Prevention of Osteoporosis

Age	Daily Calcium Intake
1 to 3	500 mg/day**
4 to 8	800 mg/day**
9 to 18	1,300 mg/day**
19 to 50	1,000 mg/day*
51 to 64	1,200 mg/day*
65 and older	1,500 mg/day*

PREVENTION

To help prevent osteoporosis and bone fractures, determine whether you are getting enough calcium in your diet by using the Calcium Calculator.

Situation	You Need	What Should Happen
Woman nearing menopause, or postmenopausal	Complete medical evaluation to ensure good health; Bone Mineral Density test (BMD); assessment for skeletal risk factors	Discussion with your doctor about the effects of menopause; 1200 mg* of calcium daily; daily exercise program; vitamin D; consider treatment for osteopenia if FRAX score is abnormal (see About section) or T-score (measure of bone loss, is -2.5 or worse
Growing teenager	Assess diet, exercise, lifestyle	Regular exercise; no smoking; maintain normal weight; avoid unhealthy foods like soft drinks
Adult taking Thyroid Hormone	Thyroid Stimulating Hormone (TSH) test	Adjust thyroid dose to normalize thyroid level (normalize TSH)
Anyone taking a Steroid	BMD test	Take medications that counteract effect of these drugs on bone - bisphosphonates, calcium, vitamin D
Male over 50 with sexual dysfunction and/or history of osteoporosis in male family members	BMD test; endocrinologist evaluation for cause of sexual dysfunction	1200 mg* calcium daily, vitamin D 1000 units daily, regular exercise. Treat if BMD shows T-score of -2.5 or worse or FRAX score predicts high risk of fracture; treat
Teenager with delayed or absent sexual development	Complete medical and endocrine evaluation; diet assessment	Treat hormone deficiency if present; calcium, vitamin D (amount recommended by pediatrician), regular exercise if pediatrician permits; monitor growth and development
Middle-aged woman whose mother just had a hip fracture	BMD test and risk factor assessment	Discussion about good bone health measures (1200 mg calcium, 1000 IU vitamin D); treat osteopenia / osteoporosis if BMD and/or FRAX score indicates
Anyone with chronic illness, persistent unexplained weight loss, malignant disease	Complete medical evaluation for diagnosis of illness; BMD	Treat chronic disease: 1200 mg calcium; vitamin D 1000 IU daily; treat osteoporosis / osteopenia if present
Anyone taking Steroids (for example dexamethasone, prednisone, hydrocortisone)	Medical and endocrine evaluation to assess indication for cortisone and dose	Doctor to determine if dose used is equivalent to more than 5 mg of prednisone; and, if so, a bisphosphonate (for example Actonel, Fosamax), calcium and vitamin D supplements will be prescribed to protect your skeleton from the effects of your medication
Anyone with calcium levels that are higher than normal	An endocrinology evaluation for abnormal parathyroid function, vitamin D metabolism, or other causes of high calcium levels; BMD; tests for kidney function and for kidney stones	Cause of high calcium levels will be determined and treatment options fully discussed and considered

Prevent another fracture
If you have had a fracture that was not caused by severe trauma, as might occur in an auto accident, you are at increased risk to experience another fracture and additional measures may be required to avoid further fracturing.

To find out if you and your doctor are doing all you can to prevent another fracture, find the situation that best describes you in the left hand column.

Situation	You need	What should happen
Growing healthy child with a fracture suffered at play	Only to be more careful unless fractures is low impact or unusual
Growing child with multiple fractures	Pediatric endocrinology evaluation	Possibility of a congenital cause of osteoporosis will be explored
Teen or young adult with sports-related stress fractures	Medical and endocrine evaluation for possible osteoporosis	BMD in some cases; hormone tests to check for normal sexual development and maturity
Any adult with a low trauma fracture	X-rays; BMD test; evaluation for causes of osteoporosis if BMD low or x-ray suspicious for osteoporosis	1200 mg* calcium and multivitamins prescribed and osteoporosis / osteopenia treated if present
Patient 65 or older treated for a hip fracture	BMD medical evaluation	Will be treated for osteoporosis regardless of BMD result
Anyone who fractures while on approved treatment for osteoporosis	Evaluation by an endocrinologist or other specialist in metabolic bone disease	Other bone diseases, such as osteomalacia will be excluded; change in medication will be considered
Anyone who has multiple fractures and can't take prescribed treatment	Evaluation by endocrinologist or other specialist in metabolic bone diseases	Medications will be changed to a more tolerable drug, or intravenous or intramuscular drugs will be considered

*NOTE: There is concern about taking excessive amounts of calcium and vitamin D. Doses given in the tables are guides. Check with your physician, particularly if you have kidney stones or heart and vascular disease.

**Check with your pediatrician

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Osteoporosis

Osteoporosis Treatments