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Osteoporosis Nutrition Guidelines

Long-term treatment with prednisone or other corticosteroids can result in loss of bone-mineral density, or osteoporosis. Adults taking prednisone should have their height monitored twice yearly (monthly in children age 18 or younger). Bone-density scans called DEXA scans should be performed every 9 to 12 months to monitor changes in bone density while continuing on prednisone therapy.

Nutrition recommendations to minimize the risk of osteoporosis follow.


Daily Calcium and Vitamin D Requirements During Prednisone Treatment

(mg = milligram; IU = international unit)

Requirement During
Prednisone Use
Requirement During
Prednisone Use
0 to 6 months 400 mg 300 mg
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
Custard ½ cup 150
Ice cream or ice milk 1 cup 175
Macaroni and cheese: homemade or frozen
packaged or canned
1 cup
1 cup
Milk (nonfat, 2%, whole, buttermilk) 1 cup 300
Milk, calcium fortified 1 cup 400
Homemade milkshake 10 oz. 320
Pudding ½ cup 150
Tofu ½ cup 130
Yogurt: plain, coffee, vanilla
1 cup
1 cup
Ensure 1 cup 125
Ensure Plus 1 cup 165
Instant Breakfast (made with milk) 1 serving 500
Boost and Boost Plus 1 cup 200
Citracal + D 1 315
Tums 1 200
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.

Calcium Citrate
Calcium Carbonate
(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.)

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Vitamin D

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.

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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.

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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.

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Adult Hormone-Replacement Therapy

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.

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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.

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Height and Weight

Height should be measured twice yearly in adults and monthly in children age 18 or younger. Weight should be measured monthly.

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