How to manage drugs that affect bone health
| General recommendations |
| Reassess need for medication |
| Use lowest dosage and shortest duration needed |
| Counsel patients on lifestyle changes: encourage weight-bearing exercise, cessation of tobacco use, and limiting alcohol use |
| Supplement calcium and vitamin D |
| Consider screening and monitoring bone density with dual-energy absorptiometry (DXA) |
| Initiate osteoporosis treatment if indicated |
| Oral glucocorticoids |
| Therapy anticipated for ≥ 3 months at any dose: get baseline DXA scan |
| Follow American College of Rheumatology recommendations for initiating osteoporosis prevention treatment |
| Proton pump inhibitors |
| Supplement calcium with calcium citrate |
| Consider alternative therapy such as a histamine-2 receptor blocker |
| Aromatase inhibitors |
| Consider bisphosphonate treatment for postmenopausal women with T scores < –2.0 or with other risk factors |