These guidelines can help reduce loss of bone-mineral density and risk of osteoporosis, which is an issue for people who have had long-term treatment with prednisone or other corticosteroids.
- Vitamin D
- Adult hormone-replacement therapy
- Height and weight
Daily Calcium and Vitamin D Requirements During Prednisone Treatment
(mg = milligram; IU = international unit)
|0 to 6 months||400 mg||300 IU|
|6 to 12 months||600 mg||400 IU|
|1 to 3 years||800 mg||400 IU|
|4 to 5 years||800 mg||400 IU|
|6 to 8 years||1200 mg||400 IU|
|9 to 18 years||1600 mg||400 to 800 IU|
|Adults||1500 mg||800 IU|
It is good to get calcium from foods, when possible (see the calcium content of foods below). Calcium-containing foods contain other important nutrients, such as protein, vitamins, and minerals.
Calcium Content of Selected Foods
(oz. = ounce)
|Food||Serving Size||Milligrams Calcium|
|Beans: baked or refried||½ cup||65|
|Calcium-fortified orange juice||1 cup||300|
|Cheese||1 oz. or 1” cube||200|
|Cheese pizza (12”)||¼||250|
|Cocoa, instant, mixed with water||1 cup||90|
|Cottage cheese||½ cup||70|
|Cream soup (made with milk)||1 cup||180|
|Ice cream or ice milk||1 cup||175|
|Macaroni and cheese: homemade or
frozen, packaged or canned
|Milk (nonfat, 2%, whole, buttermilk)||1 cup||300|
|Milk, calcium fortified||1 cup||400|
|Homemade milkshake||10 oz.||320|
|Yogurt: plain, coffee, vanilla
|Ensure Plus||1 cup||165|
|Instant Breakfast (made with milk)||1 serving||500|
|Boost and Boost Plus||1 cup||200|
|Citracal + D||1||315|
|Viactiv or CalBurst||1||500|
Choosing a Calcium Supplement
If you are not able to get the amount of calcium you require from foods, you should take a calcium supplement. Choose a supplement with vitamin D if your intake of vitamin D from food and your multiple-vitamin supplement does not meet your requirement.
There are two main types of calcium supplements: calcium citrate and calcium carbonate. The following table shows the differences between these supplements and the best time to take them. Note: If you are taking a prescription to decrease stomach acid or you use antacids on a daily basis, calcium citrate is recommended (instead of calcium carbonate).
You should avoid taking calcium supplements at the same time that you take an estrogen-replacement medication.
Do not take more than 500 mg calcium at one time. This is the largest amount your intestines can absorb in a single dose. If you require several calcium supplement doses each day, space them throughout the day and try to take each dose at a time when your calcium intake from food is low.
(Tums, Oscal, Caltrate, Viactiv, CalBurst)
|Can be taken anytime during the day.||Must be taken with meals or snacks for best absorption.|
|Does not require stomach acid for absorption.||Requires stomach acid for absorption. Do not take with antacids.|
|Gentle on stomach.||May cause gas, constipation, bloating.|
|Look for “USP” on label or box. (Confirms pill will dissolve in normal stomach acidity.)|
Vitamin D helps your body absorb and utilize calcium. Vitamin D is obtained from your multiple vitamin, fortified milk, and vitamin D-containing calcium supplements.
Calcitriol is a special form of vitamin D available only by prescription. It may be given if your blood level of 25-OH-vitamin D is low. (This must be measured by a special blood test that your doctor can order.) Your doctor can obtain additional information about Calcitriol dosing recommendations by calling the Long-Term Follow-Up office at Fred Hutchinson Cancer Research Center at (206) 667-4415.
Daily exercise for 20 to 60 minutes is important to maintain bone density. Exercise should include both aerobic and resistive activity. Examples of aerobic exercise include walking, biking, dancing and nordic-trakking. Avoid running or other activities that put stress on your joints. Examples of resistive exercise include lifting weights, carrying groceries or doing stretch-band exercises. Talk to a physical therapist for guidelines to meet your needs.
Discuss hormone replacement therapy with your doctor. Following are general guidelines:
- Estrogen replacement therapy should be given to menopausal women, unless contraindicated.
- Testosterone replacement should be given to adult men if their serum level is below 200 ng/mL, unless contraindicated.
The safety of bisphosphonates has not been studied in transplant recipients. However, considering the benefits reported in nontransplant settings, treatment with bisphosphonates may be considered in patients with any of the following complications:
- Having a history of nontraumatic fractures, vertebral compression or impact fractures, or hip-bone density below 650 mg/cm2
- Having DEXA T-score of -2.5 or lower with steroid therapy anticipated to continue for longer than six months
- Being a post-menopausal woman who cannot receive hormone replacement therapy
- Having significant weight loss
Discuss with your doctor whether you are a candidate for an oral bisphosphonate (Alendronate) or intravenous bisphosphonate.
Height should be measured twice yearly in adults and monthly in children age 18 or younger. Weight should be measured monthly.
Bone density scans called DEXA scans should be performed every nine to 12 months to monitor changes in bone density while continuing on prednisone therapy.