FOSAMAX by decreasing its absorption into the body. Body as a Whole: hypersensitivity reactions including urticaria and angioedema. Transient symptoms of myalgia, malaise, asthenia and fever have been reported with alendronate, typically in association with initiation of treatment. Symptomatic hypocalcemia has occurred, generally in association with predisposing conditions. Peripheral edema. How should I take Fosamax? This study was not powered to detect differences at these sites. Alendronate 40 mg once daily for 6 months. escitalopram buy in usa escitalopram
It is unknown if this medication passes into milk. Consult your doctor before -feeding. Bone HG, Greenspan SL, McKeever C et al. Alendronate and estrogen effects in postmenopausal women with low bone mineral density. J Clin Endocrinol Metab. 2000; 85: 720-6. FOSAMAX 10 mg daily were similar. Your doctor may prescribe calcium and vitamin D to help prevent low calcium levels in your blood, while you take alendronate. Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Although alendronate tablets 5 mg, 10 mg, 35 mg, and 40 mg are available in the marketplace, Fosamax is no longer marketed in the 5 mg, 10 mg, 35 mg, and 40 mg strengths. Homik JE, Cranney A, Shea B et al. A metaanalysis on the use of bisphosphonates in corticosteroid induced osteoporosis. J Rheumatol. Do not take with mineral water or with other beverages. Patients should be instructed to stay upright not to lie down for at least 30 minutes and until after first food of the day to reduce esophageal irritation. If your doctor has recommended that you follow a special diet, it is very important to follow the diet to get the most benefit from this medication and to prevent serious side effects.
Do not freeze or subject to heat. Avoid taking any other medicines including vitamins, calcium, or antacids for at least 30 minutes after taking alendronate. Some medicines can make it harder for your body to absorb alendronate. Alendronate may lower the calcium levels in your blood. If you have low blood calcium before you start taking alendronate, it may get worse during treatment. Your low blood calcium must be treated before you take alendronate. Most people with low blood calcium levels do not have symptoms, but some people may have symptoms. Figure 6 shows the mean percent changes from baseline in serum alkaline phosphatase for up to six months of randomized treatment.
Osteoporosis is characterized by low bone mass that leads to an increased risk of fracture. The diagnosis can be confirmed by the finding of low bone mass, evidence of fracture on x-ray, a history of osteoporotic fracture, or height loss or kyphosis, indicative of vertebral spinal fracture. Osteoporosis occurs in both males and females but is most common among women following the menopause, when bone turnover increases and the rate of bone resorption exceeds that of bone formation. These changes result in progressive bone loss and lead to osteoporosis in a significant proportion of women over age 50. Fractures, usually of the spine, hip, and wrist, are the common consequences. From age 50 to age 90, the risk of hip fracture in white women increases 50 fold and the risk of vertebral fracture 15 to 30 fold. It is estimated that approximately 40% of 50 year old women will sustain one or more osteoporosis-related fractures of the spine, hip, or wrist during their remaining lifetimes. Hip fractures, in particular, are associated with substantial morbidity, disability, and mortality. Daily Dosing: A two-year, double-blind, placebo-controlled, multicenter study of alendronate 10 mg once daily enrolled a total of 241 men between the ages of 31 and 87 mean, 63. All patients in the trial had either a BMD T-score less than or equal to -2 at the femoral neck and less than or equal to -1 at the lumbar spine, or a baseline osteoporotic fracture and a BMD T-score less than or equal to -1 at the femoral neck. Wood AJJ. Treatment of postmenopausal osteoporosis. N Engl J Med. Take this medication regularly to get the most benefit from it. Remember to take it on the same day each week. It may help to mark your calendar with a reminder. Talk to your doctor about the risks and benefits of long-term use of this medication. Monitor serum calcium and monitor for symptoms of hypocalcemia during therapy. Do not lie down or recline for at least 30 minutes after taking alendronate. Decrease in blood pressure when you change positions. Alendronate 10 mg once daily or 70 mg once weekly in men and postmenopausal women. General information about the safe and effective use of alendronate. The committee voted 12-9 against continued marketing of the drug, citing lack of benefit and concerns about a risk. Your doctor may prescribe calcium and vitamin D to help prevent low calcium levels in your blood, while you take Alendronate sodium tablets.
