A patient who has several risk factors for osteoporosis has a bone density test that indicates osteopenia. The primary care NP plans to prescribe a bisphosphonate. Before initiating treatment, the NP should:
a. order an upper GI x-ray.
b. initiate PPI therapy.
c. order serum calcium and vitamin D levels.
d. prescribe a calcium and vitamin D supplement.
C
Patients must have adequate nutrition, calcium, and vitamin D. Hypocalcemia and vitamin D deficiency must be corrected before therapy is initiated. An upper GI x-ray is indicated only if the patient is symptomatic. Patients at risk for fracture should not take PPIs. Calcium and vitamin D supplements should be given with bisphosphonate therapy; however, the first action is to evaluate current serum levels.
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