Vitamin D helps people absorb calcium from their diet and has an important impact on bone and muscle health. Furthermore, many medicines used to treat osteoporosis work best when vitamin D levels in the blood are at least 75 nmol/L. The team stated that it is important for patients to achieve the target level of vitamin D (in their blood) before therapy for low bone density is prescribed.
When a patient's blood concentration of vitamin D is greater than 75 nmol/L, the team says that 1,000 IU/day of vitamin D3 should be sufficient to maintain this concentration.
For patients whose blood levels are between 50 and 70 nmol/L, the team says that 2,000 IU/day of vitamin D3 should help to raise these levels to the target of approximately 75 nmol/L. However, the team notes that doctors may need to "consider a more aggressive replacement strategy" if patients have any of the following conditions or features:
Higher doses of vitamin D need to be considered because patients with any of these conditions may take longer to reach the target concentration of 75 nmol/L of vitamin D in their blood.
For patients whose blood levels are between 37.5 and 50 nmol/L, the team recommends higher doses, such as the following:
Again, the team cautions that doctors may need to "consider a more aggressive replacement strategy" if patients have any of the previously listed conditions or features.
Prior to initiating therapy for low bone density, the team encourages doctors to screen their patients for potential causes of low bone density, including the following:
For more information about vitamin D, its forms, sources and recommendations by specialists, see Treatment Update 185.
A future issue of TreatmentUpdate will have more information on vitamin D.
Additionally, the team asks doctors to avoid prescribing certain medicines that are associated with thinning bones, such as the following, "if appropriate alternatives are available":
The team recommends one of the following medicines for treating low bone density:
The team states that treatment with these drugs needs to be individualized; that is, treatment should be reviewed after the first three to five years of administration. The reasons for this period of reassessment are to assess changes in bone density and fracture risk and to screen for the possibility of rare side effects such as osteonecrosis of the jaw and fracture of the thigh bone. For more information about these potential side effects, see Understanding the risk/benefit of bone drugs.
There are other medicines that could be used for the therapy of osteopenia or osteoporosis; however, the team did not provide detailed recommendations about them.
The team mentions several ways to assess whether therapy has been successful (these assessments have been validated with thousands of HIV-negative people):
If the recommended therapies do not work, the team suggests that doctors refer patients to a specialist.
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