
Prophylaxis
If a patient is likely to have a higher dose of glucocorticoids or be given prednisone for a longer period than indicated above, then measures should be initiated to try to prevent excessive bone loss. This also applies to cyclosporin and tacrolimus treatment.
- Assess BMD if any suspicion of pre-existing osteoporosis.
- Start calcium 500 mg - 1000 mg daily (caution in myeloma or other diseases if there has been previous hypercalcaemia). Use Effervescent Calcium 1000 mg nocte or Calcium Carbonate 1.25 g nocte. This should be taken with the evening meal.
- In addition, give vitamin D analogue such as colecalciferol 1.25 mg tab PO every month.
- Monitor magnesium levels if on tacrolimus and check for hypogonadism if on prolonged cyclosporin and/or steroids.
- Advise patients to maintain a calcium rich diet. To meet the recommended intake of 1000 mg/day, 3 - 4 servings of calcium rich foods /day are recommended. Choose from:
- 1 glass standard milk (blue top)
- ½ glass calcium fortified milk (yellow top)
- 30 g cheddar, edam or Colby cheese (2 medium slices)
- 1 pottle yoghurt (125 -150 g). The calcium content varies from brand to brand.
- 2 scoops (1 cup) ice cream
Topic Code: 5072