Use this treatment worksheet to outline your recommendations for calcium, vitamin D, medications, exercise, and other dietary recommendations. Your physician, physical therapist, registered dietitian, and/or patient educator should help you to fill this out.    

1. Calcium Recommendations:            

   You need _____ milligrams (mg) of calcium per day (includes both diet and supplements).

   You are getting _____ mg of calcium from your diet each day.

   You need ______mg of calcium recommended from a supplement. 

   Type of supplement: _____ Calcium Carbonate or _____ Calcium Citrate

   Each pill should have _____ mg of calcium and _____  mg of vitamin D                                           

   Instructions:  

2. Vitamin D recommendations : 

   You need _____ International Units (IUs) of vitamin D every day.      

               Multivitamin (take with food) _____

               Calcium + vitamin D supplement(s) _____

               Other _____

    Other dietary recommendations:

    ___ Sodium Restriction            ___ Caffeine Restriction

   Notes:

3. Medications:

   ___ Hormone Replacement Therapy (HRT)

   ___ Evista (Raloxifene)

   ___ Fosamax (Alendronate)

               ___ 70 mg (once per week)

               ___ 10 mg (once per day)

   ___ Actonel (Resedronate)

               ___ 35 mg (once per week)

               ___ 5 mg (once per day)

   ____ Miacalcin (Calcitonin)

   ____ Forteo (PTH/Parathyroid Hormone)

   Medication Instructions:

4. Exercise/Physical Therapy Recommendations:    

   ___ Walking

   ___ Weight Training

   ___ Other

   ___ Physical Therapy Referral for:

               ___ Neutral Spine Training

               ___ Strengthening

              ___ Fall Prevention

              ___ Balance Training

               ___ Pain Control   

    Notes: