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Looking back on a year that changed the world, yet had many silver linings

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Reflections on APCO’s highlights and achievements for 2021

 

Throughout 2021, the COVID-19 pandemic continued to weigh heavily on healthcare systems worldwide, creating a gamut of challenges that extended far beyond the impact of the virulent pathogen itself. Despite these challenges, our APCO members persevered and remained resilient, focusing on their commitment to improve osteoporosis outcomes and fulfill our organisation’s mission:

To engage with relevant stakeholders, including healthcare providers, policy makers and the public, to help develop, and implement, country and region-specific programs for the prevention and treatment of osteoporosis, and its complication of fragility fractures.

Lauded for our engagement of independent osteoporosis experts from different parts of the Asia Pacific, this year, we have continued to expand our membership, and currently have 47 osteoporosis experts representing 20 countries and regions. Our membership growth has armed us with invaluable expertise, enabling us to secure greater stakeholder awareness, and acceptance of osteoporosis as a key public health priority in countries across the vast and heterogenous region that is the Asia Pacific.

Our major highlights and achievements of 2021 include:

The APCO Framework

Representing the first major initiative since our organisation’s inception, APCO members developed ‘The APCO Framework’ – the first pan-Asia Pacific clinical practice standards for the screening, diagnosis, and management of osteoporosis, targeting a broad range of high-risk groups. This set of clear, concise, relevant, and pragmatic clinical standards aims to support national societies, guideline development authorities, and healthcare policy makers with the development of new guidelines, and to encourage the revision of existing guidelines across the Asia Pacific.

Since its publication in Osteoporosis International on January 28, 2021, ‘The APCO Framework’ has attracted extensive attention among healthcare professionals, leading osteoporosis organisations, and more than 300 regional medical and consumer news platforms. We are heartened to see many of our APCO members actively disseminating information about and encouraging implementation of The Framework in their respective countries.

We were invited to contribute to numerous editorial pieces, commentaries and opinion pieces on The APCO Framework in leading peer reviewed and indexed journals, such as The Annals of the Academy of Medicine (Singapore), Journal of the College of Physicians and Surgeons (Pakistan) and the Indian Journal of Endocrinology and Metabolism (India), as well as in other journals such as  MJA Insight+ (Australia), NZJM Digest (New Zealand), and the inaugural issue of the Newsletter of the Endocrine Society of India (ESI).

Several osteoporosis guideline development authorities in the Asia Pacific region have now committed to employ the principles advocated in the APCO Framework during the process of developing their own guidelines.

To download or access The APCO Framework, head to www.apcobonehealth.org/apco-framework.

APCO expert video series

To further heighten awareness of The APCO Framework, we launched the APCO expert video series on September 6, 2021, capturing the voices of four key APCO members – Dr Manju Chandran, Singapore, Dr Philippe Halbout, Switzerland, Dr Aysha Habib Khan, Pakistan and Dr Atsushi Suzuki, Japan.

In this video series, each expert reflects on the osteoporosis landscape in their respective country, outlines various efforts underway to address the burden of osteoporosis, and explains how The APCO Framework can be implemented region-wide, to improve the screening, diagnosis, and management of osteoporosis.

To view the expert video series, head to https://apcobonehealth.org/disrupting-the-status-quo-in-osteoporosis-management/#video-series.

APCO HCP Peer to Peer Education Modules

To aid peer-to-peer education among healthcare professionals on The APCO Framework, we developed a comprehensive educational slide kit, titled ‘Implementing the minimum clinical standards of The APCO Framework’ – also known as the APCO HCP Peer-to-Peer Education Modules.

This world-first, interactive, educational osteoporosis resource encourages widescale implementation of the minimum clinical standards of care for osteoporosis, as advocated in ‘The APCO Framework’, and will enable the delivery of best practice osteoporosis care throughout the region.

It contains 17 modules – one module for each of the 16 APCO Framework Clinical Standards, and one module on recently emerging themes in osteoporosis care.

We have received an overwhelming response to the modules since launch, with requests from all over the world to access the content.

To request access to The APCO Education Modules, head to: www.apcobonehealth.org/apco-education-modules.

World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Disease (WCO-IOF-ESCEO)

In August this year, APCO was invited to stage a virtual booth at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Disease (WCO-IOF-ESCEO), at the Committee of National Societies (CNS) village.