Some people taking alendronate may have serious jawbone problems. Your doctor should check your before you start this medication. Tell your dentist that you are taking this medication before you have any dental work done. To help prevent jawbone problems, have regular dental exams and learn how to keep your and gums healthy. Alendronate sodium is chemically described as 4-amino-1-hydroxybutylidene bisphosphonic acid monosodium salt trihydrate. McClung M, Clemmesen B, Daifotis A et al. Alendronate prevents postmenopausal bone loss in women without osteoporosis: a double-blind, randomized, controlled trial. Ann Intern Med. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-induced Osteoporosis. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. Arthritis Rheum. Take Fosamax while you are sitting or standing. Calcium plays a very important role in the body. It is necessary for normal functioning of nerves, cells, muscle, and bone. Some people using medicines similar to alendronate have developed bone loss in the jaw, also called osteonecrosis of the jaw. Symptoms may include jaw pain, swelling, numbness, loose teeth, gum infection, or slow healing after injury or surgery involving the gums. You may be more likely to develop osteonecrosis of the jaw if you have cancer or have been treated with chemotherapy, radiation, or steroids. Other conditions associated with osteonecrosis of the jaw include blood clotting disorders, anemia low red blood cells and a pre-existing dental problem. Your bone mineral density will need to be tested on a regular basis. You may not need to take alendronate for longer than 3 to 5 years if you take it for osteoporosis. Visit your doctor regularly. I'm normally very active; I work with horses and thought I picked up a deer tick or something. I can hardly get into or out of bed, when I'm up, I can hardly walk or move my arms, and the muscles in my lower spine hurt so bad it feels like I have a big bruise there. This is waking me up at night, as whenever I switch positions in bed, I wake up from the pain. All my muscles in my hands and feet hurt, too. I've been using an elastic band to stretch my legs and arms before I get out of bed as I can hardly walk after I wake up. I don't believe this is an old age thing that came on this quickly and severely and am going to call my Dr. tomorrow to see if they've ever heard of this happening before. I would guess that I was off the Alendronate at least 1 month before these symptoms started. If this is what is causing me to feel like I've been run over by a wild buffalo, I hope it doesn't take too long to go away! Esophageal adverse experiences, such as esophagitis, esophageal ulcers and esophageal erosions, occasionally with bleeding and rarely followed by esophageal stricture or perforation, have been reported in patients receiving treatment with oral bisphosphonates including Fosamax. In some cases these have been severe and required hospitalization. Physicians should therefore be alert to any signs or symptoms signaling a possible esophageal reaction and patients should be instructed to discontinue Fosamax and seek medical attention if they develop dysphagia, odynophagia, retrosternal pain or new or worsening heartburn. Weekly Dosing: A one-year, double-blind, placebo-controlled, multicenter study of once weekly alendronate 70 mg enrolled a total of 167 men between the ages of 38 and 91 mean, 66. Patients in the study had either a BMD T-score less than or equal to -2 at the femoral neck and less than or equal to -1 at the lumbar spine, or a BMD T-score less than or equal to -2 at the lumbar spine and less than or equal to -1 at the femoral neck, or a baseline osteoporotic fracture and a BMD T-score less than or equal to -1 at the femoral neck. F. Keep in well-closed container. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Some people who take Alendronate sodium tablets may develop problems in the esophagus the tube that connects the mouth and the stomach. These problems include irritation, inflammation, or ulcers of the esophagus which may sometimes bleed. zebeta
Products containing calcium and other multivalent cations are likely to interfere with absorption of alendronate. No substantial differences in safety and efficacy relative to younger adults, but increased sensitivity cannot be ruled out. Animal studies have indicated the following mode of action. At the cellular level, alendronate shows preferential localization to sites of bone resorption, specifically under osteoclasts. The osteoclasts adhere normally to the bone surface but lack the ruffled border that is indicative of active resorption. Alendronate does not interfere with osteoclast recruitment or attachment, but it does inhibit osteoclast activity. This category of drugs includes alendronate. Most of the patients were postmenopausal women. The time to onset of symptoms varied from one day to several months after starting the drug. Discontinue use if severe symptoms develop. Most patients had relief of symptoms after stopping. A subset had recurrence of symptoms when rechallenged with the same drug or another bisphosphonate. If patients miss a dose of once weekly alendronate, instruct patients to take one dose on the morning after they remember. They should not take two doses on the same day but should return to taking one dose once a week, as originally scheduled on their chosen day. TYMLOS pen, talk with your healthcare provider. There are no data on fetal risk in humans. Take FOSAMAX exactly as your doctor tells you. Store at room temperature away from moisture and heat. What happens if I miss a dose? Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. TYMLOS pen when not using the pen.
