Bone Density Test Before Starting ADT?

I had a baseline bone density scan before starting 3 years of ADT2 (Lupron + Casodex). My health insurance covered it at the time, and I'd have to look up the cost. My baseline was almost exactly nominal, slightly low (overall, T score was 0, so "normal"; there are many spots they assess so they vary somewhat).

After 18 months on ADT2, another bone density scan revealed osteopenia (T score of -2.3, with osteoporosis beginning at -2.5). That is a very significant drop in such a short time, so ADT was clearly giving me some issue there. We began Prolia therapy as a result.

But I don't know that the baseline reading really made a big difference. It sure supported that ADT was the likely cause. However, with or without the baseline we wouldn't have done anything different. I wasn't going to stop ADT even if it was the cause, and with that low T value we would have done something to help with bone density anyway.

Looking back, I guess I'd say the baseline was interesting to me, and possibly clinically helpful, but overall with or without wouldn't have changed what we did. However, if it had started out at -2.3, we would have still done ADT, but likely wouldn't have waited very long before initiating Prolia.

As an engineer, we often have to decide whether to do some test or another. If it will change what we do, then go ahead and test. If not, then the test isn't worth doing. For my personal situation, the baseline bone density scan was really only of marginal utility. Would I have spent $400 for it, knowing what I do now? Probably, but I was facing a daunting diagnosis and wanted to know everything.

ADT can cause loss of bone density, but it's generally slow. I'm sure Tall Allen has informational links, but I'm just sharing my humble experience, a sample of one.

I had a baseline bone scan prior to 18 months of ADT, but insurance did pay for it. I was also on Prolia for the entire time as a preventive measure--also paid for by insurance. In my case, my follow-up bone scan showed no loss of bone density over that period.

Unfortunately, I don't really have a way of assessing the value of it if you have to pay for it out-of-pocket. I also don't know if adding Prolia--or a similar drug--would provide a value or if insurance would pay for it.

Thanks for the brotherly replies. Teddy9 has made a good case that the pre-ADT test may be useful in making a decision about therapy at a later date. That's enough to push me into doing the DEXA scan. Contrary to what I was told by the UCSF NP, the nurse I talked to at Northern California Institute for Bone Health asked me some questions that convinced her that Medicare would pay in my case. We shall see.

I forgot to ask whether anyone's ever heard of the Tribecular Bone Score is worth doing. NCIBH recommends it, because it provides better information about the texture of the bone in the spine, which, I understand, is one place that ADT may bring about significant deterioration with nasty consequences. Perhaps Tall Allen has written about this, but I couldn't find any comments on the subject.

T