Osteoporosis calcium/vitamin D — GPhC CRA MCQ
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Correct answer: A — Assess and correct calcium and vitamin-D status before treatment proceeds
Assess and correct calcium and vitamin-D status before treatment proceeds: Deficiency and hypocalcaemia must be addressed for safe effective antiresorptive treatment, but calcium-containing products would impair oral alendronate absorption if co-administered. Begin alendronate alone because it supplies calcium and vitamin D: Alendronate contains neither nutrient and does not correct deficiency. Take alendronate with calcium-fortified milk to improve skeletal delivery: Food and calcium markedly reduce alendronate absorption. Use high-dose vitamin D indefinitely with no biochemical monitoring: Replacement depends on deficiency and should transition to an appropriate maintenance strategy. Avoid calcium throughout treatment because it antagonises alendronate action: Adequate calcium is important; only co-administration timing is problematic.
Reference: NOGG clinical guideline for osteoporosis: https://www.nogg.org.uk/full-guideline; BNF: alendronic acid: https://bnf.nice.org.uk/drugs/alendronic-acid/; BNF: calcium carbonate: https://bnf.nice.org.uk/drugs/calcium-carbonate/