Our virtual booth showcased a plethora of our materials, including:

  • Posters providing an overview of APCO
  • The APCO Framework Infographic
  • A Summary of The APCO Framework
  • Three videos – APCO Executive Committee Chairperson announcing the launch of The APCO Framework; Implementing the APCO Framework in the Asia Pacific (APCO expert video series); and
  • The APCO Framework animation.

Awards and Honours

A highlight of the year for APCO was two of its members winning two of the International Osteoporosis Foundation’s most prestigious awards. The IOF Olof Johnell Science Award, which recognizes a distinguished medical professional and researcher who has an outstanding record of achievements in education, research and policy implementation within the bone and musculoskeletal field, was conferred upon Prof Manju Chandran – APCO Chairperson. Dr Philippe Halbout, CEO of the IOF and Executive Committee Member, clinched The President’s Award – recognising individuals who have made a significant and unstinting contribution to the advancement of the work of the IOF.

The election of APCO Executive Committee Member, Prof Peter Ebeling as the President of the American Society of Bone and Mineral Research (ASBMR), representing the first person outside of North America to be elected to this role, was another momentous occasion for APCO.

World Osteoporosis Day 2021

APCO members across the Asia Pacific region celebrated World Osteoporosis Day on October 20, 2021, with gusto. This annual event, which was initiated by the International Osteoporosis Foundation in 1997, serves as a reminder of the importance of increasing awareness of the devastating disease that is osteoporosis.

Under the WOD 2021 overarching theme of ‘Take Action for Bone Health’, we were thrilled to see so many of our APCO members, particularly those from Australia, Bangladesh, India, Japan, Malaysia, Pakistan, Philippines and Singapore, working proactively to place bone health on the medical, policy maker and community agenda.

The 15th International Federation of Ageing Global Conference

The International Federation of Ageing’s (IFA) 15th Global Conference was held virtually and in person, at Niagara Falls, Canada between 9-12 December, 2021. At this conference, under the overarching theme of “Rights Matter”, APCO Executive Committee Member, Mr Paul Mitchell, and Prof Manju Chandran were invited to speak at the Special Symposium on “A Life Course Approach to Bone Health: From Fragility Fractures to Resilience”, and to take part in the subsequent panel discussion.

The IFA has General Consultative Status at the United Nations and its agencies, and formal working relations with the World Health Organization. The symposium attracted attendees from around the world and helped to focus attention on the work being done in the bone field across the Asia Pacific.

IOF Regional 8th Asia-Pacific Osteoporosis Conference

The IOF Regional 8th Asia-Pacific Osteoporosis Conference was held virtually between 1-2 December, 2021. This virtual, CME accredited congress showcased breakthrough science, research, and the latest updates on clinical practice.

On day two of the conference, APCO hosted a joint session with the Asia Pacific Fragility Fracture Alliance (APFFA), during which APCO Chairperson, Prof Manju Chandran, Singapore, spoke on ‘Driving policy change to promote best practice in osteoporosis care in Asia Pacific’, and Dato’ Dr Joon Kiong Lee, Malaysia, canvassed the ‘Management of Osteoporosis in the Asia Pacific Region’. We were also invited to stage another virtual booth within the CNS virtual village.

Several of our members contributed to the success of the conference, by leading various discussions and presentations, including Prof Chandran, Dr Philippe Halbout, Dr Greg Lyubomirsky, Prof Derrick Chan, Prof Ambrish Mithal, Dr Tanawat Amphansap and Prof Sarath Lekamwasam.

“Indeed, to paraphrase Charles Dickens, 2021 was the worst of times and the best of times” reflected Prof Chandran.

“Despite the challenging times the world is facing, and through the fight against the virulent enemy in our midst which is the pandemic, we were able to focus much needed attention on non-communicable diseases such as osteoporosis.

“We were able to launch many innovative, ground-breaking initiatives in osteoporosis, expand our APCO membership pool of thought leaders in healthcare, and to speak up for the silent disease,” Prof Chandran said.

“We are looking forward to 2022, in which we have many projects lined up including engaging policy makers and guidelines development authorities in multiple countries in the Asia Pacific to implement The Framework, developing and disseminating pathfinder audit templates, establishing digital educational platforms for the public, and working with external entities to build up communities of good practice.

