Your Osteoporosis Treatment Worksheet

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.

  1. Calcium Recommendations:

    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

    Instructions:

  2. Vitamin D recommendations :

    You need _____ International Units (IUs) of vitamin D every day.

    Multivitamin (take with food) _____

    Calcium + vitamin D supplement(s) _____

    Other _____

    Other dietary recommendations:

    ___ Sodium Restriction ___ Caffeine Restriction

    Notes:

  3. Medications:

    ___ 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)

    Medication Instructions:

  4. Exercise/Physical Therapy Recommendations:

    ___ Walking

    ___ Weight Training

    ___ Other

    ___ Physical Therapy Referral for:

    ___ Neutral Spine Training

    ___ Strengthening

    ___ Fall Prevention

    ___ Balance Training

    ___ Pain Control

    Notes: