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11. I have a family history of osteoporosis Yes responses indicate increased risk for osteoporosis. All patients will family history meet the minimum requirement for BMD testing. Notes/Initials For recommendations and testing options see “Labs/Tests for Bone Density” IF test results determine the curvature is due to osteoporosis, see “Diagnosis/Treatment Support” for evaluation and management guidelines. While family history is a risk factor that cannot be controlled by patient, there are preventive measures that can help postpone or prevent early onset of osteoporosis. Adequate calcium and vitamin D is an important factor in reducing risk of osteoporosis. If patient already has osteoporosis, getting adequate calcium and vitamin D, as well as taking other measures, can help prevent bones from becoming weaker. The amount of calcium needed to stay healthy changes over one’s lifetime. The body’s demand for calcium is greatest during childhood and adolescence, when one’s skeleton is growing rapidly, and during pregnancy and breast-feeding. Postmenopausal women and older men also need to consume more calcium. Over time, the body becomes less efficient at absorbing calcium. Also, older patients are more likely to take medications that interfere with calcium absorption. Premenopausal women and postmenopausal women who use HT should consume at least 1,000 milligrams (mg) of elemental calcium and a minimum of 800 international units (IU) of vitamin D every day. Postmenopausal women not using HT, anyone at risk of steroid-induced osteoporosis, and all men and women older than 65 should aim for 1,500 mg of elemental calcium and at least 800 IU of vitamin D daily. Calcium and vitamin D supplements are most effective taken together in divided doses with food. Other tips for prevention (These measures can also help prevent bone loss) Exercise (particularly weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope, skiing and impact-producing sports) Add soy to your diet Don't smoke Hormone therapy. Hormone therapy can reduce a woman's risk of osteoporosis during and after menopause. But because of the risk of side effects, discuss the options with your doctor and decide what's best for you. Testosterone replacement therapy works only for men with osteoporosis caused by low testosterone levels. Taking it when you have normal testosterone levels won't increase bone mass. Avoid excessive alcohol Limit caffeine Sources: http://www.mayoclinic.com/health/osteoporosis/DS00128/DSECTION=prevention