Risk Factors
Race (caucasian has greater risk than African American/Asian), family history, small stature/weight, anorexia, decreased estrogen levels (I.e. post-menopausal), increased age, female, smoking, decreased physical activity, low calcium intake, high phosphate diet (i.e. cola), caffeine use, hyperthyroidism, Cushing's syndrome, rheumatoid arthritis, medications (aluminum antacids, corticosteroids, furosemide, phenytoin, synthroid)
Diagnosis of Osteoporosis
Done by DEXA (bone) scan: 1-2.5 standard deviations from average - osteopenia
2.5 or greater standard deviations from average - osteoporosis
Prevention Guidelines
1. Maintain adequate intake of dietary calcium (from daiy products, etc.)
2. Increase intake of vitamin D (from fortified daily products, cod, or fatty fish)
3. Weight-bearing exercise (walking, etc.) three-five times per week
4. Calcium supplementation: 1000-1500mg elemental calcium daily (divided into 500mg per dose).  Amount of calcium needed based on patient demographics: adults over 51 - 1200mg/day, post-menopausal women on estrogen - 1000mg/day, post-menopausal women or men over 55 - 1500mg/day
5. Bisphosphonates (alendronate 5mg/day or 35mg/week; risidronate 5mg/day or 35mg/week)
6. Selective estrogen receptor modulators (SERMs) - can be used in patients where hormone replacement therapy is contraindicated (ex. Evista 60mg daily)
7. Estrogens - not considered first line therapy for prevention of osteoporosis because of increased risk of breast cancer, heart disease, stroke, and DVT (premarin 0.625mg/day +/- provera 2.5mg/day (only use provera if patient has intact uterus))
8. Vitamin D supplementation if dietary intake inaqequate: 400-800 units/day and/or 15 minutes exposure to direct sunlight
Treatment Guidelines
1. Calcium, vitamin D, and exercise as listed in prevention guidelines above
2. Estrogen therapy as listed above if tolerated
3. Bisphosphonates are considered first line agents in the treatment of osteoporosis (alendronate 10mg/day or 70mg/week; risidronate 5mg/day or 35mg/week)
3. Calcitonin is often used as an adjunct treatment for hypercalcemia or in cases where estrogens or bisphosphonates are contraindicated (100u/day IM or 200u/day intranasal for osteoporosis; 4-8u/kg every 12 hours for hypercalcemia).  Adequate vitamin D intake is essential.
4. Selective estrogen receptor modulators (SERMs) can be used in patients who cannot tolerate estrogen therapy or it is contraindicated (ex. Evista 60mg daily)
5. Fall prevention - BP monitoring for orthostasis, diuretics given in the morning, minimization of sedating medications (I.e. benadryl)
Types of calcium and percent of elemental calcium contained
Type of calcium Percent elemental Ca
Acetate 25%
Carbonate 40%
Citrate 21%
Glubionate 6.50%
Gluconate 9%
Lactate 13%
Phosphate tribasic 39%
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