“Through it all we remain committed to being non-partisan, apolitical and altruistic in our path,” concluded Prof Chandran.

APCO wishes everyone a lovely end to the year and a wonderful, fulfilling and peaceful New Year!

To learn more about APCO, and to stay abreast of the latest osteoporosis news, head to apcobonehealth.org.

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Intercontinental Sharing of Principles and Guidelines: How can Europe and the Asia Pacific work together to bring better care for Osteoporosis patients?

Low Calcium Intake

Reference 1: This review examined calcium intake among adults around the world and found that many populations do not consume enough calcium to support good bone health. The authors highlight that low calcium intake is particularly common in many Asian countries, where average intakes are often well below recommended levels. Because calcium is essential for building and maintaining strong bones, inadequate intake may increase the risk of osteoporosis and fractures. The study emphasises the importance of promoting calcium rich foods and other practical ways to help people meet their daily calcium needs.

Citation: Balk EM, Adam GP, Langberg VN, et al. “Global dietary calcium intake among adults: a systematic review.” Osteoporos Int. 2017 Dec;28(12):3315-3324. doi: 10.1007/s00198-017-4230-x. Epub 2017 Oct 12. Erratum in: Osteoporos Int. 2018 May;29(5):1223. doi: 10.1007/s00198-018-4447-3. PMID: 29026938; PMCID: PMC5684325.


Reference 2: This review explores the important role of calcium in maintaining healthy bones throughout life. The authors explain that adequate calcium intake helps build and maintain bone strength, while long term low intake may contribute to bone loss and increase the risk of fractures. The paper also discusses the importance of obtaining calcium from a balanced diet, with supplements considered when dietary intake is insufficient. Overall, the review reinforces that meeting daily calcium needs is an important part of supporting lifelong bone health.

Citation: Cormick G, Belizan JM. “Calcium Intake and Health.” Nutrients. 2019 Jul 15;11(7):1606. doi: 10.3390/nu11071606. PMID: 31311164; PMCID: PMC6683260.


Reference 3: This review explores how common calcium deficiency is around the world and the impact it can have on health. The authors explain that many people do not consume enough calcium, particularly in low and middle income countries, increasing the risk of poor bone health and fractures. The paper highlights the importance of consuming enough calcium throughout life to help build and maintain strong bones. It also emphasises the need for practical strategies, such as improving access to calcium rich foods, fortified foods, and nutrition education, to help people meet their daily calcium needs.

Citation: Shlisky J, Mandlik R, Askari S, et al. “Calcium deficiency worldwide: prevalence of inadequate intakes and associated health outcomes.” Ann N Y Acad Sci. 2022 Jun;1512(1):10-28. doi: 10.1111/nyas.14758. Epub 2022 Mar 5. PMID: 35247225; PMCID: PMC9311836.

High Sodium Intake

Reference 1: This review explored whether eating too much salt affects bone health in postmenopausal women. The authors found that while high salt intake may increase calcium loss from the body, there is currently not enough high quality evidence to clearly determine its long term effects on bone mineral density or fracture risk. The paper highlights the need for more research to better understand this relationship. In the meantime, following general recommendations to limit excessive salt intake remains an important part of maintaining overall health.

Citation: Imash D, Gusmanov A, Chan MY. “High salt intake and bone health in postmenopausal women: exposing the lack of studies – a systematic review and meta-analysis.” Front Endocrinol (Lausanne). 2025 Nov 19;16:1694539. doi: 10.3389/fendo.2025.1694539. PMID: 41347127; PMCID: PMC12672310.


Reference 2: This study explored whether salt intake was linked to bone health in postmenopausal women in southern India. The authors found that women who consumed more salt were more likely to have weaker bones, poorer bone structure, osteoporosis, and vertebral fractures. These findings suggest that excessive salt intake may be associated with poorer bone health in this population. The study adds to growing evidence that a balanced diet, including limiting excess salt, may help support healthy bones.

Citation: John R, Cherian KE, Kapoor N, et al. “Excess dietary salt is associated with an altered bone strain index, degraded bone microarchitecture, vertebral fractures, and increased prevalence of osteoporosis in postmenopausal women – A study from a teaching hospital in southern India.” Aging Med (Milton). 2024 Oct 10;7(5):606-613. doi: 10.1002/agm2.12360. PMID: 39507226; PMCID: PMC11535168.