The fragments are primarily eliminated through renal excretion. Center for Drug Evaluation and Research, Food and Drug Administration. Alendronate may be administered to patients taking nonsteroidal anti-inflammatory drugs NSAIDs. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip themissed dose and resume your usual dosing schedule. It is important that you take Fosamax exactly as prescribed to help lower your chance of getting esophagus problems. How do I store alendronate? In double-blind, multicenter, controlled studies, asymptomatic, mild, and transient decreases in serum calcium and phosphate were observed in approximately 18% and 10%, respectively, of patients taking Fosamax versus approximately 12% and 3% of those taking placebo. Certain medicines may affect how OSAMAX PLUS D works. nitrofurantoin buy online
The overall safety profile of Fosamax in osteogenesis imperfecta patients treated for up to 24 months was generally similar to that of adults with osteoporosis treated with Fosamax. However, there was an increased occurrence of vomiting in osteogenesis imperfecta patients treated with Fosamax compared to placebo. During the 24-month treatment period, vomiting was observed in 32 of 109 29. ONJ and clinical judgment should guide the decision. What happens if I miss a dose Fosamax? It is important that you take alendronate exactly as prescribed to help lower your chance of getting esophagus problems. In patients with renal impairment, clearance of alendronate likely to be reduced. 1 112 Somewhat greater accumulation in bone expected. Eastell R. Treatment of postmenopausal osteoporosis. N Engl J Med. Fosamax is not for use in children. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Alendronate increases bone mineral density. Cummings SR, Schwartz AV, Black DM. Alendronate and atrial fibrillation. N Engl J Med. Merck. Fosamax alendronate sodium tablets prescribing information. West Point, PA; 2011 Jul. Migliorati CA, Casiglia J, Epstein J et al. Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper. J Am Dent Assoc.
In healthy subjects, oral prednisone 20 mg three times daily for five days did not produce a clinically meaningful change in the oral bioavailability of alendronate a mean increase ranging from 20 to 44%. Eliglustat tartrate Cerdelga. It's a newer drug you take twice a day. It may not work well for people who metabolize -- or break down -- the drug too quickly. The safety of Alendronate, the free acid 35 mg once weekly compared to Alendronate, the free acid 5 mg daily was evaluated in a one-year, double-blind, multicenter study of 723 patients. The overall safety and tolerability profiles of once weekly Alendronate, the free acid 35 mg and Alendronate, the free acid 5 mg daily were similar. For at least the first 30 minutes after taking an alendronate tablet, do not lie down or recline; do not eat or drink anything other than plain water; and do not take any other medicines including vitamins, calcium, or antacids. Drug Interactions: Intravenous ranitidine was shown to double the bioavailability of oral alendronate. The clinical significance of this increased bioavailability and whether similar increases will occur in patients given oral H 2-antagonists is unknown. The decrease in the rate of bone resorption indicated by these markers was evident as early as one month and at three to six months reached a plateau that was maintained for the entire duration of treatment with alendronate. Read the Guide provided by your before you start taking and each time you get a refill. If you have any questions, ask your doctor or pharmacist. In placebo-controlled clinical studies of alendronate, the percentages of patients with these symptoms were similar in the alendronate and placebo groups. Adami S, Mian M, Gatti P, Rossini M, Zamberlan N, Bertoldo F, Lo Cascio V "Effects of two oral doses of alendronate in the treatment of Paget's disease of bone. If the once-weekly dose is missed, take one dose on the morning after remembering; two doses should not be taken on the same day. As a result of inhibition of bone resorption, asymptomatic reductions in serum calcium and phosphate concentrations were also observed following treatment with alendronate. In the long-term studies, reductions from baseline in serum calcium approximately 2% and phosphate approximately 4 to 6% were evident the first month after the initiation of alendronate 10 mg. No further decreases in serum calcium were observed for the five-year duration of treatment; however, serum phosphate returned toward prestudy levels during years three through five. cheap dipyridamole indication
