a combination of diet and supplements. Too much calcium can cause tummy (abdominal) pain and diarrhoea.

Your body needs vitamin D to absorb calcium. Sunlight helps the body to make vitamin D. A daily short walk in natural sunlight makes enough vitamin D for most people. Vitamin D is also found in margarine, oily fish and egg yolks. Public Health England recommends that in winter and autumn, people in the UK should consider taking a daily supplement of vitamin D containing 10 micrograms. This is because it is difficult for people to get enough vitamin D through their diet.

Your doctor or nurse can refer you to a dietitian to check that your diet has enough calcium and vitamin D to keep your bones healthy. 

Alcohol and caffeine 

Drinking alcohol increases the risk of bone loss (osteoporosis). National guidelines recommend that you don't drink more than 14 units of alcohol per week. Caffeine can cause calcium to be lost in the urine.

Exercise

Exercise is important for bone health but it needs to be weight bearing exercise. This means that you are supporting your own weight with your legs and arms. This can strengthen muscles, improve posture, and could help with pain.

Many of us don’t do enough regular exercise. Bringing exercise into your daily life is the best way to make sure you get enough.

Tips:

• Walking is good.

• Household activities can help, such as cleaning, gardening, shopping or even going up and down stairs.

• You could join an exercise group or class. It doesn’t have to be very energetic. Gentle controlled exercise such as Tai Chi can be good.

• Although swimming doesn’t help, exercise classes in the swimming pool (aqua-aerobics) can. Walking and exercising in the pool is quite hard work because of the resistance of the water.

Medicines to help bone loss

Bones naturally break down and repair themselves. Hormone therapy can weaken your bone and increase your risk of a bone breaking (fracture).

You might also have bisphosphonates if you have osteoporosis and are having hormone therapy. 

You might also have bisphosphonates for pain if you have cancer that has spread to other parts of your body. This is metastatic or advanced prostate cancer. Bisphosphonates can help with bone pain.

Bisphosphonates move calcium cells from your blood stream into your bone. This helps to keep the bone strong. As you need to keep some calcium in your blood stream, your doctor may give you calcium tablets.

Bisphosphonates include:

• alendronate tablets

• risedronate tablets

• zoledronic Acid (Zometa) - this is a drip that you have into your bloodstream

Denosumab is a different type of drug. It works by stopping the activity of bone cells called osteoclasts. Denosumab can increase bone density to help strengthen the bone. It can be used instead of bisphosphonates to help to reduce fractures in people whose cancer has spread.

Find out more about bisphosphonates