Treatment Recommendation Algorithm: English

Treatment Recommendation for Osteoporosis/Osteopenia

Regarding: Name ______________________       ID_____________________

Dear Doctor, your patient has sustained a fracture of the hip as a result of underlying osteopenia or osteoporosis. Recommendations based on best-practice are for the patient to be on medication to help prevent additional future fragility-related fractures.

The recommended treatment listed below is based on the specific medical history of the patient named above. Please note that the recommendations are based on published data and approved by the Ministry of Health and reviewed by a specialist in each of the kupot (Clalit, Leumit, Macabbi, Meuchedit)

We recommend the following for ALL patients:

Alpha D3 0.25 micrograms/day   ☐ ☐Vitamin D 1000 IU/day OR If pt has renal failure

Calcium 750 mg/day ☐ and

The last calcium level:   _____ The last albumin level: ______ Date of labs: _________

Your patient’s adjusted calcium level* is: ________mg/dL (normal range is 8.5-10.2 mg/dL)

*(Adjusted Calcium Level= Total Calcium + 0.8 x (4.0 – Albumin Level)) mg/dL

Please order the following medication (after adjusted calcium > 8.5mg/dL):

Not initially on medication (not on bisphosphonate or on bisphosphonate < 12 months):

  1. Aclasta (zolendronic acid) – intravenously once yearly (5mg) – (preferred treatment).
  2. Prolia (denosumab) – subcutaneous injection of 60 mg every 6 months (second line option).

Someone who had hip fracture while on bisphosphonate Tx (12 months) – considered treatment failure:

  1. Forteo (teriparatide) – 20 micrograms subcutaneously once a day (for 2 years) – (preferred treatment).
  2. Prolia (denosumab) – subcutaneous injection of 60 mg every 6 months (second line option).

Renal failure (creatinine clearance <30 mL/min)

Prolia (only option) – subcutaneous injection of 60 mg every 6 months.(relative contraindication is active auto-immune disease).

  • In Rheumatology and Autoimmune diseases (like SLE) should be careful in giving Prolia.