Who should not take Alendronate sodium tablets? This can be useful if Gaucher's has given you extreme fatigue from anemia. A blood transfusion can boost your red blood cell count so you feel better. Bisphosphonates may interfere with diagnostic imaging agents such as technetium-99m-diphosphonate in bone scans. Shane E, Burr D, Ebeling PR et al. Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. Rash and have occurred. Take alendronate with a full glass 6 to 8 ounces of plain water. Do not use coffee, tea, juice, or mineral water. Do not eat or drink anything other than plain water. Do not take Alendronate sodium tablets with mineral water, coffee, tea, soda, or juice. Preventive Services Task Force. Postmenopausal hormone replacement therapy for primary prevention of chronic conditions: recommendations and rationale. Fosamax after developing symptoms suggestive of esophageal irritation. OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional. What are the ingredients in alendronate sodium oral solution? How should I take FOSAMAX PLUS D tablet? Consult WARNINGS section for additional precautions. NSAIDs nonsteroidal anti-inflammatory drugs--ibuprofen Advil, Motrin naproxen Aleve celecoxib, diclofenac, indomethacin, meloxicam, and others. Optimal duration of treatment not established. 89 90 91 Safety and efficacy based on data supporting fracture reduction over 4 years of treatment. 89 90 Reevaluate need for continued therapy periodically in all patients receiving bisphosphonates. Food and Drug Administration. FDA MedWatch label change: Atypical fractures update for bisphosphonates osteoporosis drugs including alendronate marketed as Fosamax alendronate with cholecalciferol marketed as Fosamax plus D risedronate marketed as Actonel and Atelvia risedronate with calcium carbonate marketed as Actonel with Calcium ibandronate marketed as Boniva and zoledronic acid marketed as Reclast. Silver Spring, MD; 2010 Oct 13. From FDA web site.
Levy RM, Keller M et al. Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum. Patient may experience headache, constipation, or diarrhea. Have patient report immediately to prescriber signs of low calcium muscle cramps or spasms, numbness and tingling, or seizures; black, tarry, or bloody stools; angina; coughing up blood; severe abdominal pain; heartburn; difficulty swallowing; pain when swallowing; pharyngitis; severe nausea; severe vomiting; vomiting blood; severe bone pain; severe joint pain; severe muscle pain; groin, hip, or thigh pain; mouth sores; or jaw pain, or edema HCAHPS. Tablet Fosamax: Must be taken with 6 to 8 oz of plain water. The tablet should be swallowed whole; do not chew or suck. Vitamin D is required for normal bone formation. For patients requiring invasive dental procedures, discontinuation of bisphosphonate treatment may reduce the risk for ONJ. It may harm them. Take Fosamax exactly as your doctor tells you. Jeal W, Barradell LB, McTavish D. Alendronate: a review of its pharmacological properties and therapeutic efficacy in postmenopausal osteoporosis. Drugs. Pharmacologically inactive while incorporated into bone matrix. 1 2 3 4 11 112 Continuous administration required for activity. These studies enrolled 232 and 328 patients, respectively, between the ages of 17 and 83 with a variety of glucocorticoid-requiring diseases. Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Certain medicines may affect how Alendronate sodium tablets work. Take Alendronate sodium tablets exactly as your doctor tells you. The safety of Fosamax 70 mg once weekly for the treatment of postmenopausal osteoporosis was assessed in a one-year, double-blind, multicenter study comparing Fosamax 70 mg once weekly and Fosamax 10 mg daily. The overall safety and tolerability profiles of once weekly Fosamax 70 mg and Fosamax 10 mg daily were similar. Dietary requirements of vitamin D 3 are increased in the elderly. Pre-dose serum calcium was similar to baseline in both groups. ditropan
Sambrook PN. Corticosteroid osteoporosis: practical implications of recent trials. J Bone Miner Res. Gastric and duodenal ulcers some severe and with complications reported during postmarketing experience. TYMLOS pen for your full dose. TYMLOS. Each dose will contain 80 mcg of TYMLOS. Remember that your doctor has prescribed this because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication not have serious side effects. After bubbling from the tablet stops, wait at least 5 minutes until it is completely dissolved. Then stir the liquid for about 10 seconds and drink all of it. Stay fully upright sitting, standing, or walking for at least 30 minutes and do not lie down until after your first food of the day. The drug makes your bones stronger and lowers your chances of getting fractures. Merck. Fosamax Plus D alendronate sodium and cholecalciferol tablets patient information. Whitehouse Station, NJ; 2011 Jul.