Lower Protein Intake Among Older Adults

Reference 1: This review explored how protein intake and regular exercise can help slow the progression of age-related muscle loss in older adults living in the community. The authors found that combining adequate protein with strength or resistance exercise was more effective than either approach alone in helping to maintain muscle strength and physical function. The paper highlights that preserving muscle health is important for reducing the risk of falls, fractures, and loss of independence. It also reinforces the value of healthy lifestyle habits in supporting active and healthy ageing.

Citation: Li L, He Y, Jin N, Li H, Liu X. “Effects of protein supplementation and exercise on delaying sarcopenia progression in Asian community-dwelling older adults.” Food Chem X. 2022 Jan 20;13:100210. doi: 10.1016/j.fochx.2022.100210. PMID: 35128383; PMCID: PMC8808080.


Reference 2: This consensus paper encourages a broader focus on maintaining muscle health throughout life rather than only identifying or treating sarcopenia after it develops. The authors explain that healthy muscles are essential for mobility, balance, independence, and overall wellbeing, especially as people age. The paper highlights the importance of regular physical activity, good nutrition, and early action to help preserve muscle strength and function. It also encourages healthcare professionals and the public to view muscle health as an important part of healthy ageing alongside bone health.

Citation: Chen LK, Hsiao FY, Akishita M, et al. “A focus shift from sarcopenia to muscle health in the Asian Working Group for Sarcopenia 2025 Consensus Update.” Nat Aging. 2025 Nov;5(11):2164-2175. doi: 10.1038/s43587-025-01004-y. Epub 2025 Nov 4. PMID: 41188603.

High Prevalence of Lactose Intolerance

Reference 1: This review explores how lactose intolerance may affect bone health. The authors explain that people who avoid dairy because of lactose intolerance may miss out on important nutrients, particularly calcium, if these nutrients are not replaced from other foods. The paper highlights that getting enough calcium is important for maintaining strong bones and reducing the risk of fractures. It also emphasises that there are many ways to meet calcium needs, including lactose free dairy products and other calcium rich foods.

Citation: Hodges JK, Cao S, Cladis DP, Weaver CM. “Lactose Intolerance and Bone Health: The Challenge of Ensuring Adequate Calcium Intake.” Nutrients. 2019 Mar 28;11(4):718. doi: 10.3390/nu11040718. PMID: 30925689; PMCID: PMC6521087.


Reference 2: This review explores whether drinking milk can help support bone health in Asian populations, particularly those at higher risk of osteoporosis. The authors highlight that many people in Asia consume less milk than recommended, which may contribute to lower calcium intake and poorer bone health. The paper explains that milk provides important nutrients for strong bones and discusses practical options for people who cannot tolerate regular milk, such as lactose free milk and yoghurt. Overall, the review suggests that finding suitable ways to include dairy or alternative calcium rich foods in the diet may help support lifelong bone health.

Citation: Jiao H, Xu Y, Zhang Y, et al. “Is it advisable for Asians to drink milk, especially those at risk of osteoporosis?” Front Nutr. 2025 Jun 25;12:1586623. doi: 10.3389/fnut.2025.1586623. PMID: 40635901; PMCID: PMC12239142.


Reference 3: This review explores ways to protect bone health in populations where calcium and vitamin D intake is often too low. The authors explain that getting enough of these nutrients is essential for building and maintaining strong bones, yet deficiencies remain common in many parts of the world. The paper highlights that healthy eating, safe sun exposure, regular physical activity, and, where needed, fortified foods or supplements can all help support bone health. It also emphasises the importance of public health efforts to improve awareness and make nutritious foods more accessible, particularly for people at greater risk of osteoporosis.

Citation: Yeum KJ, Ju S, Choe U. “Strategies for preventing bone loss in populations with inadequate calcium and vitamin D intake.” Nutr Res Pract. 2025 Apr;19(2):155-169. doi: 10.4162/nrp.2025.19.2.155. Epub 2025 Mar 13. PMID: 40226767; PMCID: PMC11982687.

Vitamin D Deficiency Despite Sunshine

Reference 1: This review examined how common vitamin D deficiency is around the world and found that it remains a widespread public health concern. The authors explain that many people do not get enough vitamin D because of factors such as limited sun exposure, diet, and lifestyle. As vitamin D plays an important role in maintaining strong bones and muscles, low levels may increase the risk of poor bone health. The study highlights the importance of improving awareness and ensuring people have adequate vitamin D through safe sun exposure, diet, fortified foods, or supplements when needed.

