Risk factors for osteopenia or osteoporosis:
(1) long term therapy with corticosteroids, especially oral doses above 5 mg prednisone per day (or equivalent) for >= 3 months
(2) older age, especially for post-menopausal women
(3) immobility from lung disease
(4) concurrent diseases (COPD, malignancy, cystic fibrosis, malabsorption, etc)
(5) anorexia and malnutrition
Steps to prevent or reverse osteopenia or osteoporosis:
(1) Avoid oral steroid therapy if possible.
(1a) Use inhaled steroids over oral, but these can result in decreased bone density.
(1b) If oral steroids are necessary, use the lowest dose for the shortest period.
(1c) Alternate day therapy with oral steroids does not reduce the adverse effects on bone.
(2) Discontinue smoking and minimize alcohol intake.
(3) Exercise.
(4) Identify risk factors for fall injury and take steps to minimize.
(5) Maintain adequate calcium and vitamin D intake (1,200 mg calcium and 800 IU vitamin D per day).
(5) Initiate bisphosphonate therapy if indications are present. If the patient is unable to tolerate bisphosphonates then consider calcitonin or parathyroid hormone 1-34.
(6) If deficient in estradiol or testosterone, then consider hormone therapy.
(7) Identify and treat other diseases impacting bone.
