Prevent Osteoporosis… GET HEALTHY KENTUCKY
SPONSORED BY: <ul><li>Kentucky Department for Public Health </li></ul><ul><li>Osteoporosis  </li></ul><ul><li>Prevention a...
PRESENTED BY:
 
WHAT ARE WE GOING TO LEARN TODAY ??? <ul><li>What Is Osteoporosis ? </li></ul><ul><li>What Happens When Bones Break ? </li...
WHAT IS OSTEOPOROSIS ? <ul><li>Osteo = bone </li></ul><ul><li>Porosis = full of holes </li></ul><ul><li>Osteoporosis = mea...
Normal Bone
Osteoporosis
NORMAL HEALTHY BONE OSTEOBLASTS OSTEOCLASTS
OSTEOPOROTIC BONE <ul><li>The loss of living bone tissue makes </li></ul><ul><li>bones fragile and more likely to fracture...
 
Role of Estrogen <ul><li>Hormone that protects against bone loss </li></ul><ul><li>After menopause, estrogen production de...
WHAT HAPPENS WHEN BONES BREAK
Osteoporosis When Bones Break <ul><li>The most common breaks in weak bones are in the: </li></ul><ul><ul><li>Wrist </li></...
Osteoporotic Spine Fracture Compressed bone Fractured Normal
 
Osteoporosis When Bones Break <ul><li>Hip fractures are the most devastating </li></ul><ul><ul><li>One in five elderly peo...
TRUE OR FALSE GAME <ul><li>Men do not get osteoporosis. </li></ul><ul><li>Diet can provide all of the calcium a body needs...
CLARIFICATIONS <ul><li>There is no relationship between osteoporosis and arthritis. </li></ul><ul><li>Osteoporosis is a ge...
CLARIFICATIONS <ul><li>Steroids are sometimes used to treat arthritis, and using steroids may put a person at risk for ost...
HOW COMMON IS OSTEOPOROSIS?
 
 
KENTUCKY STATISTICS (2002) <ul><li>Projections for 2010  </li></ul><ul><li>834,000 Kentuckians age 50  & over will be affe...
RISK FACTORS
Are You at Risk for Weak Bones? Check Any of These that Apply to You <ul><li>I’m older than 65 </li></ul><ul><li>I’ve brok...
Are You at Risk for Weak Bones? Check Any of These that Apply to You <ul><li>I sometimes fall </li></ul><ul><li>I’m not ph...
Are You at Risk for Weak Bones? Check Any of These that Apply to You <ul><li>I take one of these medications: </li></ul><u...
Osteoporosis & Persons with Disabilities <ul><li>Low intake of dietary calcium </li></ul><ul><li>Medications </li></ul><ul...
Osteoporosis Affects Women &  Men  of  All  Ethnicities
RISK FACTOR REVIEW <ul><li>Discuss significant risks with a health care professional </li></ul><ul><ul><li>Gender  </li></...
STEPS TO PREVENTION
STEPS TO PREVENTION <ul><li>Live a Healthy Lifestyle </li></ul><ul><li>Eat foods rich in calcium and vitamin D </li></ul><...
STEPS TO PREVENTION <ul><li>Don’t smoke </li></ul><ul><li>Limit alcohol intake </li></ul><ul><li>Limit caffeine </li></ul>
A cup = 8 ounces.
Activity – Calcium Card (Optional)
LACTOSE INTOLERANCE <ul><li>Individuals who have difficulty digesting the sugar found in milk, called  lactose </li></ul><...
CALCIUM SUPPLEMENTS <ul><li>Read Labels--several different types of calcium supplements available  </li></ul><ul><li>Avoid...
Supplements: Calcium carbonate vs. citrate <ul><li>Calcium carbonate </li></ul><ul><ul><li>Needs acid to dissolve and for ...
CALCIUM SUPPLEMENT TIPS <ul><li>Be knowledgeable about the type of calcium you are taking </li></ul><ul><li>Space out your...
 
