Treatment of osteoporosis. What is the role of calcium?

On the basis of currently available information, the following recommendations can be made for treating osteoporosis. Women with no contraindications should maintain a total calcium intake of 1,000 mg daily before menopause and 1,500 mg daily after menopause. Calcium supplementation should be considered adjunct treatment in postmenopausal women and those who already have osteoporosis. At menopause, women with no contraindications should be given the option of taking estrogen to prevent osteoporosis. Vitamin D supplementation up to the recommended dietary allowance should be used in patients who may not get adequate dietary intake or sunlight exposure. Calcium carbonate should be the main calcium supplement when possible, because it is usually the least expensive and has the highest percentage of calcium. In older patients, who may have achlorhydria, calcium carbonate should be taken with food or another form of calcium that is well absorbed should be used. In compliant patients, calcium supplements should be given in two or three divided doses. Until more is known about exercise and osteoporosis, low-intensity exercise that promotes cardiovascular fitness should be prescribed. One appropriate regimen is brisk walking for 1 hour three times a week.