Selection of therapeutic agent should be individualised based on patient-specific factors including fracture history, severity of osteoporosis (T-scores), risk for hip fracture, patterns of BMD, comorbid conditions (such as peptic ulcer disease, gastroesophageal reflux, malabsorption syndromes
, malignancy), cost, and other factors.
In those countries, folate testing could be limited to specific indications such as macrocytic anaemia with peripheral blood morphological changes suggestive of megaloblastosis, alcoholism, malabsorption syndromes
such as coeliac disease (most foods fortified with folic acid are not gluten free), some haemopoietic disorders, and chemotherapy patients.
Monitoring 25(OH) D levels and taking higher doses of vitamin D (such as 2000 IU per day or more) may be worthwhile for selected patients, such as those with advanced age, malabsorption syndromes
, or certain other health conditions, and people with dark skin or minimal sunlight exposure.
Decreased carotene levels are seen in several malabsorption syndromes
, including, but not limited to, some pancreatic diseases, sprue, post-small intestine resection, and celiac disease.
This would include patients with osteoporosis, those with malabsorption syndromes
, patients taking medications interfering with vitamin D, those with chronic kidney disease and older adults.
It is possible that malabsorption syndromes
and drug interactions cause a decreased uptake of oral drugs administered, which leads to higher dosage requirements, thereby increasing the likelihood of adverse effects and narcotic dependency.