Dr. Michael Holick explains the importance of monitoring bone health during prostate cancer treatment, discussing how vitamin D, calcium, bone density testing, and medications such as Xgeva or Zometa can help reduce bone loss and support long-term bone health, particularly for patients with metastatic disease.
Dr. Michael Holick:
Now I'm beginning to continue to wonder about my muscle function and bone health, and so I did a bone density. And since I ran the bone healthcare clinic, I knew very well what bone density means. And so they did a bone density at a local hospital and I had what's called a T-score of minus 1.4 in my hip. And what that means is that I have osteopenia. By definition, a T-score of minus one to minus 2.5 means that you have less bone mass than you would like, but it's not osteoporosis. Minus 2.5 and greater is considered to be osteoporosis. And so the patients that I saw with breast cancer and prostate cancer to prevent bone loss, I had them on adequate amount of vitamin D.
Now, the Endocrine Society recommends that men and women, all adults, should be on 1,500 to 2,000 units of vitamin D a day, and you need an adequate amount of calcium, 1,000 milligrams a day. And so many of my patients that followed my advice did very well and maintained their bone density. But men and women with metastatic bone disease often are placed on what's called Xgeva, also known as Zometa. And what it does, this drug has an effect on your bone cells to possibly help reduce the activity of the metastatic disease in your bones. And so I had been treating patients for more than a decade for this.
And so I personally take 5,000 units of vitamin D a day, my 25 hydroxyvitamin D level, the Endocrine Society recommends should be at least 30 nanograms per ml, and the preferred range is 40 to 60 nanograms per ml. And so I'm on 5,000 units a day. My blood level is 72 nanograms per ml. I drink three glasses of milk a day. There's 300 milligrams and eight ounces of skim milk. And so I have adequate calcium and adequate vitamin D.