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Grampian Osteoporosis Service

Grampian Osteoporosis Service exists to provide bone density scans and clinical assessments to those at risk of osteoporotic fractures.  

 

Please note that a DXA Scan and an Isotope Bone Scan are different procedures - please see link to indications for a bone density scan

 

For more information please click on the links on the LHS Homepage.

 

                           Important Calcium Update

                                         

                             Calcium and Vitamin D Supplementation

Following the recent studies suggesting a possible link of oral calcium supplements with cardiovascular disease the following advice is suggested for patients with osteoporosis or those treated with bisphosphonates:

 

1) Do not prescribe calcium supplements without additional vitamin D supplementation. 



2) If oral intake of calcium is calculated by questionnaire as being <700 mg/day, please supplement with calcium and Vitamin D tablets to total calcium intake between 800 and 1200 mg. Encourage patient to improve their dietary calcium intake with view to potentially stopping the supplement in the long term.  

 

Please click on link for Calcium Questionnaire Calcium Questionnaire

 

3) If oral calcium intake>700 mg but vitamin D levels are low (<50 nmol/l) consider giving vitamin D alone either intramuscularly, by using cod-liver oil capsules, or using a multivitamin preparation.

 

Examples of vitamin D preparations:

 

High strength cod liver oil capsules-'across the counter'-for those with borderline vitamin D levels.

 

Ergocalciferol IM injection 300,000 IU-annual- Particularly prior to IV zoledronate or in those who appear to have poor absorption of medications

 

Ergocalciferol 250ug -10,000 IU orally, this could be given as a weekly oral tablet

 

Vitamin A and D supplements oral 4000 U vitamin A, 400 IU Vitamin D
not suitable in pregnancy and need to watch amount of Vitamin A being prescribed

 

Multivitamin Capsule: ascorbic acid 15mg, nicotinamide 7.5 mg, riboflavin 500ug, Thiamine 1mg, Vitamin A 2500 U, Vitamin D 300IU

 

It is estimated that 400 IU =10ug can prevent deficiency in vitamin D but 800IU or more may be needed to restore levels if already deficient.

 

Sunvitd3 is a commercially available vitamin D preparation which can be sourced and bought from the website www.sunvitd3.co.uk
This preparation may be valuable for some patients as it is in tablet form and contains 1000IU vitamin D. It is not a medicine available on prescription.

 

 

Dr Alison Black Consultant Rheumatologist

Prof David Reid   Professor of Rheumatology