Presentation on theme: "Osteoporosis “No Bones About It” Please see note below:"— Presentation transcript:
1 Osteoporosis “No Bones About It” Please see note below: Points to be covered in PPT or any educational opportunity with age 60+ audience-If you are addressing various ages please refer to document with Osteoporosis Education Over the Life Span-Key Points on the CD.Mature Adults 60+Nutrition- Calcium/Vit DPhysical Activity- weight bearing/balance training importanceAlcohol/SmokingFall Prevention & Home SafetyOral Health--Vision examRisk FactorsWomen - BMD/DEXA all women > 65 yearsMen - BMD/DXA – NOF recommends all men over age 70 yearsTreatment – Medications mention there are medications available and consult healthcare provider for more information
2 No Bones About It FYI do not have to announce to group- 1st picture – 50 year old postmenopausal with hot flashes2-3 picture postmenopausal- at greater risk for vertebral fractures than any other type of fracture.Last picture:75 year old + with kyphosis: at risk for hip and vertebral fractures
3 Typical comments from people with osteoporosis “I’ve lost six inches in height and none of my clothes fit me anymore.”
4 Comments“It’s hard to get clothes that look nice when my back is so hunched over.”
5 “What will I do if I have to give up driving?” Comments“What will I do if I have to give up driving?”
6 Comments“Medications are expensive. But I can’t afford to let my condition get worse and this medicine will help stop or slow down the bone loss.”
7 Comments“If somebody had told me sooner what I know now about osteoporosis, none of this might be happening to me!”
8 OverviewOsteoporosis causes weak bones. In this common disease, bones lose minerals like calcium. They become fragile and break easily.NormalBoneBone withOsteoporosisWith Osteoporosis your body’s frame (bones)becomes like the frame of a house damaged by termitesWeak bones break easilyMay never walk againCan even be fatalSource: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at
9 Osteoporosis The Most Common Bone Disease Characterized by low bone mass and deterioration of bone structureNot a natural part of agingIncreased risk for women, post-menopausal, over age 65All races, sexes, and ages are susceptiblePreventable and treatable!
10 The “silent disease” Often called the “silent disease” Bone loss occurs without symptomsFirst sign may be a fracture due to weakened bonesA sudden strain or bump can break a boneFragile bones are not painful at first
11 The problem in AmericaMajor health threat for an estimated 44 million (55%) of people 50 years and older10 million estimated to have osteoporosis34 million have low bone mass placing them at risk1 in 2 women and 1 in 4 men over 50 will have an osteoporosis-related fractureNever too old to improve your bone healthImportant to follow the steps known to strengthen and protect bonesweight bearing exercise such as walking or stair climbing – at least 30 minutes per dayWeight liftingdiet adequate in calcium and vitamin DCaring for bone fractures from osteoporosis cost American $18 billion each yearA stack of dollar bills 1,119 miles high – farther than the distance from New York to St. LouisThe cost of caring for these patients and the work that is lost adds billions moreBroken bones in your spine are painfulHeal slowlyWeak bones in spineGradually lose heightPosture becomes hunched overDifficult to walk or sit upRisk of osteoporosis is greatest for womenalso high for Whites and Asians than other groupsRisk for older men and women of all backgroundsSource: National Osteoporosis Foundation Web site; retrieved July 2005 at
12 A woman’s hip fracture risk equals her combined risk of breast, uterine and ovarian cancer. Source: National Osteoporosis Foundation Web site; retrieved July 2005 at
13 People who break a hip might not recover for months or even years. Hip fractures account for 300,000 hospitalizations annually.People who break a hip might not recover for months or even years.Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at
14 1 in 5 people with a hip fracture end up in a nursing home within a year. Some people never walk again.Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at
15 The most common breaks in weak bones are in the wrist, spine and hip. If you break a bone after the age of 50, talk to your health care professional about measuring your bone densitySource: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at
16 Why Are Healthy Bones Important? Strong bones support us and allow us to moveBones are a storehouse for vital mineralsStrong bones protect our heart, lungs, brain and other organs
17 After mid-30’s, you begin to slowly lose bone mass. Women lose bone mass faster after menopause.Men lose bone mass too.Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at
