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General Lifestyle Advice

Patients with osteoporosis should be given general lifestyle advice to help reduce their future risk of fracture. Measures which are appropriate in most patients included:

Optimising dietary calcium and Vitamin D intake

Stopping smoking

Maintaining alcohol intake to within recommended limits (<14 units/week in women; < 21 units/ week in men)

 

Our calcium questionnaire is shown below. 

To assess your average daily calcium intake enter the number of times in a week that you eat the food listed below, multiply that number by the values given and enter that in the column total.  Add up the totals in the last column and then divide by seven to get your average daily calcium intake.

 

Example:  for cups of tea with milk if you have tea 21 times in a week:

 

Cups of tea with milk  21 X 40mg = 840mg

 

 

Food

Total per week

Multiplied by

Total mg calcium

 

Cups of tea with milk

 

40mg

 

 

Cups of coffee with milk

 

50mg

 

 

Milky drinks

 

250mg

 

 

Milk with cereal

 

155mg

 

 

Slices of white or brown bread

 

30mg

 

 

Slices of wholemeal bread

 

15mg

 

 

Portions of cheese

 

320mg

 

 

Portions of cottage cheese

 

50mg

 

 

Biscuits

 

30mg

 

 

Portions of cake

 

50mg

 

 

Portions of milk pudding

 

100mg

 

 

(custard, ice cream, yoghurt etc)

 

 

 

 

Portions of green vegetables

 

40mg

 

 

Portions of sardines or pilchards

 

350mg

 

 

Portions of fish

 

50mg

 

 

Porridge

 

37mg

 

 

Muesli

 

100mg

 

 

Pancakes or crumpets

 

80mg

 

 

Oranges

 

75mg

 

 

Eggs (X2 for scrambled or omelette)

 

37mg

 

 

Cheese omelette

 

477mg

 

 

Cheese sauce

 

190mg

 

 

Quiche

 

200mg

 

 

Lasagne, moussaka or similar

 

225mg

 

 

 

 

TOTAL per week

 

 

 

 

Divide by 7

 

 

 

 

 

for daily intake

 

 

 

 

Website: nhsggrampian.org/osteoporosis

NHSG Osteoporosis Advice Line: 01224 555078 (message service)

National Osteoporosis Society Helpline: 0845 450 0230

 

Additionally if a patient with osteoporosis appears to be at increased risk of falls (has fallen more than 3 times in the last year or is unable to get out of a chair without using the arms of the chair) then appropriate falls advice should be given. This includes:

assessments for the medical causes of falls such as postural hypotension, Parkinson?s disease and cerebral vascular disease

Eye sight assessments

Physiotherapy assessments

Home modifications to provide a safe environment.

 

Medications

The aims of medical treatments for osteoporosis are to reduce fracture risks. Medications which do this do so either by preventing osteoclastic bone resorption (antiresorptive drugs) or by stimulating bone formation (anabolic drugs). The most appropriate medication fro osteoporosis are those which prevent both vertebral and hip fractures. NICE guidelines promote the use of generic Alendronic acid, other medications are only suggested at certain risk cut offs: please see http://www.nice.org.uk/ advice section.

 

Calcium and Vitamin D

Calcium and vitamin D supplements are generally used as adjunct therapy to other osteoporosis medications. They do not appear to be effective in reducing fractures when used alone, except in those at high risk of vitamin D deficiency, such as nursing home patients and potentially the house bound elderly. Additionally Vitamin D supplements may have a role in improving muscle function and hence falls reduction.

The UK recommendations for calcium intake are 700 mg in adults. USA recommendations are higher (up to 1000 mg per day).

Most international pharmaceutical studies co prescribed calcium and vitamin D in all their subjects-normally with 1000 mg calcium and 800 IU vitamin D.

 

The following medications are all licensed for use in osteoporosis

Bisphosphonates:

Alendronic acid 10 mg daily, 70 mg weekly

Risedronate 5 mg daily, 35mg weekly

Ibandronate 150 mg monthly, 3 mg IV 3 monthly

Cyclical etidronate therapy 400mg daily for 2 weeks in every 12

Hormone Replacement Therapy

Oral, or patch: with/ without progestogens depending of whether previous hysterectomy or not

 

Raloxifene Therapy

60 mg daily

Strontium Ranelate

2 gram sachets daily

Calcitriol

250ng twice daily

Calcitonin

IM (50 units/ml) or nasal (200 units/day)

Parathyroid Hormone Analogues

Teriparatide (Forsteo) daily SC injection for 18 months

Parathyroid Hormone (Preotact) daily SC injection for 24 months

 

Denosumab (Prolia) 60mg sc injection 6 monthly (recetly approved for use in primary and secondary care for those women unable to take a bisphosphate after specialist advice)