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 D
Physical Activity- weight bearing/balance training importance
Alcohol/Smoking
Fall Prevention & Home Safety
Oral Health--
Vision exam
Risk Factors
Women - BMD/DEXA all women > 65 years
Men - BMD/DXA – NOF recommends all men over age 70 years
Treatment – 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 flashes
2-3 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. Overview
Osteoporosis causes weak bones. In this common disease, bones lose minerals like calcium. They become fragile and break easily.
Normal
Bone
Bone with
Osteoporosis
With Osteoporosis your body’s frame (bones)
becomes like the frame of a house damaged by termites
Weak bones break easily
May never walk again
Can even be fatal
Source: 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 structure
Not a natural part of aging
Increased risk for women, post-menopausal, over age 65
All races, sexes, and ages are susceptible
Preventable and treatable!

10. The “silent disease” Often called the “silent disease”
Bone loss occurs without symptoms
First sign may be a fracture due to weakened bones
A sudden strain or bump can break a bone
Fragile bones are not painful at first

11. The problem in America
Major health threat for an estimated 44 million (55%) of people 50 years and older
10 million estimated to have osteoporosis
34 million have low bone mass placing them at risk
1 in 2 women and 1 in 4 men over 50 will have an osteoporosis-related fracture
Never too old to improve your bone health
Important to follow the steps known to strengthen and protect bones
weight bearing exercise such as walking or stair climbing – at least 30 minutes per day
Weight lifting
diet adequate in calcium and vitamin D
Caring for bone fractures from osteoporosis cost American $18 billion each year
A stack of dollar bills 1,119 miles high – farther than the distance from New York to St. Louis
The cost of caring for these patients and the work that is lost adds billions more
Broken bones in your spine are painful
Heal slowly
Weak bones in spine
Gradually lose height
Posture becomes hunched over
Difficult to walk or sit up
Risk of osteoporosis is greatest for women
also high for Whites and Asians than other groups
Risk for older men and women of all backgrounds
Source: 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 density
Source: 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 move
Bones are a storehouse for vital minerals
Strong 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 factors
If 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 1
I’m older than 65
I’ve broken a bone after age 50
My close relative has osteoporosis or has .broken a bone
My health is “fair” or “poor”
I smoke
I am underweight for my height

21. I've never gotten enough calcium 2
I started menopause before age 45
I've never gotten enough calcium
I have more than two drinks of alcohol .several times a week
I have poor vision, even with glasses
I sometimes fall
I'm not active

22. I have one of these medical conditions:
Hyperthyroidism
Chronic lung disease
Cancer
Inflammatory bowel disease
Chronic liver or kidney disease
Hyperparathyroidism
Vitamin D deficiency
Cushing's disease
Multiple sclerosis
Rheumatoid arthritis 3

23. 4
I take one of these medicines:
Oral glucocorticoids (steroids)
Cancer treatments (radiation, chemotherapy)
Thyroid medicine
Antiepileptic medications
Gonadal hormone suppression
Immunosuppressive 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 1
Get 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 foods
Between 51 and 70 – need 400 International Units (IU) of vitamin D
Over 70 – need 600 IU of Vitamin D
Vitamin D helps your body absorb calcium
Calcium is critically important to bone health
Use 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 week
At least 30 minutes of physical activity per day
Any activity that puts stress on bones keeps them strong
walking, gardening, dancing, running
Balance training at least once per week
Examples:
Yoga
Pilates
Tai Chi
One-leg balances
Toe walking
Forward-backward leg swings with knee flexed
The physical activity will also strengthen your body – leads to fall reduction
Benefits of exercise only last as long as the exercise is part of a regular routine
Even 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 factors
Your medication
Calcium & vitamin D intake
Do you need a bone density scan

