1. Welcome and Introductions
Healthy Bones for Life™
Welcome and Introductions
PURPOSE: To welcome participants and tell them about you and your interest in bone health.
One out of every two women and one of every four men over the age of 50 are at risk for osteoporosis, low bone density, and will suffer a fracture.
Osteoporosis is a life altering disease and a major public health problem in this country.
Osteoporosis is a silent disease; but a fracture can change your life in an instant.
Every 20 seconds someone in this country will have a preventable fracture. So during our time together today, 180* Americans will have a preventable fracture. Imagine that!
Today we will learn about bone loss and the disease of osteoporosis and what you can do to avoid being one of the faces of osteoporosis.”
First I would like to introduce myself …. I am (name).
I am interested in osteoporosis because (background)
I am pleased to say that I am a trained American Bone Health Representative”
Discuss any housekeeping items - The logistics of the session = time, questions, if you have to leave, where restrooms are, when we break (or how long you will talk), if you want interaction etc.
*calculate based on your talk - 3 fractures/minute x # min in talk. 60 minute talk =180 fractures
[Note to presenters: You might “warm up” the audience by asking the audience a question. Question can be something as simple as tell me “one thing you KNOW about osteoporosis OR one thing you’ve heard about osteoporosis. You could ask how many people are from the area? Out of state? Etc. Anything to get them “involved”]

2. outreach and education
awareness
outreach and education
advocacy
Community talks
Bone health hotline
Bone health fairs
Bone-safe workshops
All About Bones
BONESENSE eNewsletter
Fracture risk screening
Purpose: – to introduce American Bone Health and our mission –
“As I mentioned, I am here on behalf of American Bone Health.
We are mobilizing communities across the country to improve bone health and prevent osteoporosis and fractures.
With our national network of trained volunteers, we are raising awareness, educating the public, and advocating for policies that will help reduce the impact of this public health epidemic.
I have listed some of the resources that we offer in the community. The best place to find out more is by going to our website at

3. Osteoporosis or Fractures Today’s presentation
Learn why bone health should matter to you NOW
Understand the disease called osteoporosis
Learn about
Prevention
Screening
Diagnosis
Treatment
Fall prevention 
Osteoporosis or
Fractures
Purpose: Describe what they will learn from the talk.
“In our time together we will talk about diagnosis, treatment and prevention of osteoporosis. By the end of my talk, I hope you will know why bone health should matter to you NOW; understand the disease we call osteoporosis; and learn how to prevent, diagnose and treat it!”

4. So…is osteoporosis a problem?
70%
…of people over 65 with osteoporosis have never been screened and don’t know they have osteoporosis.
KEY MESSAGES:
Osteoporosis is an epidemic in this country.
Early screening is important, especially if you have one or more risk factors.
Purpose:
“If you remember nothing else about what I say, please remember this. OSTEOPOROSIS IS A PROBLEM! 70% of the people with osteoporosis have not been screened so they are not aware they have osteoporosis. By attending this talk, you are one of the lucky ones. I hope you will not only learn this for yourself, but for your family and friends as well.”
NOTE TO SPEAKER: this statistic is for people over age 65.
Curtis, J. Osteoporosis International 2009

5. Annual incidences
Purpose: Put osteoporosis into perspective with other diseases. It is significant, silent and sadly can cause death.
“Osteoporosis is a major public health problem in this country. It affects more women than breast cancer, uterine cancer, and colon cancer combined!
We must all make bone health and osteoporosis prevention a priority. It affects men and women from all racial groups, and can rob people of their independence and quality of life.
And the good news is that osteoporosis is very preventable, and now treatable. Today is a great day to take actions that will improve your bone health for your lifetime.”
NOTE TO SPEAKERS: The osteoporosis fractures in the slides includes all fractures major osteoporotic (wrist, ribs, hip and spine).
National Osteoporosis Foundation, 2005
American Heart Association, 2011
Stroke Center, 2011
American Cancer Society 2011
(C) Trelle Enterpirses Inc

6. 19/05/2018
What is osteoporosis?
Osteoporosis is disease characterized by loss of bone mass leading to fragile bones that break easily.
Purpose: identify osteoporosis as a disease.
“Osteoporosis is a disease characterized by loss of bone mass leading to fragile bones that break easily.”
“Bone is living tissue - it goes through a continual process of remodeling, where old bone is removed and replaced by new bone. Healthy bone (on the left) is strong, it holds us up, it protects our internal organs, and when muscles contract and relax, bones help us move around!”
There are lots of things that can affect bone tissue, causing it to become osteoporotic (on right). You can see that the bone on the right is thinner and you can just imagine that it will not be able to hold up to all that we might expect it to do. We frequently hear about people sneezing and breaking a bone. If you compare the two pictures, you can see why that might happen”
NOTE TO SPEAKERS:
Try to find a prop to use as a demonstration.
(C) Trelle Enterpirses Inc

7. Bones remodel every 7-10 years
Bone remodeling means you have the opportunity to have new bones every 7-10 years!
Purpose: To discuss bone growth, development and remodeling. Pp 16-19
“It is easy to think of bone as a hard, lifeless part of our body. In fact, bone is living, growing tissue that is constantly being formed and broken down.”
Because of this process called remodeling, where osteoclasts break down bone and osteoblasts build bone, the bones that you have now are not the same bones that you had 7-10 years ago, and they will not be the same bones you will have in 7-10 years in the future. This gives you the possibility of improving your bones!”
“In healthy bones, the osteoclast and osteoblast activity is balanced. When this remodeling becomes unbalanced – in other words when the breaking down happens faster than the reformation of bone - bones can become thin and fragile.”
Osteoblasts – Build bone
Osteoclasts – Breakdown bone

8. Purpose: to describe healthy bone and normal aging, birth to peak bone mass. pp. 19-20
“So let’s talk about how bone changes throughout our lives. Throughout childhood, the osteoblasts or bone forming cells are working harder than the osteoclasts or cells that are breaking down bone. There is a very steep acquisition of bone [demonstrate on slide] until ‘peak bone mass’ at around the age of 30. Once you reach peak bone mass, the remodeling process stays balanced. The osteoblasts and osteoclasts are working at the same pace and your bone mass stays relatively stable until around menopause for women (and about age 70 for men). At menopause, because of the decrease in the hormone estrogen, the osteoblasts (bone building cells) do not keep up with the osteoclasts (cells breaking down bone) and there is a rapid period of bone loss. [demonstrate on slide] During the five years around menopause* women can lose as much as 25-30% of their bone mass.
Men continue to lose bone at a steady slower rate than women and at about age 70, the reduction in the hormone testosterone begins to cause more rapid bone loss in men.
Having an understanding of how bone develops helps us understand how we can prevent osteoporosis. There are very important things we can do to support our bone health throughout our lives. Kids need to build as much bone as they can in their teens because during the years around puberty (9-14), kids will build more bone than they will lose in their lifetime. Calcium, vitamin D and physical activity are important at all ages.
We also need to think about reducing behaviors that are bad for bones. We will talk about those shortly.
Now, let’s talk about how silent fractures in the spine can affect your life.”
*average age of “natural” menopause is 51. Some women may have “surgical” menopause (hysterectomy) earlier in life and they are subject to the same bone loss issues as women with natural menopause.

9. Risk factors for osteoporosis
19/05/2018
Risk factors for osteoporosis
Things you can’t change
Gender
Heredity
Age
Fracture history
Medical conditions
Medications
Purpose: Identifying some of the risk factors for bone loss and osteoporosis. pp (Primary and secondary osteoporosis)
“There are some risk factors that you cannot change. Let’s talk about these.
First, 80% of people who have osteoporosis are women. Women have a higher risk of osteoporosis than men due to lower estrogen levels as they age which protects bone.
About 65% of your bone health can be attributed to heredity – if your mother or father had osteoporosis, you are at a higher risk yourself.
As we age, there is a certain amount of bone loss, so the older you are, the higher your risk.*
Finally, there are a number of medical conditions and medications that can affect the bone. I’ll show you a list of the most common in a minute. We can’t do too much about these risk factors, but it is important that you are aware of them so that you can take extra steps to minimize their impact.”
*This is considered primary osteoporosis – age-related osteoporosis.
(C) Trelle Enterpirses Inc

