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Table 8 Structured treatment program of the SALT Osteoporosis Study

From: Design of the SALT Osteoporosis Study: a randomised pragmatic trial, to study a primary care screening and treatment program for the prevention of fractures in women aged 65 years or older

Treatment protocol
Calcium supplementation
- ≥4 dairy consumptions/day: none
- 2-3 dairy consumptions/day: 500 mg calcium/day
- 0-1 dairy consumptions/day: 1000 mg calcium/day
Vitamin D supplementation
- 20 μg (800 IU)/day if serum 25-hydroxyvitamin D < 50 nm/L
Bone sparing drugs for a duration of 5 years
- First choice treatment: alendronate 70 mg/week or risedronate 35 mg/week
- Second choice treatment: zoledronic acid 5 mg/year intravenous or denosumab 60 mg subcutaneous/6 monthsa
- Third choice treatment: ibandronic acid 150 mg/month or strontium ranelate 2 mg/day at night (if subject is ≥74 years of age)
Fall prevention
- Notification to GP of increased fall risk if ≥2 falls in the last year mentioned in the questionnaire, or 1 fall in combination with immobility, or fear of falling
Additional evaluation by GP or referral to secondary care
- ESR >50 mm/h
- Calcium (albumin corrected) ≥2.60 mmol/L
- TSH <0.3 mU/L and free T4 > 21 pmol/L
- TSH >3.7 mU/L and free T4 < 12 pmol/L
- Creatinine clearance according to Cockcroft-Gault formula <30 mL/min
Parathyroid hormone analogues
- New vertebral fractures after one year treatment with bone sparing drugs with multiple prevalent vertebral fractures
  1. GP general practitioner, ESR erythrocyte sedimentation rate, TSH thyroid stimulating hormone, T4 thyroxine
  2. aDenosumab has been added as an treatment option since the inclusion of denosumab in the updated version of Dutch guidelines for GP’s in October 2012