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Bone and Joint Health
Androgen deprivation therapy (ADT) often results in low testosterone levels in men. This negatively impacts bone health. This blog by Theralogix provides insight on how supplementing Vitamin D and calcium can promote bone health.

Many believe that bone health is a women’s concern, but 1 in 5 men over the age of 50 will experience significant bone loss resulting in bone health issues. This fact alone should move bone health to a top priority for men.  

Bones are crucial to our lives as they provide support to our bodies and protect our organs. Our bone is continually changing as new bone replaces old bone. When we are young, we produce more bone than what is removed, so our skeleton grows in size and strength. As we age, the amount of bone we make begins to decline slowly, and the removal of old bone is greater than new bone formation.  

The rate of bone loss is influenced by various factors, such as family history, being underweight, and excessive cigarette smoking or drinking alcohol. Certain medications and therapies can also increase the rate of bone loss. Steroids, thyroid, and anticonvulsant medications are known to weaken bone. Undergoing hormone therapy, known as androgen deprivation therapy (ADT), can also contribute to bone loss.

ADT is a therapy for men that reduces testosterone levels and prevents abnormal cells in the prostate from growing. Unfortunately, testosterone also plays a vital role in men’s bone health. When testosterone levels drop, bone health is at risk. Although ADT is effective, it increases the risk of bone loss.  

ADT and Bone Health 

The American Urological Association (AUA) has recognized bone loss as a significant side effect of ADT and published guidelines recommending that health care providers prescribe calcium and vitamin D for all men receiving ADT. AUA also recommends smoking cessation and weight-bearing exercises to help reduce bone loss. The Food and Drug Administration (FDA) also recognizes the importance of calcium, vitamin D, and physical activity on bone health. They approved the health claim that “adequate calcium and vitamin D as part of a healthful diet, along with physical activity, may reduce the risk of osteoporosis in later life.”  

A Deeper Look at Nutrients Needed During ADT 

Calcium for Bone Health 

Calcium is the most abundant mineral found in the body and stored in the bones. Milk, dairy products, and calcium-fortified juices, cereals, and plant-based “milks” (soy, almond, coconut, etc.) are rich calcium sources. Other foods with calcium include broccoli, cabbage, kale, mustard, and turnip greens. Even with all these options, many people still fall short of meeting their daily calcium needs. 

The National Osteoporosis Foundation (NOF) and the National Academy of Medicine (NAM) recommend men between the ages of 50 to 70 consume 1,000 mg of calcium per day, and men 71 years and older consume 1,200 mg of calcium daily. These recommendations take into consideration calcium from both food and supplements.  

It is essential to know how much calcium you are consuming because more calcium is not necessarily better. Too much calcium (more than 1,200 to 1,500 mg per day) may increase the risk of developing kidney stones and heart health concerns.  

To find out how much calcium you get from your diet, the International Osteoporosis Foundation offers a simple calcium calculator you can use. As general guidance, three to four servings of dairy foods daily will provide you with the calcium you need. Examples of one serving of dairy include 8 oz. of milk or 1.5 oz. of cheese. If you are looking to get your calcium from non-dairy sources, it will take a bit more. Two and a half (2 ½) cups of steamed broccoli will provide one serving of calcium. 

Vitamin D for Bone Health 

Vitamin D is a fat-soluble vitamin that is naturally present in some foods (egg yolks, cheese, beef liver, and fatty fish), fortified to other foods, and available as a dietary supplement. It is also produced endogenously when ultraviolet (UV) rays from sunlight strike the skin and trigger vitamin D synthesis. The amount made by your skin varies depending on age, location or latitude, time of day, smog, and use of sunscreen. Unfortunately, very few Americans get enough sun exposure to keep their vitamin D levels healthy. At least one-third of Americans have low vitamin D levels.  

Adequate vitamin D is needed for your body to absorb calcium. Without Vitamin D you cannot achieve optimal bone health. The recommended daily allowance (RDA) for vitamin D for adults is 15 mcg (600 IU) and increases to 20 mcg (800 IU) after age 71. Many vitamin D experts consider the RDA to be conservative and recommend higher intakes for most adults. Even the NOF recommends a higher intake of 20 to 25 mcg (800 to 1,000 IU) of vitamin D daily for all men over age 50.  

These recommended doses consider all sources – food, supplements, and sunlight. Even if following a healthy diet, many people will need to take a calcium and vitamin D supplement to support bone health. Always discuss with our health care team to determine what you need to keep your bones healthy. 

Exercise During ADT  For Bone Health Support

In addition to calcium and vitamin D supplementation and smoking cessation, the American Urological Association recommends adding weight-bearing exercises to your daily routine to help slow down bone loss in men on ADT.  

Weight-bearing exercises are activities that force you to work against gravity. When you do weight-bearing exercises, your bones support your bodyweight. Exercises such as walking, hiking, climbing stairs, playing tennis, and even dancing to your favorite music are examples of weight-bearing activities. Aim to participate in weight-bearing exercises for at least 30 minutes on most days of the week. You can do 30 minutes all at once or break it up throughout the day. For example, you can either go for a 30-minute walk once a day or for a shorter 10-minute walk three times a day.  

Another form of exercise that can keep bones healthy is resistance training. These are activities where you move your body against a weight or some other type of resistance. Exercises such as weightlifting and using elastic exercise bands are examples of resistance training activities.  

As with starting any exercise routine, men on ADT should discuss with their health care team to determine the best type of physical activity for them. 


ADT is an effective therapy. Including weight-bearing exercises, resistance exercises, not smoking, and ensuring adequate calcium and vitamin D intake are some simple steps to maintain a healthy quality-of-life and reduce the risk of bone loss.  

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