Osteoporosis

• RISK FACTORS FOR OSTEOPOROSIS: include early menopause, family history of osteoporosis, inadequate calcium or Vitamin D intake (eg, alcoholism, anorexia, celiac disease), Asian or Caucasian descent, smoking, amenorrhea, personal history of bone fractures as an adult, history of bone fractures in a parent or sibling, having a small or thin frame, type 1 diabetes, thyroid or renal disease, immobility/inactivity, and some drugs (eg, chronic corticosteroid intake, anticonvulsants, immunosuppressants, antiestrogens).

• PREVENTION OF OSTEOPOROSIS: includes adequate lifetime intake of calcium (preferably from dietary sources) and Vitamin D, weight-bearing exercise, and drug therapy for patients at risk.

a) Recommended calcium intake: Birth–6 months: 400mg/day. 6–12 months: 600mg/day. 1–5 yrs: 800mg/day.
6–10 yrs: 800 to 1200mg/day. 11–24yrs: 1200mg to 1500mg/day. Women 25–50yrs: 1000mg/day.
Pregnant or lactating women: 1200 to 1500mg/day. Postmenopausal women on estrogen replacement therapy: 1000mg/day.
Postmenopausal women not on estrogen replacement therapy: 1500mg/day. Women and men over 65yrs: 1500mg/day.
Up to 2000mg/day appears to be safe in most individuals.

b) Vitamin D recommended intake is 400 IU/daily for women under the age of 25 yrs (usually met through daily exposure to sunlight). If supplements are used, the goal is to attain the minimum RDA without toxicity.

c) HRT: If bone loss is due to estrogen deficiency at menopause, estrogen therapy may be started. Individualize to the lowest effective dose and reevaluate periodically. Administer progestin with estrogens in women with intact uteri. Women who have had a hysterectomy may be given estrogen continuously.