Osteoporosis: Nutrition Guidelines
Osteoporosis: Nutrition Guidelines
Long-term treatment with prednisone or other corticosteroids can result in loss of bone mineral density or "osteoporosis." People taking prednisone should have their height monitored twice yearly (monthly in children 18 years of age or younger). Bone density (DEXA) scans should be performed every 9-12 months to monitor changes in bone density while continuing on prednisone therapy.
Nutrition recommendations to minimize the risk of osteoporosis follow.
1. Calcium
2. Vitamin D
3. Calcitriol
4. Exercise
5. Adult Hormone Replacement Therapy
6. Bisphosphonates
7. Height and Weight
Calcium and Vitamin D Requirements during Prednisone Treatment
| AGE: | CALCIUM Requirement During Prednisone Use |
VITAMIN D Requirement During Prednisone Use |
| 0-6 months | 400 mg | 300 mg |
| 6-12 months | 600 mg | 400 IU |
| 1-3 years | 800 mg | 400 IU |
| 4-5 years | 800 mg | 400 IU |
| 6-8 years | 1200 mg | 400 IU |
| 9-18 years | 1600 mg | 400-800 IU |
| Adults | 1500 mg | 800 IU |
It is good to get calcium from foods, when possible (see the list of calcium content of foods below). Calcium-containing foods contain other important nutrients, such as protein, vitamins and minerals.
Calcium Content of Selected Foods
| Food | Serving Size | Calcium mg per serving |
| 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 |
200 100 |
| 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 Fruit |
1 cup 1 cup |
400 315 |
| 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 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 (Citracal®) |
Calcium Carbonate (Tums®, Oscal®, Caltrate®, Viactiv®, CalBurst®) |
| Can be taken any time during the day. | Must to 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.) |
2. 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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3. Calcitriol
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 which your physician can order). Your physician can obtain additional information about Calcitriol dosing recommendations from the Long-Term Follow-Up Office, Fred Hutchinson Cancer Research Center (206-667-4415).
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4. Exercise
Daily exercise for 20 to 60 minutes is important to maintain bone density. Exercises should include both aerobic and resistive. Examples of aerobic exercise include walking, biking, dancing and nordic-trakking. Avoid running or other activities which put stress on the joints. Examples of resistive exercise include use of weights, carrying groceries or doing stretch-band exercises. Talk to a physical therapist for guidelines to meet your needs.
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5. Adult Hormone Replacement Therapy
Discuss hormone replacement therapy with your physician. General guidelines are:
- Estrogen replacement therapy should be given to menopausal women, unless contraindicated.
- Testosterone replacement should be given to adult men if the serum level is below 200 ng/mL, unless contraindicated.
6. Bisphosphonates
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:
- History of non-traumatic fractures, vertebral compression or impact fractures, or hip bone density below 650 mg/cm2
- DEXA T-score of -2.5 or lower with steroid therapy anticipated to continue for greater than 6 months
- Post-menopausal women who cannot receive hormone replacement therapy
- Significant weight loss
Discuss with your physician if you are a candidate for an oral bisphosphonate (Alendronate) or intravenous bisphosphonate.
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7. Height and Weight
Height should be measured twice yearly in adults or monthly in persons 18 years of age or younger. Weight should be measured monthly.
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