Use this treatment worksheet to outline your recommendations for calcium, vitamin D, medications, exercise, and other dietary recommendations. Your physician, physical therapist, registered dietitian, and/or patient educator should help you to fill this out.
You need _____ milligrams (mg) of calcium per day (includes both diet and supplements).
You are getting _____ mg of calcium from your diet each day.
You need ______mg of calcium recommended from a supplement.
Type of supplement: _____ Calcium Carbonate or _____ Calcium Citrate
Each pill should have _____ mg of calcium and _____ mg of vitamin D
Vitamin D recommendations :
You need _____ International Units (IUs) of vitamin D every day.
Multivitamin (take with food) _____
Calcium + vitamin D supplement(s) _____
Other dietary recommendations:
___ Sodium Restriction ___ Caffeine Restriction
___ Hormone Replacement Therapy (HRT)
___ Evista (Raloxifene)
___ Fosamax (Alendronate)
___ 70 mg (once per week)
___ 10 mg (once per day)
___ Actonel (Resedronate)
___ 35 mg (once per week)
___ 5 mg (once per day)
____ Miacalcin (Calcitonin)
____ Forteo (PTH/Parathyroid Hormone)
Exercise/Physical Therapy Recommendations:
___ Weight Training
___ Physical Therapy Referral for:
___ Neutral Spine Training
___ Fall Prevention
___ Balance Training
___ Pain Control