Before beginning hormone treatments for prostate cancer, talk to your doctor and have him assess your bone density, vitamin D and calcium levels.

Men battling prostate cancer often face bone loss as a result of both the cancer and some of the treatments. As your bones lose density, you can be at risk for fractures, joint paint and even spine compression, where vertebrae can sink into each other.

If you’re one of the men facing bone loss from prostate cancer, all is not lost—there are ways to ease the burden on your bones.

The Culprit

Hormone treatments like androgen deprivation therapy that reduce levels of male hormones are used in certain prostate cancer cases. But reducing hormones like testosterone in a man’s system can lead to low bone density. Making matters worse, if prostate cancer has spread to bones, then you’re not only facing bone loss from the hormone treatments but also from the cancer.

Before beginning hormone treatments, talk to your doctor and make sure it’s safe and healthy.

“It’s important to assess bone density, vitamin D and calcium levels before beginning this treatment,” says Dr. Sven Wenske, urologist with New York-Presbyterian Hospital.

Treatment Plan: Medication

Bisphosphonates are medicines that help slow or stop bones tissue from breaking down. They are commonly used to prevent and treat osteoporosis and can be used in situations where cancer has spread to bones.

Zoledronic acid is a bisphosphonate given through injection once every three to four weeks. It slows down bone breakdown, increases bone density and reduces the amount of calcium released by the bone, according to the National Institutes of Health.

There are also medicines known as RANK ligand inhibitors that help prevent breakdown of down bone cells. One of these is denosumab, which is approved by the U.S. Food and Drug Administration and injected under the skin every four weeks.

A newer drug called Xofigo was approved by FDA in 2013 to treat advanced prostate cancer. Xofigo binds to certain bone minerals to help make sure radiation targets cancer tissue rather than surrounding healthy tissue.

“It’s a very short radiation treatment that happens exactly in those metastatic sites and can delay skeletal related events or fractures,” Wenske says.

Treatment Plan: Lifestyle

Throughout prostate cancer treatment, it’s important to maintain a healthy weight and stay active, both of which are key to helping prevent bone loss, Wenske says. You should also make sure you’re getting the right amount of vitamins and nutrients.

“Take calcium and vitamin supplements during treatment,” Wenske says.

Who to talk to

Find out as much information as possible about available treatment options for bone loss, even if it means talking to more than one urologist to get a different perspective, Wenske says.

“Many urologists are still hesitant or unaware of the workup of patients who experience metastatic prostate cancer and need to be treated with the hormone treatments, and they don’t assess their bone density well enough at baseline,” Wenske says.

“Many urologists don’t implement the treatments we have now to prevent (bone loss) from happening. These are things urologists needs to be aware of and implement more often.”