18 You’re never too young or old to improve bone health!
19 Risk factorsIf you have any of these “red flags,” you could be at high risk for weak bones. Talk to your health care professional.Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at
20 I’ve broken a bone after age 50 1I’m older than 65I’ve broken a bone after age 50My close relative has osteoporosis or has .broken a boneMy health is “fair” or “poor”I smokeI am underweight for my height
21 I've never gotten enough calcium 2I started menopause before age 45I've never gotten enough calciumI have more than two drinks of alcohol .several times a weekI have poor vision, even with glassesI sometimes fallI'm not active
22 I have one of these medical conditions: HyperthyroidismChronic lung diseaseCancerInflammatory bowel diseaseChronic liver or kidney diseaseHyperparathyroidismVitamin D deficiencyCushing's diseaseMultiple sclerosisRheumatoid arthritis3
23 4I take one of these medicines:Oral glucocorticoids (steroids)Cancer treatments (radiation, chemotherapy)Thyroid medicineAntiepileptic medicationsGonadal hormone suppressionImmunosuppressive agents
24 The good news: Osteoporosis is preventable for most people! Healthy diet and lifestyle are important for BOTH men and women.If you have osteoporosis, your doctor can detect and treat it
25 Simple Prevention Steps The Surgeon General recommends five simple steps to bone health and osteoporosis prevention …
26 Use MyPyramid.gov to help plan an overall healthy diet Step 1Get your daily recommended amounts of calcium and vitamin D.Over 50 – need 1200 mg of calcium per day or 120% of the “Nutrition Fact” food label on packaged foodsBetween 51 and 70 – need 400 International Units (IU) of vitamin DOver 70 – need 600 IU of Vitamin DVitamin D helps your body absorb calciumCalcium is critically important to bone healthUse MyPyramid.gov to help plan an overall healthy diet
27 Step 2 Be physically active everyday Improve strength and balance Strength training, including light weights, 2 – 3 times per weekAt least 30 minutes of physical activity per dayAny activity that puts stress on bones keeps them strongwalking, gardening, dancing, runningBalance training at least once per weekExamples:YogaPilatesTai ChiOne-leg balancesToe walkingForward-backward leg swings with knee flexedThe physical activity will also strengthen your body – leads to fall reductionBenefits of exercise only last as long as the exercise is part of a regular routineEven simple activities such as walking, stair climbing and dancing can strengthen bones.
28 Step 3 Avoid smoking and excessive alcohol. 12 oz. 5 oz. 1.5 oz. MyPyramid.gov recommends no more than 1 drink per day for women and 2 for men.
29 Step 4 Talk to your doctor about bone health. Be sure to discuss Your risk factorsYour medicationCalcium & vitamin D intakeDo you need a bone density scan
30 Testing is a simple, painless procedure. Step 5Have a bone density testand take medicationwhen appropriate.Source of photo: USDA ARS Photo Unit Photo by Peggy GrebTesting is a simple, painless procedure.Discuss significant risks with a health care professionalMedicationsFamily historyRecent falls or broken bonesAll Women - BMD/DXA > 65 years. Physicians decision!Men - BMD/DXA –. Guidelines for DXA only address postmenopausal women. NOF recommends all men over age 70 years have a bone density scan. Physician decision!
