0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18
1110 OsteoporosisGeneral Measures
■Hygienic program of adequate calcium intake unless patient hyper-
calciuric (24-h urine calcium >300 mg/d)
■Vitamin D maintenance: At least 800 IU/day. Can use 50,000 IU vita-
min D capsule once each week. For vitamin D-deficient patients,
3 months repletion with 50,000 IU/week should precede mainte-
nance. Vitamin D3 superior to Vitamin D2.
■Program of daily weight-bearing exercise adjusted by individual tol-
erability
■Attention to risk of fall
Indications
Criteria for treatment
■History of low-trauma fracture
■BMD T-score of−2.5 or lower
■BMD T-score of−2 or lower in presence of additional risk factors
(family history, menopausal status)
■For higher BMD values, and no low-trauma fractures, pharmacologic
treatment not recommended
specific therapy
■Established osteoporosis:
■Antiresorptive medications: act to reduce osteoclastic bone resorp-
tion
➣Bisphosphonates:
Alendronate, risedronate taken fasting with 6 oz water only
Wait 30 min in upright position before taking other medica-
tions or food
Decrease risk of subsequent vertebral and non-vertebral frac-
tures, including hip fracture, by 40–50% when given for 3 y
Reduced vertebral fracture incidence within 1 y of treatment
Ibandronate, vertebral fracture reduction, no reduction in
non-vertebral fracture
➣Selective estradiol receptor modulator (SERM):
■Raloxifene
➣Decrease vertebral fracture incidence by∼40% in women with
osteoporosis; fracture efficacy at other sites less certain
■Calcitonin:
➣Decreases vertebral compression fracture incidence by∼40%,
but no effect on non-vertebral fractures
➣Prevention of osteoporosis: