12 February 2026

Protecting Bone Health: Maintaining Strength During Hormone Therapy

Written by Bernie Riley, Head of Telenursing and Supportive Care Programs

Bone health is a major health consideration for men prescribed hormone therapy for advanced and high-risk prostate cancer.  

Chemotherapy and Hormone therapy, also referred to as Androgen Deprivation Therapy (ADT), are common treatments for intermediate, high-risk and metastatic prostate cancer. Chemotherapy may temporarily affect your bone marrow, the inner part of your bone that makes new blood cells. ADT injections and sometimes additional tablets are prescribed with the intent to reduce testosterone levels in the body to best treat the disease by controlling tumour progression. Reducing testosterone can cause your bones to lose calcium, making them less dense and more brittle.  

Understanding Bone Density and ADT

The hormone testosterone is essential for maintaining bone health; it plays a critical role in the body's ability to maintain the calcium needed for bone strength and density. When testosterone levels are reduced during ADT, this process is disrupted, increasing the risk of osteoporosis and painful and debilitating bone fractures.

Beyond the effects of ADT, several other risk factors can further compromise your bone health, including:

  • Lifestyle & History:
    • Smoking and excessive alcohol intake
    • Age 70 years -testosterone generally naturally declines with age
    • a family history of osteoporosis
    • inadequate intake of calcium
    • inadequate exposure to vitamin D and exercise
    • previous bone fractures.
  • Autoimmune & Malabsorption Issues: Rheumatoid arthritis and Coeliac disease.
  • Organ & Endocrine Health: Diabetes, Overactive thyroid or Parathyroid disease, as well as chronic kidney or liver diseases.

Proactively managing bone health is vital to minimise bone loss and protect your skeletal health.

Investigating Bone Health

A check of your baseline bone health is important when you commence ADT. It is recommended that your specialist or GP order a blood test to check calcium and vitamin D levels and a bone density scan to assess your bone density and recommend suitable management of your bone health.

A Bone Mineral Density (DEXA) scan is a quick, painless procedure that uses low-dose X-rays to measure calcium and mineral deposits in your bones, providing a measure of bone density and strength. The cost of this can be covered by Medicare.

A DEXA scan is often repeated every 2 years. Blood tests may be repeated seasonally (as you go into winter and out of winter, for instance). Vitamin D levels change throughout the year. Your levels are highest in late summer and lowest at the end of winter. 

Diet and Supplements

Discussion with your Health care team about best management for you with required supplements and exercise can reduce the risks of long-term loss of bone density and manage any increased risks of falls and bone fractures.

To support bone health while on ADT, you should speak with your doctor about how much calcium is recommended in your situation. You may be able to achieve your intake by prioritising calcium-rich foods such as low-fat dairy products, almonds, canned fish (with bones), and dark leafy green vegetables.

Maintaining an optimal weight and specific nutrient balance is vital for bone density and consulting a dietitian is highly recommended. If you are underweight, you may have a higher risk of bone thinning. If you are overweight, you also increase the risk of fracturing bones. A Dietitian can provide a personalised plan to ensure you are meeting your nutritional goals effectively through your daily meals.

You can refer to this website for referral to a dietician near you Find a Dietitian | Dietitians Australia

Where diet alone is insufficient, calcium supplements are often prescribed. These are typically paired with Vitamin D supplements, as Vitamin D is essential for the body to properly absorb and utilise calcium. These two supplements are frequently taken together for maximum efficacy. Not all people treated for prostate cancer will be suitable for supplements and these should be discussed with your treating doctors to ensure they are safe to take.

Benefits of physical activity and exercise prescription

Regular exercise is known to have many health benefits, both for your physical as well as for your mental health. Specific exercise programs are beneficial and encouraged for those on ADT. As important as taking your prescribed medication to control your prostate cancer,  an exercise prescription should be tailored to your individual requirements to maximise maintaining bone health. Current recommendations are for a combination of cardiorespiratory exercise with weight bearing, resistance training and balance exercises.

Guidance with a suitable exercise program can be accessed virtually or in person. Ask your health care team if the ADT medication you have been ordered has a supported exercise program. An exercise physiologist with an understanding of the needs of someone on ADT is best trained to provide a suitable and safe exercise program for you. We encourage anyone undergoing hormone therapy to access a suitable accredited exercise physiologist.

You can find an accredited exercise professional specialising in cancer management here: https://www.essa.org.au/find-aep

Your GP can help arrange a GP Chronic condition management plan which can help subsidise 5 visits with an allied health professional like a dietician or exercise physiologist per year.

BPA’s – Bone-protecting Agents

Another acronym I hear you say!

Recent evidence suggests that everyone receiving ADT injections with or without concurrent Androgen Receptor Pathway inhibitor (ARPI) tablets or with additional risk factors should be evaluated to determine the ideal strategy and need for Bone Protective Agents by their medical team. Your specialist can provide further information about whether you need additional bone protection agents.   

Discuss with your team whether a referral to an endocrinologist is needed for advanced management of bone health. 

Additional information and wider reading

You can refer to these websites for wider reading on ADT and Bone health.

https://www.prostate.org.au/treatments-side-effects/side-effects/bone-health/

Hormone Therapy and Bone Health - Healthy Bones Australia

What are the different types of hormone therapy

A final word and where to get help

Prostate Cancer Foundation of Australia (PCFA) can help with information from our Specialist Nurses, our free and confidential Telenursing and Counselling service, and peer support networks, providing reliable guidance on next steps. Reach out to PCFA to connect with expert support and community.

For any questions about your current situation and if you need to talk, you can call 1800220099, email telenurse@pcfa.org.au or request a call back here https://www.prostate.org.au/nursing-support/