Proper dietetic supervision is essential for general nutritional monitoring and to keep calcium intake above the average requirement. Similarly, vitamin D intake and blood levels need regular review. Exercise should be actively encouraged not only for the way it complements chest physiotherapy, but because weight-bearing activity increases bone mineral content. Exercise programmes can result in important increases in bone mineral content. Smoking, of course, and excess alcohol should be avoided.
Drug therapy is available for osteoporosis.
An endocrine specialist should advise post-menopausal women with CF about the appropriateness of hormone replacement therapy. This treatment may retard bone loss. We are beginning to use these in CF associated osteoporosis but as yet no have data that shows they are effective. But this data is being collected and we will be able to report on it within the next two to three years. There are some potential problems with bisphosphonate drugs.