TEST YOUR CALCIUM SUPPLEMENT <ul><li>Put   a calcium tablet in a cup of half water and half vinegar.  </li></ul><ul><li>St...
Activity – Exercise Guide (optional)
 
BONE  DENSITY TESTING
WHO SHOULD GET TESTED <ul><ul><li>All women age 65 and older  </li></ul></ul><ul><ul><li>All postmenopausal women under 65...
Dual-Energy X-Ray Absorptiometry <ul><li>“ Gold Standard” test to determine a diagnosis </li></ul><ul><li>Measures hip & s...
UNDERSTANDING YOUR  T-SCORE
Medicare Criteria for Bone Mineral Density Testing   <ul><li>Women who are estrogen deficient  </li></ul><ul><li>Individua...
TREATMENT OPTIONS
Medication For Prevention and/or Treatment In post-menopausal women 1.  BISPHOSPHONATES a. Alendronate, Risedronate & Iban...
BISPHOSPHONATES Alendronate-Brand Name-Fosamax® Risedronate-Brand Name-Actonel® <ul><li>Slows or Stops Bone Loss </li></ul...
<ul><li>Ibandronte Sodium-Brand Name-Boniva® </li></ul><ul><li>Slows Bone Loss </li></ul><ul><li>Increases Bone Density </...
<ul><li>BRAND NAME: MIACALCIN® </li></ul><ul><li>Naturally occurring hormone involved in calcium regulation </li></ul><ul>...
ESTROGEN THERAPY (ET) <ul><li>Approved for the prevention of osteoporosis in postmenopausal women </li></ul><ul><li>Increa...
ESTROGEN THERAPY (ET) HORMONE THERAPY (HT) <ul><li>Women who still have their uterus can protect the endometrial lining by...
WOMEN’S HEALTH INITIATIVE STUDY <ul><li>Study confirmed that one type of HT, Prempro®, reduced the risk of hip and other f...
WOMEN’S HEALTH INITIATIVE STUDY <ul><li>Prescribe the lowest possible doses of ET/HT for the shortest period of time to ma...
PARATHYROID HORMONE OR PTH (1-34) <ul><li>Approved for the treatment of osteoporosis in  postmenopausal women and men at i...
SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMs) <ul><li>Raloxifene-Brand Name-Evista® </li></ul><ul><li>Prevents Bone Loss ...
MEN <ul><li>More than 2 million men have the disease and nearly 12 million more are at risk </li></ul><ul><li>Alendronate ...
FALL PREVENTION
Osteoporosis Falls Break Bones <ul><li>You can prevent most falls </li></ul><ul><ul><li>Improve your balance, coordination...
Protect Your Bones Ways to   Make Your Home Safer 1 2 3 4 5 6 7 8 9 10 11 Have handrails and plenty of light in all stairw...
Protect Your Bones  Ways to Make Your Home Safer 12 5 Remove all small rugs. They can make you trip.  Use non-slip mats in...
Bone Health & Oral Health <ul><li>Oral health care is important.  </li></ul><ul><li>Bone loss in the jaw and osteoporosis ...
Summary  You are never too old or too young  to improve your bone health <ul><li>Adults </li></ul><ul><ul><li>At least 30 ...
<ul><li>Children & Teens </li></ul><ul><ul><li>Teens are at greater risk for poor bone health because of rapidly growing b...
 
Everyone has a Role to Play in Improving Bone Health   This report is a starting point for national action
How Can You Help? Educate Others <ul><li>Know your own risks </li></ul><ul><li>Improve your bone health habits and those o...
How Can You Help? Educate Others
Let’s Work Together to  Get Kentucky Bone Healthy!
Acknowledgements <ul><li>Thanks to: </li></ul><ul><li>Florida Department of Health </li></ul><ul><li>Osteoporosis Preventi...
Resources <ul><li>The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You http://www.surge...
QUESTIONS ?
<ul><li>Kentucky Department for Public Health </li></ul><ul><li>Osteoporosis  </li></ul><ul><li>Prevention and Education P...
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Kentucky Osteoporosis Curriculum Adults Long version

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  • Note to Presenter: This presentation with notes includes general information on osteoporosis: What it is? Risk factors Role of estrogen-menopause Diagnosis-detection Prevention Fractures Treatment options Fall prevention How you can help?
  • NOTE TO PRESENTER: Explain to your audience that this presentation is sponsored by: THE KENTUCKY DEPARTMENT FOR PUBLIC HEALTH - OSTEOPOROSIS PREVENTION AND EDUCATION PROGRAM. You may want to use this time to tell your audience the importance of building strong bones at an early age. You may want to tell them that although this presentation is geared towards an adult audience that it is important for them to use the information they learn today and spread it throughout their support system. (Next Slide)
  • NOTE TO PRESENTER: Introduce yourself and welcome your audience. ** PLEASE FEEL FREE TO AMEND THIS SLIDE TO REFLECT YOUR PARTICULAR ORGANIZATION. (NEXT SLIDE)
  • NOTE TO PRESENTER: Advise your audience that this presentation is based on the 2004 Surgeon General’s Report, “BONE HEALTH &amp; OSTEOPOROSIS.” (NEXT SLIDE)
  • NOTE TO PRESENTER: Click on mouse or right arrow key to advance each item. What is Osteoporosis? How Common Is It? What Are The Risk Factors? What happens When Bones Break? Steps To Prevention Bone Density Testing Treatment Options Fall Prevention How You Can Help? NOTE TO PRESENTER: CLICK ONE MORE TIME AND A HEAD SPINNING GRAPHIC WILL APPEAR. USE THIS AS AN ICE BREAKER WITH YOUR AUDIENCE AND JOKE THAT YOU WILL BE PRESENTING A LOT OF INFORMATION TODAY AND ASK IF THEY ARE READY?? YOU MAY WANT TO JOKE THAT THEIR HEADS MAY BE SPINNING LIKE THIS BY THE TIME THE PRESENTATION IS OVER. Enjoy your audience. Have fun but be professional. (NEXT SLIDE)
  • NOTE TO PRESENTER: Read the slide to the audience then use the following speaker notes for emphasis. Osteo means bone. Porosis means full of holes. Osteoporosis means bones full of holes. Osteoporosis is a serious and complicated disease that progresses silently and typically without symptoms until a fracture occurs. Osteoporosis may go undetected for many years. People may not realize they have it until they fracture a hip, vertebra or another bone. By this time, they have probably lost a significant amount of bone and even routine activities such as lifting a bag of groceries or turning over in bed can cause a fracture. (NEXT SLIDE)
  • NOTE TO PRESENTER: Use speaker notes below for emphasis: This picture shows a normal healthy bone which has a spongy like structure. Note the horizontal rows and the vertical column-like appearance in the picture of the micro-architecture of this bone. Next slide has picture of osteoporosis (shredded wheat) NOTE TO PRESENTER: You can show sponges or shredded wheat for visual effect. (NEXT SLIDE)
  • You can visually see the difference…less of a layered effect which is needed to handle compression in our spine. The horizontal rows are not as visible as the previous slide and the vertical chambers are much less noticeable. The holes are greatly enlarged, which makes bones less dense. NOTE TO PRESENTER: You can show sponges or shredded wheat for visual effect. (NEXT SLIDE)
  • NOTE TO PRESENTER: USE THE ILLUSTRATIONS FROM THE SLIDE FOR EMPHASIS WHILE USING THE SPEAKER NOTES BELOW: Most people think that bone is hard and lifeless, but, in reality, bone is living, growing tissue that is constantly being broken down and rebuilt in a process called remodeling. Special bone-removing cells called osteoclasts remove old bone and create a cavity in a process called resorption. Then special bone building cells called osteoblasts fill in the cavity with new bone tissue that uses calcium and other minerals to harden into new bone called formation. The entire remodeling process takes about 90 days. (NEXT SLIDE)
  • NOTE TO PRESENTER: Use speaker notes below to emphasize slide: With osteoporosis, more bone is removed than replaced. If the removal of bone occurs too quickly and/or replacement occurs too slowly, bones become less dense and can break….as indicated by the arrow on this picture. NOTE TO PRESENTER: POINT OUT THE BREAK ON THE SLIDE. (NEXT SLIDE)
  • NOTE TO PRESENTER: USE THE SPEAKER NOTES BELOW TO EMPHASIZE THE DIFFERENT BONE GROWTH CATEGORIES. From birth through adolescence , new bone is built faster than old bone is removed and bones grow larger, heavier and denser. Remember when I discussed remodeling where bone is broken down and rebuilt? Bone mass increases progressively during growth and for some time after adult height is reached. Peak bone mass is achieved in women in their early 20s with gradual bone loss beginning in their 30s, paralleling an age-related decline in muscle mass. Depending on lifestyle and other factors: the accelerated bone loss is thought to be related to an increase in the breaking down of bone compared to the building of bone. We will discuss lifestyle and risk factors later in this presentation. After menopause in women, bone removal increases due to a decrease in estrogen. We will discuss the effects of menopause and the role of estrogen in the NEXT slide. Bone loss often occurs without symptoms or warning signs. (NEXT SLIDE) ** Chart made available from the Surgeon General’s Report on Bone Health and Osteoporosis.