10. Risk factors for osteoporosis
19/05/2018
Risk factors for osteoporosis
Things you can change
Calcium consumption
Vitamin D intake
Quit smoking
Alcohol consumption
Physical activity
Posture
Some medications
Low body weight(BMI<20)
Purpose: Identifying some of the risk factors for bone loss and osteoporosis. pp (Primary and Secondary osteoporosis)
“There are a number of risk factors that you have control over and you can change. Getting enough calcium and vitamin D, not smoking, limiting alcohol, increasing physical activity – especially weight bearing activity and remembering to improve your posture.
Before going on any medication, it is important that you talk with your doctor or pharmacist about any medications that you are taking and how they might affect your bones.” Women who have estrogen deficiency due to either early menopause(<age 45) or prolonged premenopausal amenorrhea(>1 year).
Note: Having your doctor look at your risk factors on the FRC (Fracture Risk Calculator) will help your doctor determine if you need medication.
(C) Trelle Enterpirses Inc

11. Secondary osteoporosis
Medical Conditions
Disordered Eating
Hypogonadism
Alcoholism
Hyperthyroidism
Cancers
Liver Disease
Celiac Disease
Malabsorption
Crohn’s Disease
Rheumatoid Arthritis
Cushing’s Disease
PURPOSE: To highlight the number of medical conditions that can cause bone loss and increase fracture risk. P28
“If a specific illness is causing osteoporosis, it is called secondary osteoporosis.
I show you this slide so that you have an appreciation of the large number of medical conditions that can cause secondary osteoporosis.
If you are diagnosed with a chronic illness, you should ask your doctor what other illnesses may be associated with it. If osteoporosis is a concern, you need to increase your prevention strategies.
Again, cancer and cancer treatments can cause bone loss. Be sure to talk with your doctor.”

12. Secondary osteoporosis
Medications
PPIs(Nexium,Prilosec)
SSRIs(Prozac,Zoloft,Paxil)
Anticoagulants (Heparin®)
Lithium
Anticonvulsants (Dilantin®)
Methotrexate
Steroids
Chemotherapy drugs
Thyroxine - high doses (Synthroid®)
Cyclosporine
Tamoxifen(premenopausal use)
Aromatase Inhibitors
PURPOSE: To highlight the number of medications that can cause bone loss and increase fracture risk. pp.30-32
“If a medication used to treat another medical condition is causing osteoporosis, it is also called secondary osteoporosis.
I show you this slide so that you have an appreciation of the large number of medications that can also cause osteoporosis. Being on steroid drugs, like prednisone is one the most common causes of secondary osteoporosis. (p. 188) There are other medications that can cause bone loss that are not on this slide. If you are taking any medication currently, or start a something new, always talk to your doctor about its affect on your bone health. Excess vitamin A and E intake can also be considered for secondary osteoporosis.
NOTE TO SPEAKER: Cancer treatments can cause bone loss. People with cancer should talk with their doctors. P188

13. Screening Diagnostic Wrist fractures Height loss
Wrist and heel screening
FORE Fracture Risk Calculator™ (FRC)
Diagnostic
Bone Mineral Density test (DXA)
Women >65
Men >70
Anyone younger with a risk factor
KEY MESSAGES:
There is a difference between screening and making a diagnosis of osteoporosis. Screening tools may lead to a diagnosis, but the gold standard is DXA which is X-ray technology. The heel screening uses ultrasound and there is a much lower correlation with t-scores.
Purpose: To distinguish between screening and testing pp
“There are many ways to assess your risk of osteoporosis and bone loss.
Wrist fractures may seem insignificant, but they can be an important signal that your bones may not be as strong as they could be.
Height loss – more than 1½ inches can signal fractures in your spine. Make sure that you get your height measured at every doctor’s visit.
There are opportunities to get wrist screenings at health fairs that can indicate low or high risk for fracture coupled with the results of your Fracture Risk Calculator score.
Our tool, called the FORE Fracture Risk Calculator is available on-line and takes into account the risk factors that we have discussed and tells you whether you are at low, moderate or high risk of having a fracture.
If any of these screening tools show that you are at risk for osteoporosis, you need to get diagnosed. Right now, the only way to diagnose osteoporosis is with a Bone Mineral Density Test or DXA. This test measures the amount of bone density, usually in the spine and hip. All women over age 65 and all men over 70 need to get a DXA. At the age of 65, Medicare fully covers a DXA scan every 24 months. If you are younger and have any ONE risk factor, you should talk with your doctor about ordering this test.”
Go to
(C) Trelle Enterpirses Inc

14. About the FORE Fracture Risk Calculator
Find the calculator by going to:
The FORE Fracture Risk Calculator (TM) estimates fracture risk for postmenopausal women and men over age 45.
Take the test to determine your risk of bone fracture.

