Prevention in Postmenopausal Women

Intervention	Guideline
Calcium	NIH Guidelines: If less than 65 years and receiving estrogen, 1000 mg/day. If more than 65 years or not receiving estrogen, 1500 mg/day. Divide doses into 500 mg or 600 mg/dose to improve absorption
Vitamin D	400-800 IU/day.
Exercise	If woman is physically able, recommend weight-bearing exercise.
Individual Risk Factor Reduction	Limit alcohol, caffeine intake, concomitant drugs known to affect bone metabolism; increased body weight decreases risk.
Hip Protectors	Hip protectors have been shown to statistically significantly decrease the rate of infracture in high risk patients who have a poor balance or a prone to fall for other reasons.
Fall Prevention Strategies	Review and implement interventions when applicable and possible (medications, gait, balance, muscle strength, transfer skills).
Estrogen Replacement Therapy	Initial preventive therapy. Note FDA-approved doses for osteoporosis prevention. 80% of women maintain BMD at these doses. Give progestin therapy to women with intact uterus.
Evista	60mg/day for preventive therapy. FDA aprroved. 80% of women maintain BMD at the FDA approved dose. No progestin therapy is necessary.
Alendronate	5 mg/day for preventive therapy.
Risedronate	5 mg/day for preventive therapy.
Calcitonin	Not approved for preventive therapy.
Anabolic Steroids (testosterone)	Not recommended.
Diagnostic Strategies	Measurement of bone mineral density; risk factor assessment. See also our sample DEXA scans.

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