Fosamax 70 mg enrolled a total of 167 men between the ages of 38 and 91 mean, 66. Patients in the study had either a BMD T-score less than or equal to -2 at the femoral neck and less than or equal to -1 at the lumbar spine, or a BMD T-score less than or equal to -2 at the lumbar spine and less than or equal to -1 at the femoral neck, or a baseline osteoporotic fracture and a BMD T-score less than or equal to -1 at the femoral neck. Not all side effects for alendronate may be reported. You should always consult a doctor or healthcare professional for medical advice. Instruct patients to read the Medication Guide before starting therapy with Alendronate sodium and to reread it each time the prescription is renewed. Stop taking Alendronate sodium tablets and call your doctor right away if you get chest pain, new or worsening heartburn, or have trouble or pain when you swallow. Lourwood DL "The pharmacology and therapeutic utility of bisphosphonates. Alendronate sodium was effective regardless of dose or duration of glucocorticoid use. In addition, Alendronate sodium was similarly effective regardless of age less than 65 vs. greater than or equal to 65 years race Caucasian vs. other races gender, underlying disease, baseline BMD, baseline bone turnover, and use with a variety of common medications. What are the possible side effects of Fosamax? Histomorphometric studies of transiliac biopsies in 92 subjects showed normal bone architecture. Compared to placebo there was a 98% suppression of bone turnover as assessed by mineralizing surface after 18 months of combined treatment with alendronate and HRT, 94% on alendronate alone, and 78% on HRT alone. The long-term effects of combined alendronate and HRT on fracture occurrence and fracture healing have not been studied. Alendronate sodium is not indicated for use in pediatric patients. Do not share this medication with others. If patients miss a dose of once weekly Fosamax, instruct patients to take one dose on the morning after they remember. They should not take two doses on the same day but should return to taking one dose once a week, as originally scheduled on their chosen day. Alendronate sodium is indicated for the treatment of osteoporosis in postmenopausal women. sucralfate cost cvs
Some evidence from postmarketing experience and observational studies suggests a possible association between use of oral bisphosphonates and an increased risk of esophageal cancer. 88 100 101 However, because of conflicting data, 101 102 103 additional study needed to confirm such findings. Vitamin D, calcium, or other supplements may help ease Gaucher's symptoms too. Your doctor may recommend them if he thinks you're not getting enough in your diet. Talk with your doctor about the risks and benefits of using this medication. The relative inhibitory activities on bone resorption and mineralization of alendronate and etidronate were compared in the Schenk assay, which is based on histological examination of the epiphyses of growing rats. In this assay, the lowest dose of alendronate that interfered with bone mineralization leading to osteomalacia was 6000-fold the antiresorptive dose. The corresponding ratio for etidronate was one to one. These data suggest that alendronate administered in therapeutic doses is highly unlikely to induce osteomalacia. Instruct patients to read the Medication Guide before starting therapy with Fosamax and to reread it each time the prescription is renewed. TYMLOS injection is given. Safety labeling change and REMS notification. Silver Spring, MD; 2010 Oct 13. From FDA web site. Sellmeyer DE. Atypical fractures as a potential complication of long-term bisphosphonate therapy. JAMA. Manufactured in Germany for: Radius Health, Inc. Ask your pharmacist about using those products safely. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. FOSAMAX compared to placebo. Chesnut CH III, McClung MR, Ensrud KE et al. Alendronate treatment of the postmenopausal osteoporotic woman: effect of multiple dosages on bone mass and bone remodeling. Am J Med. Committee on Educational Bulletins of the American College of Obstetricians and Gynecologists. ACOG Educational Bulletin: osteoporosis. Obstet Gynecol. Importance of swallowing tablets whole, without chewing or sucking.
