Pre-operative nutritional screening |
Albumin, calcium, magnesium, phosphorus, ALP, folate, Vit B12, TSH, Vit D and PTH |
FBC, LFT, glucose, creatinine, electrolytes, iron, B12, folate, calcium, PTH, Vit D, albumin, zinc, B1 |
Screen for co-morbidities for example calcium, Vit D, PTH, |
Pre-operative calcium and vitamin D supplementation |
Prophylactive multivitamins and minerals (pharmacological doses if deficient) |
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Treat co-morbidities as identified prior to surgery |
Post-operative nutritional screening and management |
As above at 4 weeks, then 3, 6 and 12 months then annually |
Vitamin D, calcium, phosphorus, PTH and ALP every 6 months for two years then annually |
Regular screening in the first 12 months and then annually. If the patient has co-morbidities regular screening for 24 months, then annual |
Post-operative investigation and evaluation |
DEXA as recommended by examination and patients risk factors |
DEXA performed yearly until stable |
Investigations to be guided by examination and risk factors; for example in metabolic bone disease, DEXA at three sites and two year follow up |
Post-operative calcium and vitamin D supplementation |
IV multivitamins until able to take oral.
1800mg calcium with 800-1000IU vitamin D |
Vitamin D deficiency to be treated with ergocalciferol 50000IU one to three times a week or if severe up to three times daily |
1200-2000mg calcium with 400-800IU vitamin D daily
(May need to as high as 50000-150000IU daily) |
