Med/Psych Update

Osteoporosis in depression: Which patients are at risk?

Current Psychiatry. 2010 April;9(4):9-25

References

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Table 3

Reducing osteoporosis risk: Recommendations for patients age >50

Assess dietary calcium (at least 1,200 mg/d) and dietary vitamin D intake (800 to 1,000 IU/d)
Exercise regularly, especially weight-bearing and muscle-strengthening activities (eg, walking, jogging, stair climbing, weight-lifting)
Stop using tobacco
Avoid heavy alcohol use
Implement fall precautions such as rubber-soled shoes when walking, handrails for staircases, and removing tripping hazards, including loose rugs
Source: Reference 1

CASE CONTINUED: High risk can be lowered

Ms. P’s family history, antidepressant use, smoking, and low dietary calcium intake associated with lactose intolerance increase her risk for osteoporosis. Her history of anorexia nervosa also increases her risk if she experiences amenorrhea. You advise her that she can ameliorate some of these factors by quitting smoking, exercising regularly, and taking calcium and vitamin D supplements. You refer her to her primary care physician because she wishes to undergo bone mineral density screening.

Related resources

National Osteoporosis Foundation. Clinician‘s guide to prevention and treatment of osteoporosis. www.nof.org/professionals/Clinicians_Guide.htm.
World Health Organization Fracture Risk Assessment Tool. Calculates a 10-year probability of hip fracture using demographic data, family history, comorbid medication and predisposing medical conditions. www.shef.ac.uk/FRAX.

Drug brand names

Alendronate • Fosamax
Carbamazepine • Tegretol
Clonazepam • Klonopin
Diazepam • Valium
Fluoxetine • Prozac
Haloperidol • Haldol
Lamotrigine • Lamictal
Lithium • Eskalith, Lithobid
Lorazepam • Ativan
Oxcarbazepine • Trileptal
Prednisone • Deltasone, Meticorten
Raloxifene • Evista
Risperidone • Risperdal
Teriparatide • Forteo
Valproate • Depakote

Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.