[Precautions before starting a treatment for osteoporosis].

Abstract

To be optimal, the treatment of osteoporosis must be global, including nonpharmacological measures. At the initiation of the treatment, a personalized evaluation of the patient must be realized on diet, physical activity, risk of fall and adhesion of the patient. Dietary calcium is estimated and advices given to attain 1000 in 1200 mg/day and limit excessive coffee, soft drinks and salt intake. Dietary calcium is recommended, but if it is impossible, a complement is prescribed, adapted to the intensity of the deficiency. Serum 25-(OH)-vitamine D is measured and, if below 30 ng/ml, a supplementation prescribed. Low protein intake is looked for and corrected if necessary. Advises are given to limit the alcohol to 2 units/day, stop smoking and to have a regular and high impact physical activity. Subjects at risk of fall must be identified and risk factors corrected if possible. Dental recommandations for the use of bisphosphonates in osteoporosis must be apply. Finally, patient education could be used to optimize patient adherence to pharmacological and non pharmacological anti-osteoporotic treatments.