Osteoporosis Patient Education

• Educate all patients on how to reduce the risk of fragility fractures and encourage adherence to drug treatment 

Exercise 

• Regular weight-bearing exercises and muscle strengthening exercises can improve agility, strength, posture and balance, which may help to prevent falls
  • Jogging, brisk walking, tai chi, weight training
  • Type of exercise will depend on age of patient and physical ability
  • At least 30 minutes of regular exercise 3-4x/week is recommended
• May modestly increase bone density (for as long as exercise is being done)
• Physiotherapist-guided exercise is recommended for pain reduction and improvement of daily function in patients with painful vertebral fractures

Avoid Cigarette Smoking and Excessive Alcohol Consumption 

• Both are associated with increased risk of osteoporotic fractures and should be avoided
• Alcohol intake may be limited to <2 units/day

Limit Caffeine Intake 

• High caffeine intake (>330 mg/day) increases risk of fragility fracture
• Caffeinated drinks should be limited to <1-2 servings/day (240-360 mL/serving)
• Patients who regularly consume caffeinated drinks should increase their calcium intake (ie 40 mg Calcium for every 177.5 mL cup of coffee)

Fall Prevention

• Individuals with a history of falls should be assessed for fall risk and advised to undergo a DXA scan 
• Counsel the patient, especially the elderly and those with a history of falls, on ways to reduce risk of falls
  • Implement measures to prevent falls (eg installing grab bars/handrails, nonslip flooring, adequate lighting, removing loose wires, keeping things within reach)
  • Hip protectors may help reduce the impact on the hip during the fall
• Evaluate for certain medications (eg sedatives, hypnotics, narcotic analgesics, antihypertensives), neurologic conditions, alcohol use, poor vision and hearing, frailty and deconditioning as these may lead to falls
• Recommend exercise and physical therapy referral