31 Food and supplement labels Assess calcium and vitamin D intake by using food and supplement labels.
32 Calcium Requirements for 50+ Years GoalOver 50 years1,200 mgSource: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at
33 Nutrition labels & calcium FDA uses “Percent Daily Value” (% DV) to describe amount of calcium needed by general U.S. population daily120% DV for calcium = 1,200 mgLook for this label:“Nutrition Facts” on foods“Supplement Facts” on vitamin/mineral supplements
34 You need more vitamin D as you age 600 IU200 IU400 IU100200300400500600up to 5051-70over 70Daily vitamin D needs in International Units (IU)Age
35 Calcium & vitamin D recommendations years 1,200 mg calcium (120% DV) IU vitamin D (100% DV)70 and older 1,200 mg calcium (120% DV) IU vitamin D (150% DV)Senior adults over age 70 have the greatest need for vitamin D and are less able to make vitamin D from sunlight. Seniors need to be sure to consume enough vitamin D. It is difficult for many seniors to get enough vitamin D from foods and therefore a supplement may be needed. There is some evidence that the intake of 800 IU/day of vitamin D (or more) along with adequate calcium may reduce the risk for falls (by increasing muscle strength) and reduce the risk for fracture in postmenopausal women and seniors. All at-risk individuals should follow the advice of their medical professional to get enough vitamin D through either food and/or supplements.
36 Percent Daily Value (DV) of calcium in common foods Approximate % DV for foods based in part on The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at
37 % DV calcium: Milk group Yogurt 1 cup (8 oz.) = 30% DVMilk 1 cup = 30% DVCheese 1 ½ oz. natural/2 oz. processed = 30% DVMilk pudding 1/2 cup = 15% DVFrozen yogurt, vanilla, soft serve ½ cup = 10% DVIce cream, vanilla ½ cup = 8% DVSoy or rice milk, calcium-fortified 1 cup = varies—check labelChoose fat-free or low fat most often
38 % DV calcium: Grain products group Cereal, calcium- fortified Serving size and amount of calcium varies— check labelCalcium-fortified
39 % DV calcium: Vegetable group Broccoli, raw 1 cup = 9% DVCollards 1/2 cup = 20% DVTurnip greens, boiled 1/2 cup = 10% DV
40 % DV calcium: Fruit group Orange juice and other calcium-fortified beverages 6 oz. = 20 to 30% DV, varies—check labelLook for 100% juice
41 % DV calcium: Meat & Beans Group Baked beans 1 cup = 14% DVSalmon, canned, with edible bones 3 oz. = 18% DVSardines, canned, in oil, with edible bones 3 oz. = 32% DVSoybeans, cooked 1 cup = 26%Tofu, firm, with calcium ½ cup = 20% DV; check label
42 What about Vitamin D? Main dietary sources of vitamin D are: Fortified milk (400 IU per quart)Some fortified cerealsCold saltwater fish (Example: salmon, halibut, herring, tuna, oysters and shrimp)Some calcium and vitamin/mineral supplements
43 Vitamin D from sunlight exposure Vitamin D is manufactured in your skin following direct exposure to sun.Amount varies with time of day, season, latitude and skin pigmentation.10–15 minutes exposure of hands, arms and face 2–3 times/week may be sufficient (depending on skin sensitivity).Clothing, sunscreen, window glass and pollution reduce amount produced.Source: National Osteoporosis Foundation Web site; retrieved July 2005 at
44 Help for the lactose-intolerant Some people lack the enzyme lactase needed to digest lactose (milk sugar).Start with small portions of foods such as milk and gradually increase serving size.Eat dairy foods in combination with a meal or solid foods.Try dairy foods other than milk:Many hard cheeses (cheddar, Swiss, Parmesan) have less lactose than milkYogurt made with live, active bacteriaIt may be easier to digest lactose that is pre-digestedTryLactose-hydrolyzed milk and dairy productsCommercial lactase preparations
45 When you don’t like to “drink” milk Make oatmeal and cream-type soups with milk instead of waterAdd powdered milk to food (1 tablespoon = 50 mg calcium)Add milk to coffeeServe milk-based desserts (puddings, tapioca, frozen yogurt, custard, ice cream).Limit fat and sugar.Try chocolate milk.8-oz. has only mg caffeine.Average glass provides only 60 more calories than unflavored milk.Make instant hot cocoa with milk, not water.Top baked potatoes with plain yogurt; sprinkle with chivesEnjoy plain or flavored low fat yogurt straight from the carton or combinedUsed flavored yogurt as a fruit salad dressing; experiment with substituting plain yogurt for some or all of the sour cream in vegetable salad dressings
47 Calcium carbonate vs. citrate Needs acid to dissolve and for absorptionLess stomach acid as we ageOften taken at meals when more stomach acidCalcium citrateDoesn’t require stomach acid for absorptionMay be taken anytime—check with your healthcare providerMay cost more
48 Vitamin D necessary for calcium absorption Choose a supplement with vitamin D unless obtaining vitamin D from other sources.Follow age group recommendation. Avoid going over a daily combined total of 2,000 IU or 50 mcg from food and supplements.It’s not necessary to consume calcium and vitamin D at the same time to get the benefit of enhanced calcium absorption.Vitamin D is like a key that unlocks the door and lets calcium into the body.