Citation: Cui A, Zhang T, Xiao P, Fan Z, Wang H, Zhuang Y. “Global and regional prevalence of vitamin D deficiency in population-based studies from 2000 to 2022: A pooled analysis of 7.9 million participants.” Front Nutr. 2023 Mar 17;10:1070808. doi: 10.3389/fnut.2023.1070808. PMID: 37006940; PMCID: PMC10064807.


Reference 2: This review examined vitamin D levels among adults living in South Asia and found that vitamin D deficiency is very common across the region. The authors explain that factors such as limited sun exposure, lifestyle, skin pigmentation, and diet may all contribute to low vitamin D levels. Because vitamin D is essential for maintaining healthy bones and muscles, addressing this deficiency is an important part of supporting lifelong bone health. The study highlights the need for greater awareness and practical strategies to help people achieve adequate vitamin D levels.

Citation: Siddiqee MH, Bhattacharjee B, Siddiqi UR, MeshbahurRahman M. “High prevalence of vitamin D deficiency among the South Asian adults: a systematic review and meta-analysis.” BMC Public Health. 2021 Oct 9;21(1):1823. doi: 10.1186/s12889-021-11888-1. PMID: 34627207; PMCID: PMC8501935.

Vegetarian and Plant-Based Diets

Reference 1: This review explores how vegetarian diets may affect bone health. The authors explain that while well planned vegetarian diets can provide many health benefits, they may also be lower in important nutrients such as calcium, vitamin D, protein, and vitamin B12 if not carefully balanced. The paper highlights that these nutrients play an important role in maintaining strong bones and reducing the risk of fractures. It also emphasises that people following vegetarian diets can support their bone health by choosing a varied, nutrient-rich diet and including fortified foods or supplements when needed.

Citation: Falchetti A, Cavati G, Valenti R, et al. “The effects of vegetarian diets on bone health: A literature review.” Front Endocrinol (Lausanne). 2022 Aug 5;13:899375. doi: 10.3389/fendo.2022.899375. PMID: 35992115; PMCID: PMC9388819.


Reference 2: This review examines how vegetarian diets may influence bone mineral density, a measure of bone strength. The authors explain that people following vegetarian diets may have lower bone mineral density if they do not consume enough nutrients that are important for healthy bones, such as calcium, vitamin D, and protein. However, the paper also highlights that a well planned vegetarian diet can support good bone health when these nutritional needs are met. The review emphasises the importance of choosing a balanced diet to help maintain strong bones throughout life.

Citation: Chuang TL, Lin CH, Wang YF. “Effects of vegetarian diet on bone mineral density.” Tzu Chi Med J. 2020 Sep 16;33(2):128-134. doi: 10.4103/tcmj.tcmj_84_20. PMID: 33912409; PMCID: PMC8059457.


Reference 3: This review examined how vegan and vegetarian diets may affect bone mineral density and fracture risk. The authors found that people following plant based diets, particularly vegan diets, may have lower bone mineral density and a higher risk of fractures if they do not get enough nutrients that support bone health. The paper highlights the importance of consuming adequate calcium, vitamin D, protein, and other key nutrients when following a plant based diet. It also emphasises that well planned vegetarian and vegan diets can support healthy bones when nutritional needs are carefully met.

Citation: Iguacel I, Miguel-Berges ML, Gomez-Bruton A, Moreno LA, Julian C. “Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis.” Nutr Rev. 2019 Jan 1;77(1):1-18. doi: 10.1093/nutrit/nuy045. PMID: 30376075.

I Think I Might Be at Risk of Osteoporosis

Why should I ask?

Osteoporosis is often called the “silent disease” because there are usually no symptoms until a fracture occurs. If you have risk factors, it is important to discuss your bone health before a fracture happens. Some common risk factors include but not limited to: Family history, Smoking, Alcohol, Low Body Weight, Age and Previous Falls.

Questions to ask your Doctor

1Am I at risk of osteoporosis?
2Should I have a bone health assessment?
3Should I have a DXA scan?
4What are my personal risk factors for osteoporosis and fractures?
5Are any of my medications affecting my bone health?
6What lifestyle changes can help protect my bones?

