NCIS, Vitamin D: The Often Missing Link In Bone Health (NAPS)—Womenoverthe age of 50 may go to great lengths to keep their bones strong, but they may not realize that their bone health regimen may be lacking a key ingredient—vitamin D. A recent report from the U.S. Surgeon General listed vitamin D as an essential element to help build strong, healthy bones. However, an analysis based on the Third National Health and Nutrition Examination Survey (NHANESIII) found that over 70 percent of women ages 5170 and almost 90 percent of women over 70 are not getting an adequate intake of vitamin D from food and supplements. This analysis was based on the adequate intake, as defined by the National Institutes of Health’s Institute of Medicine, of 400 IU Gnternational units) per day for women ages 5170 and 600 IU per day for women over 70. Other organizations, such as the National Osteoporosis Foundation (NOF), recommend vitamin D intake of up to 800 IU per day. Inadequate intake of vitamin D is a major health risk that threatens the bone health of many Americans. Maintaining adequate levels of vitamin D is necessary for the development of strong bones because it helps increase the intestinal absorption of calcium. Givenits effect on calcium absorption, vitamin D insufficiency is an important medical concern for patients with osteoporosis as it can lead to bone loss and an increased risk of fracture. Osteoporosis, the most common form of bone disease, affects 10 million Americans and the Surgeon General estimates that by 2020, one in two Americans over 50 will experience an osteoporosis-related fracture in hisor herlifetime. Aside from vitamin D supplementation, vitamin D is obtained from two sources: sunlight and diet. The skin manufactures the majority of the body’s vitamin D after direct exposure to sunlight, but as adults age, the ability to make vitamin D ill, over the age of 70 years) and with gastrointestinal malabsorption syndromes should receive vitamin D supplementation in addition to that provided in FosAMAxX Pius D. Many women do not realize how important vitamin D is to their bone health. through the skin diminishes. Avoiding sun exposure or using sunscreen can also limit a person’s production of vitamin D. Vitamin D can also come from diet, but there are limited dietary sources that contain the nutrient. Good dietary sources include fatty fish, and vitamin D fortified milk and orangejuice. However, for many people, dietary sources alone are not enough. Fortunately, new developments in osteoporosis treatment are giving both physicians and patients a new option. The newly approved Fosamax Pius D"™ (alendronate sodium/cholecalciferol tablets), marketed by Merck & Co. Inc., provides the proven powerof FosAMAX (alendronate sodium), with the added benefit of a weekly dose of vitamin D in a single onceweekly tablet. Fosamax Pius D is indicated for the treatment of osteoporosis in postmenopausal women and contains 70 mg of Fosamax and 2800 IU of vitamin D3, representing seven days’ worth of 400 IU of vitamin D (the recommended intake of vitamin D is 400-800 IU daily). Patients at increased risk for vitamin D insufficiency (e.g., those who are nursing-home bound, chronically Fosamax Puius D, like other bisphosphonate containing products should be used with caution in people with certain stomach or digestive problems. FOSAMAX Pius D should not be used if the patient has certain disorders of the esophagus that delay emptying or if the patient is unable to stand or sit upright for at least 30 minutes. In addition, FOSAMAX Pius D should not be used in patients with severe kidney disease or low levels of calcium in their blood, in patients who are allergic to Fosamax Pius D or in patients who are pregnant or nursing. FosAMAx Pus D alone should not be used to treat vitamin D insufficiency. A recent report from the U.S. Surgeon Generallisted vitamin D as an essential elementto help build strong healthy bones. @ “Many physicians and patients frequently are unaware of the importance of vitamin D in bone health,” said Robert P. Heaney, MD, FACP, FACN, professor of medicine at Creighton University in Omaha and scientist at its Osteoporosis Research Center. “Having a product like FosAMAx Pius D available to help physicians better manage their patients should be welcomed newsfor the estimated 10 million Americans who have osteoporosis and the physicians who treat them.” Additional selected cautionary information about Fosamax Pius D Patients should talk to their doctor if they have or have had problems with swallowing. In addition, patients should talk to their doctor if they have conditions, that may cause an overproduction of vitamin D (e.g. sarcoidosis, leukemia, lymphoma). Patients should tell their doctor about all medicines they are taking, including prescription and non-prescription medicines, vitamins, and herbal supplements. Some patients may develop severe digestive reactions including irritation, inflammation or ulceration of the esophagus. The risk of severe esophageal experiences appears to be greater in patients whofail to follow dosing instructions (see the adjacent Patient Product Information for moredetails). Patients who experience new or worsening heartburn, difficulty or pain when swallowing or chest pain should stop taking the drug and call their doctor right away. Patients who develop severe bone, joint, and/or muscle pain at any time should contact their doctor. The most commonly reported side effects with Fosamax in clinical studies have been abdominal pain (3.7 percent), musculoskeletal pain (2.9 percent), indigestion (2.7 percent), regurgitation (1.9 percent) and nausea (1.9 percent). The standard dosing regimen for Fosamax PLus D includes swallowing the tablet with six to eight ounces of plain water the first thing upon arising for the day and at least 30 minutes before the first food, beverage or medication of the day. After swallowing Fosamax Pius D, patients should not lie down for at least 30 minutes and not until after consuming their first food of the day. Patients should not chew or suck on a tablet of Fosamax Pius D. To learn more, visit www.fosamaxplusd.com or speak with your doctor about your bone health and appropriate treatment options.