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 need ______mg of calcium recommended from a supplement. Each pill should have _____ mg of calcium and _____  mg of vitamin D
3. Instructions:  
4. Type of supplement: _____ Calcium Carbonate or _____ Calcium Citrate
5. You are getting _____ mg of calcium from your diet each day.
6. Vitamin D recommendations : You need _____ International Units (IUs) of vitamin D every day.                  Calcium + vitamin D supplement(s) _____ Other dietary recommendations:Notes:
9.  ___ Sodium Restriction            ___ Caffeine Restriction
10.             Other _____
11.             Multivitamin (take with food) _____
12. Medications:___ Hormone Replacement Therapy (HRT)___ Fosamax (Alendronate)            ___ 10 mg (once per day)            ___ 35 mg (once per week)____ Miacalcin (Calcitonin)Medication Instructions:
14. ____ Forteo (PTH/Parathyroid Hormone)
15.             ___ 5 mg (once per day)
16. ___ Actonel (Resedronate)
17.             ___ 70 mg (once per week)
18. ___ Evista (Raloxifene)
19. Exercise/Physical Therapy Recommendations:    ___ Walking___ Other            ___ Neutral Spine Training           ___ Fall Prevention            ___ Pain Control
20.  Notes:
21.            ___ Balance Training
22.             ___ Strengthening
23. ___ Physical Therapy Referral for:
24. ___ Weight Training