I am experiencing Height Loss, Stooped Posture, or Bone Pain

Why should I ask?

Losing height, developing a stooped posture or experiencing persistent back pain may not simply be part of ageing. These symptoms can sometimes be caused by vertebral fractures that happen without a major injury.

Questions to ask your Doctor

1Could my symptoms be caused by osteoporosis?
2Should I have spinal imaging or a VFA?
3Could I have had a spinal fracture without realising it?
4What treatments are available if I have vertebral fractures?
5How can I reduce my risk of future fractures?

I have Risk Factors but my DXA Scan was Normal

Why should I ask?

A normal bone density result does not always mean your bones are healthy. Some people may still be at increased fracture risk because of other risk factors or underlying conditions that affect bone quality.

Questions to ask your Doctor

1Does a normal DXA scan mean I cannot have osteoporosis?
2Why am I still at risk of fractures?
3Should my fracture risk be assessed using other tools?
4Are there additional tests I should have?
5How often should my bone health be reviewed?

I am worried about being on an Osteoporosis Medication

Why should I ask?

Many people are concerned about possible side effects of osteoporosis medicines. Understanding both the benefits and risks can help you make an informed decision with your doctor.

Questions to ask your Doctor

1Why are you recommending this medication?
2What are the common side effects?
3How common are the serious side effects?
4What happens if I decide not to take treatment?
5Are there other treatment options that may be suitable for me?

I am going through Menopause

Why should I ask?

Bone loss accelerates during and after menopause because of declining oestrogen levels. Acting early can help maintain bone strength and reduce future fracture risk.

Questions to ask your Doctor

1Does menopause increase my risk of osteoporosis?
2Should I have a DXA scan?
3Am I getting enough calcium and vitamin D?
4Would hormone therapy or another treatment benefit me?
5What lifestyle changes can help protect my bones?

I Have Another Medical Condition That May Affect My Bones

Why should I ask?

Some medical conditions can weaken bones, affect bone quality or interfere with the body’s ability to absorb important nutrients. Others may increase your risk of falls and thus fractures. These include diabetes, rheumatoid arthritis, thyroid disease, kidney disease, celiac disease among others.

Questions to ask your Doctor

1Does my medical condition increase my risk of osteoporosis or fractures?
2Should I have a DXA scan or other bone health tests?
3Are there treatments that can help protect my bones?
4Do I need to see a bone specialist?
5How often should my bone health be monitored?

I take Long-Term Medicines

Why should I ask?

Some medicines can reduce bone strength or increase fracture risk, particularly if they are taken over a long period. Your doctor can help determine whether you need additional monitoring or treatment.

Questions to ask your Doctor

1Could this medication affect my bones?
2Should I have a DXA scan?
3Do I need calcium or vitamin D supplements?
4Should I take medication to help protect my bones?
5How often should my bone health be reviewed while taking this medication?

I am Falling More Often and am Worried about my Balance

Why should I ask?

Most fragility fractures occur after a fall. Identifying the causes of falls and improving balance and strength can significantly reduce your fracture risk.

Questions to ask your Doctor

1Why might I be falling more often?
2Could my medications be contributing?
3Should my vision or hearing be checked?
4Would physiotherapy or balance training help?
5Can I be referred to a falls prevention programme?

I am an Older Man

Why should I ask?

Although osteoporosis is often thought of as a women’s disease, men can also develop osteoporosis and experience serious fractures. Unfortunately, osteoporosis in men is frequently under-recognised and underdiagnosed.

Questions to ask your Doctor

1Can men develop osteoporosis?
2Should I have a bone density test?
3What are my personal risk factors?
4Do I need treatment to reduce my fracture risk?
5Are there lifestyle changes I should make?

My Blood Tests show Low Vitamin D and/or Low Calcium

Why should I ask?

Vitamin D and calcium play essential roles in maintaining healthy bones. Low levels may contribute to bone loss and increase the risk of fractures if left untreated.

Questions to ask your Doctor

1What may have caused my low vitamin D and/or calcium levels?
2Do I need supplements?
3How much calcium and vitamin D should I be taking?
4Should my levels be checked again?
5Are there other tests needed to identify the underlying cause of my my low vitamin D and/or calcium levels?