Patients should be advised to accommodate total daily calcium (dietary and oral supplements) and vitamin D intake accounting for their age and menopausal status. Daily physical activity should be encouraged.
In addition, patients should be advised to lower salt intake, maintain adequate dietary protein, and increase intake of fruits and vegetables. The latter measures will help to lower urinary calcium loss and maintain bone mass. Provide patients with counseling and treatment for tobacco cessation and cessation of excessive alcohol use.
Effective fracture risk reduction in patients with osteoporosis requires long-term management, but adherence to pharmacotherapy and lifestyle changes is often low.[81] Royal Australian College of General Practitioners. Osteoporosis management and fracture prevention in post-menopausal women and men >50 years of age. Mar 2024 [internet publication].
https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/osteoporosis/executive-summary
[219]D'Andrea E, Schneeweiss S, Franklin JM, et al. Efficacy versus effectiveness: the horizon-pivotal fracture trial and its emulation in claims data. Arthritis Rheumatol. 2025 Jan;77(1):12-21.
http://www.ncbi.nlm.nih.gov/pubmed/39129266?tool=bestpractice.com
Before starting treatment, discuss the patient’s values and preferences, and address the expected risks and benefits of treatment to support shared decision-making.[220]Billington E, Aghajafari F, Skulsky E, et al. Bisphosphonates. BMJ. 2024 Aug 21;386:e076898.[221]Paskins Z, Babatunde O, Sturrock A, et al. Supporting patients to get the best from their osteoporosis treatment: a rapid realist review of what works, for whom, and in what circumstance. Osteoporos Int. 2022 Nov;33(11):2245-57.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9568441
http://www.ncbi.nlm.nih.gov/pubmed/35688897?tool=bestpractice.com
Regularly reassess patient satisfaction, adherence, and concerns with therapy.[62]LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049-102.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9546973
http://www.ncbi.nlm.nih.gov/pubmed/35478046?tool=bestpractice.com