15. T-scores -4 -3 -2 -1 +1 +2 +3 +4 Low Bone Density Osteoporosis+1 +2 +3 +4
-2.5
KEY MESSAGE:
It is important to understand that when your t-score is below normal in either your spine, hip, or wrist, you have low bone density.
Bone density is only one part of your bone health story, make sure to keep it in perspective.
Purpose: to explain T-score and to give it some meaning. PP
“How many of you have had a bone density test?
When you get a bone density test, the results are reported as a T-score (p 141) which is a measurement term. The T-score indicates how far away you are from the norm and the norm is based on the bone density expected for an average person at age 30.
Your T-score is reported as a standard deviation (SD), which indicates how far you are from the norm. If your T-score is greater than -1.0; you are classified as having normal bone density. If you have a T-score between -1.0 and -2.5, you are classified as having low bone mass; and if you have a T-score that is -2.5 or lower, then you are classified as having osteoporosis.
It is really important to keep a copy of your bone density tests. Since bone density changes pretty slowly, you want to be able to compare your results when you have subsequent tests. Take your DXA results with you to each doctor visit.”
Low Bone Density
Osteoporosis
Porous bone that can lead to fractures
Normal
As compared to an average 30 year old
(osteopenia)

16. Calcium Vitamin D Weight bearing activity
Preventing bone loss
Calcium
Vitamin D
Weight bearing activity
“Now that you understand about osteoporosis and how we diagnose it, let’s talk about prevention.”

17. The dynamic duo for bone health
Calcium
Vitamin D
EVERY DAY!
mg* /day (diet + supplements)
Body can only absorb mg at a time
You can take too much (no more than 1500 /day)
EVERY DAY!
,000 IU* /day (supplements)
Sunshine alone is not a reliable source
Research shows vitamin D can reduce falls up to 20%
Purpose: important ‘fast facts’ about calcium and vitamin D based on the 2010 Institute of Medicine recommendations
Chapters 4 and 5 pp 54-82
“Calcium and vitamin D are the dynamic duo for bone health. Calcium is the mineral that makes your bones strong and calcium needs vitamin D to absorb it into the body. So the two go hand in hand. The amounts that you need of each vary with age. The BONESENSE handout that you got today has more specific age-related requirement information about both.
Generally you want to get between 1,000 and 1,200 milligrams of calcium EVERY day. It would be great if you can get it in your diet from the food you eat. This is pretty easy if you eat dairy. If you don’t eat dairy products, you may need a calcium supplement. Your body can only absorb about 500 milligrams at a time, so if you are taking supplements, split them up. You can get too much calcium, so dietary is best because it does not seem to cause concerns for the heart.
The most recent recommendation from the Institute of Medicine for vitamin D is between 800 IU’s if you have healthy bones and 2000 IU’s per day if you have concerns about your bone health. (Check with your doctor about your vitamin D3 test results for proper dose).
We know that vitamin D is often called the sunshine vitamin, but concerns about skin cancer and the latitude of the sun make it not such a reliable source of vitamin D. Vitamin D supplements are inexpensive and everyone with concerns about their bone health should be taking them. Stay tuned as we hear more about the benefits of vitamin D. Some research now shows vitamin D can reduce falls up to 20% for those over 65!
NOTE TO PRESENTER: If people have never had their vitamin D level tested (23OH/D3) and they aren’t currently supplementing, they can request that it be tested the next time they go for their annual exam. They should see if it is covered by their insurance first, since it is an extra blood test and not part of the regular panel. If they are already supplementing and haven’t ever had their level checked, we suggest again, that if insurance will cover the cost, they should get it checked to make sure that they are supplementing with the correct amount of vitamin D.
*Amounts (RDAs) change with age!

