Table 5.

Counseling Strategies to Address Patient Barriers to Calcium Supplementation

Patient Belief/ConcernPhysician Response
“No one in my family ever broke their hip. I'm not at risk for osteoporosis.”“Osteoporosis can cause fractures anywhere, not just the hip. Spinal fractures are much more common than hip fractures and are frequently never diagnosed.”
“The older we get, the more likely we are to develop osteoporosis. All of us are at risk for osteoporosis and need to do everything we can to prevent it.”
“I get enough calcium in my diet.”“Most people do not. Let's briefly review your diet and estimate your typical daily calcium intake.”
“I thought that studies showed calcium supplements don't help prevent fractures.”“What studies suggested is that women whose calcium intakes are already at target don't get a lot of added benefit from taking even more calcium.”
“I don't like to take pills.”“Let's talk about good dietary sources of calcium. There are also chewable candy calcium supplements.”
“But I take a multivitamin every day. Isn't that enough?”“Multivitamins alone don't meet your daily requirements. Let's add up how much calcium you get in a typical day's diet and see how much you need by supplement.”
“Would you rather meet your requirements by diet alone?”
“I've already had one kidney stone. I was told not to drink milk or take any supplements.”“For most people who have had a kidney stone, the more calcium you obtain through foods, the lower your risk of additional kidney stones. You are the type of person who would best meet your calcium needs primarily through diet. There are many non-dairy calcium- rich foods such as fortified cereals and orange juice.”