TABLE 3.

MANAGEMENT OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH OSTEOPOROSIS OR AT HIGH RISK FOR OSTEOPOROSIS

1. Screening of high-risk patients: men and women with a significant smoking history, those with advanced chronic obstructive pulmonary disease, and those being treated with continuous high-dose inhaled glucocorticoids or low-to-medium dose inhaled glucocorticoids with frequent courses of oral glucocorticoids

2. Dietary supplementation with calcium (recommended daily allowance 1,000–1,500 mg) and vitamin D (recommended daily allowance 400–800 IU) as needed

3. Lifestyle modification and enrollment in a pulmonary rehabilitation program

4. Risedronate (5 mg/d) or alendronate (5 or 10 mg/d) are recommended as first-line therapy for the prevention and treatment of osteopenia and osteoporosis

5. Screening for metabolic abnormalities and hormonal deficiencies