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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




Total per week

Multiplied by

Total mg calcium


Cups of tea with milk





Cups of coffee with milk





Milky drinks





Milk with cereal





Slices of white or brown bread





Slices of wholemeal bread





Portions of cheese





Portions of cottage cheese










Portions of cake





Portions of milk pudding





(custard, ice cream, yoghurt etc)





Portions of green vegetables





Portions of sardines or pilchards





Portions of fish















Pancakes or crumpets










Eggs (X2 for scrambled or omelette)





Cheese omelette





Cheese sauce










Lasagne, moussaka or similar







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.



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


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


250ng twice daily


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)