However, an epidemiologic study conducted nearly 20 years ago15 indicated that a good dietary calcium intake reduced the rate of hip fracture in both men and women. Bone mineral density response to calcium, calcitonin, and bisphosphonates in men and women treated with glucocorticoids is similar. My colleagues and I recommend a calcium supplement, about 1,000 mg a day, and a multivitamin that provides 400 U of vitamin D a day if a patient's dietary calcium intake and exposure to sunlight are inadequate. More potent formulations of vitamin D produce hypercalciuria, and their relative benefit is uncertain. Kidney stone formation, constipation, and elderly patients' reluctance to take additional pills are the main barriers to calcium supplementation.
Some patients tolerate calcium citrate better than calcium carbonate.
Other nonhormonal treatment options include the bisphosphonate alendronate and calcitonin nasal spray. All these measures suppress bone resorption. Fluoride stimulates bone formation, but the appropriate dose for and risks of sodium fluoride therapy are not known. Small studies of growth hormone, insulinlike growth factor 1, and human parathyroid hormone have produced intriguing results that warrant further investigation. Prospective studies of testosterone replacement have demonstrated modest increases in bone mass that are comparable to those achieved with other therapies.