18. How to get your calcium
PURPOSE: To show the foods that can be good sources of calcium.
“The best dietary source of calcium is dairy. Unfortunately, many people are lactose intolerant. In general, you get somewhere around 300 milligrams of calcium in a serving of dairy or a calcium fortified food or juice.
There is calcium in vegetables, but in much smaller amounts – and you must be aware that the calcium binds to the fiber in the vegetable and is not easily absorbed.
Other items that could decrease absorption are:
Caffeine, Cola Drinks, Diet Drinks, Energy drinks, Sodium.
Start to read food labels and look for foods that include calcium. There are many at the store.
Purpose: Make everyone aware of non-dairy options for getting calcium in their diet.
“OK, so you don’t eat dairy. Although it’s the easiest source of calcium, there are other options. You just need to be aware of how much you need to eat of these other sources to get the same amount of calcium. Mineral water can have a significant amount of natural calcium in it, you need to check your label. Gerolsteiner has 80mg per 8 ounces, but some others have more. Not all mineral waters have a high content, and some have none. There is no need to worry about the carbonation being bad for your bones.
If you cannot reach your daily required amount of calcium through your diet, you may need a calcium supplement.”
NOTE TO SPEAKERS: pick out a couple of your favorite examples from the list or choose any other calcium- rich food you can demonstrate.
Props can help
measuring spoons
2 cup measuring container (to showing how much broccoli/day)
bag of almonds 15 and say need 10 times this amount!
A ‘box’ of dried figs – you need 15 figs/day
tin of salmon with bones
1 pint of milk (empty)
Jar of tahini (sesame seed butter) – and measuring spoon to show 6 tablespoons
*These vegetables contain calcium, but your body may not be able to absorb it all because they contain fiber, phytates and oxalates, which inhibit calcium uptake.

19. How much calcium did you get yesterday?
Purpose: A simple tool to demonstrate how to get calcium in the diet.
“How do you know if you are getting enough calcium?
Use the Calcium Rule of 300.
Dairy is the easiest way to get your daily calcium. For each serving of dairy or calcium fortified juice, give yourself 300 milligrams. If you get a balanced diet, add another 300. If you eat a balanced diet, to reach 1200 milligrams a day you only need three servings of calcium fortified food a day. So think about it, you might be able to get your calcium by adding one more serving of dairy or a calcium rich food.
There are other sources of calcium – check the labels, but get enough every day!”
(C) Trelle Enterpirses Inc

20. Calcium supplements
Calcium citrate – Citracal, etc easier on stomach, can take with or without food
Calcium carbonate – Caltrate, Viactiv, Tums, etc. less expensive, take with food
Purpose: To explain the most common types of calcium and how to take them properly pp 67-71
“Next time you are in your local drug store, take a look at the calcium display – it is overwhelming!
What you should know is that there are two basic types of calcium supplements: calcium citrate and calcium carbonate.
Calcium citrate is easier on the stomach and you can take it without food. Be sure to read the labels – you might have to take more tablets to get the right amount of calcium.
Calcium carbonate needs the acid in your stomach to help dissolve the tablet. So you always take it after you have food in your stomach.
Be sure to read the labels – some of the supplements contain vitamin K (like Viactiv) and you don’t want that if you are on a blood thinner.
Remember that the body can only absorb approximately mg at a time, so read the label and don’t take more than mg.
Bottom line is - the best calcium for you is the one you will take everyday for the rest of your life!"
The best calcium is the one you will take every day for the rest of your life!

21. How to read a label
Simply add a 0 to the calcium percentage to get the exact milligram amount
30% + 0 =300mg
Purpose: How to read a food label to figure out how many milligrams of calcium is in each serving. P.64
“When you look at a food label it often gives the amount of calcium in percent (%) form. To know how many milligrams this is, you simply take the percent and add a zero and that is the exact number of milligrams. So, for example, it says one serving of yogurt is 30% calcium, by adding a zero, it tells you that it is the same as 300 mg of calcium.
The amounts are always based on a 2,000 calorie a day diet.”

22. How to get your vitamin D
Purpose: To show some foods that contain Vitamin D pp 73-74
“There are some food sources of vitamin D, particularly fatty fish – but many people find it easiest to supplement vitamin D.”
It’s very hard to get enough vitamin D through diet!

