Those at risk of osteoporosis should maintain an adequate dietary intake of calcium and vitamin D: calcium and vitamin D must be prescribed with all oral and intravenous bone active therapies unless a patient is hypercalcaemic or has a risk of hypercalcaemia, eg sarcoidosis, has had renal stones in the past year or where renal impairment dictates that alfacalcidol should be an alternative.

• Where patients on bone-active therapy for osteoporosis are intolerant of Adcal D3®/Calci-D®, consider colecalciferol capsules/tablets 800 units daily. For further information on the use of vitamin D outwith this patient group refer to section 9.6.
• The dose should be to the equivalent of 1000mg of calcium per day and 20 micrograms (800 units) of vitamin D
• To avoid any potential interaction when taken within 4 hours of a bisphosphonate, consider prescribing calcium and vitamin D supplements to be taken at bedtime, when the stomach is more likely to be empty, to minimise calcium loss.
• For patients with peanut/soya allergy prescribe Adcal D3® caplets, Calci-D® tablets or colecalciferol tablets.
• Calcium and vitamin D as monotherapy has only been shown to be effective in osteoporosis in ambulant nursing home residents however this should not be used in place of a proper fracture assessment in these individuals.
• For further information refer to The Royal Osteoporosis Guidelines: Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management.