Evaluation of calcium and vitamin D supplementation in bisphosphonate therapy.

OBJECTIVE: To assess the calcium and vitamin D intake of osteoporosis patients on bisphosphonate therapy. DESIGN: Prospective study. SETTING: Two independent pharmacies (Futrell Pharmacy Services, Jackson N.C., and McDowell's Pharmacy, Scotland Neck, N.C.) and one ambulatory care clinic (Scotland Neck Family Medical Center, Scotland Neck, N.C.) in eastern rural North Carolina from December 2005 to February 2006. PATIENTS: 29 osteoporosis patients on bisphosphonate therapy. INTERVENTIONS: Patients were assessed on calcium intake and counseled on the appropriateness of supplementation with bisphosphonate therapy. MAIN OUTCOME MEASURE: Degree to which osteoporosis patients on bisphosphonate therapy use concomitant calcium supplements. RESULTS: Of the 29 patients surveyed, 17 patients were using calcium supplements during bisphosphonate therapy. Reasons cited for not using calcium included constipation (7 patients), polypharmacy (3), forgetfulness (1), and deemed unnecessary (1). Types of calcium supplements used were 71% calcium carbonate (12 patients), 24% calcium citrate (4), and 5% unknown (1). Calcium doses used were 500 mg/day (4 patients), and 1,000 mg/day (3), and 1,200-1,400 mg/day (13). Also, 13 patients were taking vitamin D in addition to their calcium, with 8 patients taking 400 IU and the rest 200 IU. Among the patients surveyed, 8 reported taking a proton-pump inhibitor, and 6 were taking calcium carbonate, which is not absorbed well in those taking agents that increase gastric pH. All patients separated their bisphosphonate dose from other medications and meals. CONCLUSION: Patients do not recognize the need to supplement calcium at the recommended dosage of at least 1,200 mg/day or 1,500 mg/day for postmenopausal women with osteoporosis along with vitamin D 400 IU for osteoporosis treatment while on bisphosphonate therapy.

Lions Clubs International Foundation Core Four Photoscreening: results from 17 programs and 400,000 preschool children.

INTRODUCTION: Photoscreening programs for preschool vision screening have been promoted by Lions Clubs International Foundation (LCIF) via their 17 Core Four grant project awards since 1999. Results from 15 Core Four grant programs in the United States and one in Taiwan are presented here. METHODS: Photoscreening was modeled after the Tennessee program and instituted statewide in each area. Programs were given latitude with respect to screening instrument and referral criteria, but a partnering academic institution and medical director were expected. Preschool children were screened by volunteers; referred children were examined by community optometrists and ophthalmologists who returned results to each program's coordinating center. Outcome data included number of children screened, referral rate, follow-up rate, and positive predictive value, which was generally determined using AAPOS-defined vision screening criteria. RESULTS: All but one program used the MTI photoscreener (it chose not to participate); photoscreening referral criteria were standard for 13 programs. Through December 2004, more than 400,000 preschool children had been screened. The referral rate for programs using the MTI photoscreener averaged 5.2% (range, 3.7-12.6%). The predictive value of a positive photoscreen was 80%. Overall, 54% of referred children received follow-up examinations. Follow-up rate was the largest variable: 4 programs, screening nearly 250,000 children, had follow-up rates 70% or greater; 10 programs had follow-up data from fewer than 40% of referred children. CONCLUSIONS: Volunteer-led photoscreening programs can be instituted in other locations, including overseas, with high levels of effectiveness. Limitations include the possibility of poor success and variable attention to follow-up.