23. Exercise for strong bones* Begin with 30 minutes, 3 times/week
Weight bearing helps prevent bone loss
Walking
Weight lifting
Jump rope
Dancing
Tennis
Jogging
Pilates
Yoga
Purpose: exercise and the right type of exercise matters Chapter 6 pp Chapter 7 pp
“Weight bearing exercise helps stimulate bone building cells (the osteoblasts) through the impact of the weight being transmitted through the bone. Walking is a great activity and can promote leg strength, which we know really helps with balance. Be aware that walking does not build bone density but can maintain your current bone mass.
If you are taking an exercise class, especially Pilates or yoga, ask the instructors if they know how to work with people who have low bone mass or osteoporosis. There are many postures that must be modified to prevent fractures.
If you are starting an exercise program, be sure to talk with your doctor first.
OK – enough sitting – let’s get up for a moment and try a couple of activities.”
*Get a complete medical exam before starting an exercise program.
(C) Trelle Enterpirses Inc

24. Exercise to prevent falls and fractures
Get up from a chair without using arms
Modified squats
Y-exercise
Balance on one leg
Do It Right! And Prevent Fractures!
Maintain leg strength, balance and posture
PURPOSE: There are many movements that we do on a daily basis that puts our bones at risk. Chapter 6 pp Chapter 7 pp
“Were you able to get out of your chair without using your arms? This is a great indicator of your leg strength. Strong legs help prevent falls and fractures. One thing you can work on during your day is doing a modified squat over your chair – [demonstrate]. Do a couple of these whenever you can and see how quickly your quadriceps (thigh muscles) respond – you will notice you get stronger pretty quickly.
Now that you are standing let’s talk about posture. We learned about the importance of posture as kids, and we need to be reminded of it as we get older. Strengthening the muscles between your shoulders can help protect your spine and help prevent the spinal fractures we talked about. Let’s all stand up as straight as we can and pull our shoulders back and down. Hold this for a count of five and then relax your shoulders. Try to do this when ever you can. It may take some time to retrain your body to keep your shoulders back – but it really does feel good.
Balance is also really important. Try this – hold on to the back of the chair in front of you and see if you can lift your right leg and hold it for five seconds. Now let go of the chair. Can you balance without holding on to the chair? If you work on this small exercise when you are brushing your teeth, you will notice a difference in a short time. (Begin by holding on to the counter and standing on one leg)
So while you are standing, let’s talk about the benefits of good leg strength and balance.”

25. Good strength and balance can help prevent falls and fractures
Stop multi-tasking
Remove trip hazards
Get your eyes checked
Keep a night light on
Get your medications checked
Purpose: Preventing falls can prevent fractures. Chapter 10 p
“There are an estimated 2 million falls that occur every year that warrant a trip to the emergency room. 500,000 result in hospital stays.
Having good lower body strength and balance can reduce your risk of falling. We also know that good strength and balance can help prevent falls and fractures.
There are other ways to reduce your risk for falling.
Stop multi-tasking and pay attention to where you are walking and what you are doing. Slow down!
Take a look around your home. Do you have throw rugs that are all over – pick them up and get rid of them. What about pets – we love them, but remember that they can easily knock you off balance. Keep your eyes open for them.
Speaking of eyes, get your eyes checked! Vision plays an important role in preventing falls.
Most falls happen at night – and guess where – in the bathroom. Get a night light and use it.
If you are taking four or more medications, you are at a higher risk for falls. Talk with your doctor about what medications you are taking, and if all of them necessary? Make sure they are not interacting with each other in a negative way.
OK – have a seat and we’ll finish up by talking briefly about the medicines available for osteoporosis.”
2 million people land in the emergency room from a fall. 500,000 falls result in hospital stays.
(C) Trelle Enterpirses Inc

26. Treatments for osteoporosis
Nobody likes taking drugs,
but when thinking about taking a bone drug ask yourself...
What is my risk of having a life changing fracture?
Purpose: what are your choices?
“If you are diagnosed with osteoporosis or have a fracture, you might need a medication.  There are many options available from pills to injections, and they all reduce your fracture risk.  We are not physicians, and therefore cannot give out medical advice, so our recommendation is to talk to your doctor. (Make sure to bring your FORE Fracture Risk Calculator results with you! Also available from American Bone Health is our Talking with your doctor handout.)”
Notes to speaker: For your personal reference, you can refer to Chapter 11 in the book pp to learn more about specific treatments. We don’t cover that information in our presentations, but you should have that information for your own understanding.
Osteoporosis treatments reduce fracture risk by at least 35%
(C) Trelle Enterpirses Inc

27. 500 will suffer a fracture without treatment for Osteoporosis!
YOUR RISK OF FRACTURE
Out of 1,000 women,
500 will suffer a fracture without treatment for Osteoporosis!