49 Limit calcium to 500 mg at a time Our bodies can best handle about 500 mg calcium at one time from food and/or supplements.Spread your calcium sources throughout the day.
50 Increase amount slowly Start supplements with 500 mg calcium daily for about a week, gradually adding more.Gas and constipation can be side effects:Increase fluids and high fiber foods if diet is low in whole grains and fruits and vegetables.Try a different type of supplement if side effects continue.
51 Medications Bisphosphonates (Fosamax®) - Alendronate & Alendronate with Calcium(Boniva®) - Ibandronate (Updated 2006)(Actonel®) - Risedronate & Risedronate with Calcium(Miacalcin®) CalcitoninEstrogen Therapy/Hormone TherapyParathyroid Hormone (PTH 1-34)Selective Estrogen Receptor Modulator (SERM)(Evista®) RaloxifenePRESENTER NOTES: This is a list of available medications for the prevention and treatment for osteoporosis. There are medications available that have been approved for men. Explain: you will not cover this information but you did want them to know that medication is available and that would be a decision between you and your doctor. Like with any medication.there are side effects and everyone has a different history and set of possible diseases. Add that this slide is just to let them know there are medications available for some people depending on their health and circumstances.Alendronate= (Fosamax®) Risedronate = (Actonel®) Calcitonin= (Miacalcin®) Raloxifene (Evista®) (Boniva®) - IbandronateFDA has approved the following medications for the prevention and/or treatment of osteoporosis: bisphosphonates (alendronate, ibandronate and risedronate) Bisphosphonates are a class of drugs that can slow bone loss, increase BMD of the spine and hip, and reduce fracture risk. These drugs must be taken as directed.Calcitonin is a hormone your body produces (by thyroid gland) that controls your blood calcium levels and acts on your bone cells that control bone turnover. The drug can slow bone loss, increase spine BMD, reduce risk of fractures and it can help relieve the pain associated with spinal fractures in some people. It is available as a nasal spray or injection.Parathyroid hormone (PTH) is also a hormone your body produces (by parathyroid gland) that helps control blood levels of calcium and phosphate. It also act on bone cells. PTH is approved an injection that can help rebuild bone. You should talk to your doctor about medications that treat/help prevent osteoporosis if you have any risk factors Hormone replacement therapy can help prevent and treat osteoporosis. It can help reduce bone loss, increase spine and hip BMD and reduce risk of spine and hip fractures in postmenopausal women. Women who consider hormone therapy need to discuss the risks/benefits with their doctors and determine which therapy is appropriate for them (ERT v. HRT). Basically, postmenopausal women who still have their uterus need estrogen + progesterone (HRT) to reduce risk of uterine cancer. Selective estrogen receptor modulators (SERMs) and are approved for both prevention and treatment of osteoporosis. It can help prevent bone loss and increase BMD. It can be an option for some women who do not want to/cannot use ERT/HRT. It does not provide all the other protective benefits of ERT/HRT and will not help with menopause symptoms (e.g., hot flashes).Source:Physician’s Guide to Prevention and Treatment of Osteoporosis. 2nd ed. Washington, DC: National Osteoporosis Foundation; 2003.