Food and Drug Administration. Fosamax alendronate sodium tablets and oral solution. If you miss a dose of Alendronate sodium tablets, do not take it later in the day. Take your missed dose on the next morning after you remember and then return to your normal schedule. Do not take 2 doses on the same day. How do I store FOSAMAX? In these studies, significant increases or favorable trends in BMD for combined therapy compared with HRT alone were seen at the total hip, femoral neck, and trochanter. No significant effect was seen for total body BMD. Instruct patients not to take Fosamax at bedtime or before arising for the day. Patients should be informed that failure to follow these instructions may increase their risk of esophageal problems. Rash and erythema have occurred. Aminoglycosides: May enhance the hypocalcemic effect of Bisphosphonate Derivatives. TYMLOS or breastfeed. You should not do both. brand elimite australia
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Known risk factors include cancer, chemotherapy, radiation therapy, corticosteroids, poor oral hygiene, preexisting dental disease, anemia, coagulopathy, and infection. Discontinue this drug and seek medical attention if dysphagia, odynophagia, retrosternal pain or new or worsening heartburn develop. Three-Year Study of FIT. suge.info furadantin
McClung M, Clemmesen B, Daifortis A, et al. "Alendronate prevents postmenopausal bone loss in women without osteoporosis: a double-blind, randomized, controlled trial. Store at room temperature away from light and moisture. See packaging for the exact temperature range. What is the most important information I should know about Fosamax? Seems like doctors are washing their hands of this medication and just continue to prescribe it. This pain at times is almost unbearable. I am on Gabapentin 300 mg. twice a day and it seems to help sometimes. On occasion, when I can't stand it anymore, I take 800 mg. of Ibuprofen and that is happening more and more often. It literally has ruined my life as I once knew it. I can no longer do the type of work I used to. What really scares me is that this junk stays in your body for TEN years. Let me know how you are doing and what you think about the FDA report. Maybe you want to print it out and take it to your doctor with you.
The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Bart Clarke, MD, from the Mayo Clinic in Rochester, Minn. "I think the benefit is likely weak, but we have experience with this drug clinically, and we have a whole lot of patients who can't take the other drugs. If we take this away, a lot of our patients would be in worse shape, even acknowledging the small degree of risk that we talked about. isotrexin
Some people who take alendronate may develop problems in the esophagus the tube that connects the mouth and the stomach. These problems include irritation, inflammation, or ulcers of the esophagus which may sometimes bleed. Do not take any other medicine including vitamins, calcium, or antacids. Talk with your doctor about the best dosing schedule for your other medicines. Lifestyle changes that help promote healthy bones include increasing weight-bearing exercise, stopping smoking, limiting alcohol, and eating well-balanced meals that contain adequate calcium and vitamin D. You may also need to take calcium and vitamin D supplements. Consult your doctor for specific advice.