Prevention and treatment strategies

A. A balanced diet including 1000-1500 mg of calcium, weight bearing exercise, and avoidance of alcohol and tobacco products should be encouraged. Daily calcium supplementation (1000-1500 mg) along with 400-800 IU vitamin D should be recommended.

B. Females who are not willing or incapable of receiving estrogen therapy and have osteopenic bone densities may consider alternative agents such as alendronate and raloxifene. After the age of 65, a bone density test should be performed to decide if pharmacologic therapy should be considered to prevent or treat osteoporosis.

Drugs for Ostioporosis

Drug

Dosage

Indication

Comments

Estrogen

0.625 mg qd with medroxy-progesterone (Provera), 2.5 mg qd

Prevention and Treatment

Raloxifene (Evista)

60 mg PO QD

Prevention

No breast or uterine tissue stimulation. Decrease in cholesterol similar to estrogen.

Alendronate (Fosamax)

5 mg PO QD 10 mg PO QD

Prevention Treatment

Take in the morning with 2-3 glasses of water, at least 30 min before any food, beverages, or medication. Reduction in fracture risk.

Calcitonin

200 IU QD (nasal) 50-100 IU QD SQ

Treatment

Modest analgesic effect. Not indicated in the early post-meno-pausal years.

Calcium

1000-1500 mg/day

Prevention/Treatment

Calcium alone may not prevent osteoporosis

Vitamin D

400-800 IU QD

Prevention/Treatment

May help reduce hip fracture incidence

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