30. Testing is a simple, painless procedure.
Step 5
Have a bone density test
and take medication
when appropriate.
Source of photo: USDA ARS Photo Unit Photo by Peggy Greb
Testing is a simple, painless procedure.
Discuss significant risks with a health care professional
Medications
Family history
Recent falls or broken bones
All 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
Goal
Over 50 years
1,200 mg
Source: 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 daily
120% DV for calcium = 1,200 mg
Look for this label:
“Nutrition Facts” on foods
“Supplement Facts” on vitamin/mineral supplements

34. You need more vitamin D as you age
600 IU
200 IU
400 IU
100
200
300
400
500
600
up to 50
51-70
over 70
Daily 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% DV
Milk 1 cup = 30% DV
Cheese 1 ½ oz. natural/2 oz. processed = 30% DV
Milk pudding 1/2 cup = 15% DV
Frozen yogurt, vanilla, soft serve ½ cup = 10% DV
Ice cream, vanilla ½ cup = 8% DV
Soy or rice milk, calcium-fortified 1 cup = varies—check label
Choose fat-free or low fat most often

38. % DV calcium: Grain products group
Cereal, calcium- fortified Serving size and amount of calcium varies— check label
Calcium-fortified

39. % DV calcium: Vegetable group
Broccoli, raw 1 cup = 9% DV
Collards 1/2 cup = 20% DV
Turnip 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 label
Look for 100% juice

41. % DV calcium: Meat & Beans Group
Baked beans 1 cup = 14% DV
Salmon, canned, with edible bones 3 oz. = 18% DV
Sardines, canned, in oil, with edible bones 3 oz. = 32% DV
Soybeans, 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 cereals
Cold 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 milk
Yogurt made with live, active bacteria
It may be easier to digest lactose that is pre-digested
Try
Lactose-hydrolyzed milk and dairy products
Commercial lactase preparations

45. When you don’t like to “drink” milk
Make oatmeal and cream-type soups with milk instead of water
Add powdered milk to food (1 tablespoon = 50 mg calcium)
Add milk to coffee
Serve 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 chives
Enjoy plain or flavored low fat yogurt straight from the carton or combined
Used flavored yogurt as a fruit salad dressing; experiment with substituting plain yogurt for some or all of the sour cream in vegetable salad dressings

46. Calcium supplement considerations

47. Calcium carbonate vs. citrate
Needs acid to dissolve and for absorption
Less stomach acid as we age
Often taken at meals when more stomach acid
Calcium citrate
Doesn’t require stomach acid for absorption
May be taken anytime—check with your healthcare provider
May 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®) Calcitonin
Estrogen Therapy/Hormone Therapy
Parathyroid Hormone (PTH 1-34)
Selective Estrogen Receptor Modulator (SERM)
(Evista®) Raloxifene
PRESENTER 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®) - Ibandronate
FDA 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 falls
Improve your balance, coordination, and strength through weight-bearing physical activity such as dancing or Tai Chi
Review medicines with a health care professional (some medicines may cause drowsiness or dizziness)
Have your vision checked
Make 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 bathroom
Remove 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 rugs
Have grab bars put next to toilet, in bathtub or shower
Use non-slip mats in the bathrub and shower
Use brighter lights
Wear shoes and slippers that give good support and have non-slip soles

55. Protect Your Bones Falls Prevention
Annual medication
review
Have an annual medication review conducted by a healthcare provider or pharmacist
Insure this review includes an adequate focus on falls and fall-related injury prevention
goal of reducing or eliminating medications that increase falls risk.
Changes in cognitive and physical function, dizziness or lightheadedness, balance difficulties, confusion and sedation
refer for a comprehensive assessment.
Medication use can cause these changes
interventions aimed at medication modification to help reduce the risk of falls
modifications might include dosage reduction
elimination of a particular medication
an alternative medication.
©2005 NCOA Falls Free: Promoting a National Falls Preventions Action Plan

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.

59. Bone Health Building Blocks

60. Bone Health & Oral Health
Oral health care is important.
Bone loss in the jaw and osteoporosis have been linked
The 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 Continued
The National Institute of Arthritis and Musculoskeletal and Skin Disease Steps for Healthy Bones
Eat 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. Resources
The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You
National Osteoporosis Foundation
American 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