52 Osteoporosis Falls Break Bones You can prevent most fallsImprove your balance, coordination, and strength through weight-bearing physical activity such as dancing or Tai ChiReview medicines with a health care professional (some medicines may cause drowsiness or dizziness)Have your vision checkedMake your home safer
53 Protect Your Bones Ways to Make Your Home Safer Have handrails and plenty of light in all stairways.Wear shoes that give good support and have non-slip soles.Don’t use stepstools. Keep items you need within easy reach.Maintain a clear path to the bathroomRemove all small rugs. They can make you trip.Make sure your walkways are wide enough.Remove things that you may trip over from stairs and places where you walk.Move phone and electrical cords away from walkways and open areas.Make sure that all areas are well lit. Use bright light bulbs.Be aware that some medications, including over-the-counter medicines, can make you dizzy or sleepy.Get your vision checked
54 Protect Your Bones Ways to Make Your Home Safer Remove small rugsHave grab bars put next to toilet, in bathtub or showerUse non-slip mats in the bathrub and showerUse brighter lightsWear shoes and slippers that give good support and have non-slip soles
56 Hip Fracture Prevention: Falling How do Younger Adults Fall? In a younger person, a fall occurring during moderate or brisk walking has enough forward momentum, so that the points of impact are the hands and knees instead of the hip.Younger, more agile persons tend to fall forward, landing on the outstretched wrist, thus fracturing the distal radius
57 Hip Fracture Prevention: Falling How do Older Adults Fall? Backward and lateral falls put the patient at risk for fractures.Older people tend to collapse downwards often landing directly on the hip. A fall occurring while standing or walking slowly has little forward momentum, therefore the principal point of impact will be near the hip.
58 Hip Fracture Prevention: Hip Protectors Hip Protectors are available and actually do prevent hip fractures. They have extra strong padding to absorb some of the impact from falling and prevent a fracture. They do help with decreasing fractures of the hip but sometimes it is difficult for people to consistently wear them. The fall occurs when they are in the drawer-therefore not helping prevent hip fractures. If they are not used it can’t help.This is an option you would want to discuss with your health care provider.
60 Bone Health & Oral Health Oral health care is important.Bone loss in the jaw and osteoporosis have been linkedThe loss of bone supporting the jaw and anchoring our teeth can lead to loose teeth, tooth loss and ill fitting dentures.Your dentist may be the first health professional to suspect osteoporosis.Women with osteoporosis have been reported to have 3 x more tooth loss than women without the disease.Your dentist will take your medical history, discuss oral health risk factors and review clinical & x-ray examinations at your dental visits.
61 ORAL HEALTH ContinuedThe National Institute of Arthritis and Musculoskeletal and Skin Disease Steps for Healthy BonesEat a well-balanced diet rich in calcium and vitamin D.Live a healthy lifestyle. Don’t smoke, and if you choose to drink alcohol, do so in moderation.Engage in regular physical activity or exercise. Weight-bearing activities, such as walking, jogging, dancing, and lifting weights, are the best for strong bones.Report any problems with loose teeth, detached or receding gums, and loose or ill-fitting dentures to your dentist and doctor.Healthy Bones help with Healthy Teeth!
62 ResourcesThe 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to YouNational Osteoporosis FoundationAmerican Dental Association,American Dietetic Association:Center for Disease Control and Prevention:National Institute of Arthritis and Musculoskeletal and Skin Disease. Health Topics: Oral Health and Bone Disease.Thanks to: University of Nebraska–Lincoln Extension educational programs