28. Progression of spine fractures
Results:
height
breathing
appetite
elimination
Purpose: To discuss vertebral fractures and kyphosis pp. 22,23
“Your spine is a column of bones, with disks in between—like a stack of blocks. Ideally, they stay strong and even-sized. But if the bones in the spine becomes weak, a slight movement can cause them to break and become crushed. Most spinal fractures that occur happen in the upper back between the shoulder blades. [demonstrate on slide] The bones that were once block-shaped, become wedge shaped or triangular. When a number of triangular bones are stacked, the spine that was once straight starts to bend forward causing a stooped posture or kyphosis.
Spinal fractures may cause pain, or they may be silent. In a person with very low bone density, doing even routine things, like putting something up on a shelf, or bending to pick up a bag of groceries—can cause a fracture in the spine.
This is a picture of the progression of height loss that results from spinal compression fractures. As more bones in the spine become fractured, the lungs and the digestive organs are all compressed and people start to have problems breathing and eating.
As you can see from the picture, the ribcage begins to slowly end up sitting on top of the hip.” [demonstrate on slide]
We want you to learn about the risk factors for osteoporosis and these debilitating fractures.”

30. Medication options Bisphosphonates- Fosamax, Actonel, Recast, Boniva
SERM (Selective Estrogen Receptor Modulators)- Evista
RANK, Ligand Inhibitors- Prolia
Parathyroid Hormone- Forteo
Hormone Therapy

31. Important things to remember
Bring your previous bone density scan report with you each time you have a bone density scan (DXA)
Always ask your doctor for your T-score
Always ask your doctor for a copy of your most recent bone density scan report so you can compare it to your last report
It’s important to know your risk factors so you can advocate for early screening or diagnosis
PURPOSE: To remind people about the importance of getting and keeping their test results.
“There are some important things to remember. Always bring your previous bone density scan with you each time you have another scan. Always ask your doctor for your T-score and always ask for a copy of the report so you can compare them when you talk with your doctor.”

32. 19/05/2018
What’s next?
Assess your bone health Use the FORE Fracture Risk Calculator and take it to your doctor
Slow bone loss With calcium, vitamin D and weight-bearing exercise
Prevent falls and fractures Use good posture and practice balance exercises
Treat your osteoporosis Learn the facts about the medication side effects and rare events
Purpose: call to action (pp. 202, 203)
“So each of you probably noticed different things that caught your attention.
I would like you to leave today with at least one thing that you will do as a result of this talk.
It could be to get an assessment of your bone health and risk of fracture. This is a great place to start.
How about slowing bone loss by making sure you are getting enough calcium and vitamin D and doing weight-bearing exercise?
Remember we talked about balance and posture – this can help prevent falls and fractures.
And finally, if you have osteoporosis, learn what you need to know about the treatments that are available.
Most importantly, I hope you now understand the consequences of not taking any action. Please, don’t be a victim to osteoporosis. Support your bones for a lifetime of health.”
Understand the consequences of no action
Don’t be a victim to osteoporosis. Support your bones!
(C) Trelle Enterpirses Inc

33. How you can help
DONATE!
Become a presenter - Contact Emely at American Bone Health x 11
Follow us on Twitter and Facebook
Subscribe to BONESENSE eNewsletter at
PURPOSE: Recruit more volunteers to the cause!
“There are many ways that you can help. We are a non-profit organization and we rely on donations and volunteers. Consider getting trained to be a presenter.
Stay on top of the latest in bone health by following us on Twitter and Facebook and subscribing to our eNewsletter.
Get involved. Join us and help end osteoporosis as a major public health problem.”

34. We have covered a lot! If you don’t remember it all:
Call our hotline
Check the website
Contact me! _______________
You can reach me at: ____________________
PURPOSE: Give them places to go for more information and your contact information (if you like).
“We have covered a lot of material. We are available to you through our 800# hotline. We have great resources on the website.
And you are always welcome to talk with me.
I have time for a few questions!”
Last updated July, 2016
(C) Trelle Enterpirses Inc

35. Your risk of Osteoporosis Complications are very low when compared to Other Risks