  • Estrogen has indirect effects on bone. Bone-building cells have more available calcium before menopause because estrogen helps the intestines absorb calcium from food and also promotes conservation of calcium by the kidneys, so less is excreted. Bone mass increases progressively during growth and for some time after adult height is reached. At menopause, women begin a period of accelerated bone loss, losing an average of 1% to 2% annually during the next decade. Bone loss is faster within the first 3 to 6 years after menopause. Then it levels off and gradually assumes the level of premenapausal loss. This helps to explain that with a lower peak BMD in women than in men- there is a higher incidence of osteoporosis and osteoporotic fractures in women. The accelerated bone loss is thought to be related to an increase in the breaking down of bone compared to the building of bone.
  • NOTE TO PRESENTER: Lets talk about what happens when bones break. (NEXT SLIDE)
  • NOTE TO PRESENTER: READ SLIDE (NEXT SLIDE) ** Chart made available from the Surgeon General’s Report on Bone Health and Osteoporosis.
  • NOTE TO PRESENTER: Click on mouse or right arrow key to show graphic of normal spine. USE SPEAKER NOTES BELOW FOR EMPHASIS: When the spine breaks, it is called a compression fracture. Ask your audience, “ How many of you know what we mean by a compression fracture?” That is when the vertebra breaks on the front and the spine begins to collapse. As you can see, this causes the body to start going forward. (Point out picture of Fractured Vertebra) As the vertebra fractures, you see how this would affect the alignment of the spine? Furthermore, the bones in your back can heal in this broken state which may result in what is called a kyphotic posture or commonly referred to as the “dowagers hump.” You can actually fracture your spine and not know it. Two-thirds of spinal fractures are silent. That is why osteoporosis is often called a “silent disease.” Compression fractures are often overlooked by people who have them and by healthcare professionals. Sometimes there is no pain associated with the fracture and it might not get noticed until diagnosed during a routine chest x-ray done for other reasons, to the surprise of the patient. A compression fracture can have a serious negative impact to quality of life. Chronic pain due to vertebral fractures can interfere with enjoyable activities and magnify depression. (NEXT SLIDE)
  • NOTE TO PRESENTER: Read slide and point out the change over time on an individuals bone as it transitions. The “dowager’s hump” is a sign of advanced osteoporosis. EMPHASIZE AGAIN that this is not a sign of old age and that osteoporosis can be prevented. (NEXT SLIDE) ** Chart made available from the Surgeon General’s Report on Bone Health and Osteoporosis.
  • NOTE TO PRESENTER: Read slide then use speaker notes for emphasis: It is not surprising that many people with osteoporosis suffer from depression due to their dependence on others. In addition, the physical changes caused by multiple fractures of the vertebrae-such as a loss of height, stooped posture and protruding abdomen-may result in low self-esteem. The disease also causes patients to suffer anxiety and fear over breaking another bone or what we call “fear of falling.” As a result, osteoporosis patients may be reluctant to continue routine tasks like going to work or cleaning the house. Even pleasurable activities like gardening or attending social events and family gatherings can become difficult or painful experiences. So let’s look at how you can prevent this from happening to you or to a loved one. (NEXT SLIDE)
  • Answers and comments for PRESENTER: 1- False Men do get. 20% of those with the disease are men. Men less risk due to diet, greater bone mass and do not experience the equivalent of menopause. 2- True we will learn more about calcium later 3-False Heredity is only one of the risk factors for osteoporosis- Promote bone strength with diet, exercise 4- False milk, yogurt and cheese are the richest sources of Calcium- beans, tofu, and dark leafy greens, 5- False Avoid falls, healthy diet, medications, exercise. 6- False Bones continue to increase in mass and density through young adulthood between 20 – 30 years of age. 7 – True Often called the “silent disease” not apparent in early stages. Normal X-rays do not show bone loss until 30% of the bone has been lost. Sometimes a fracture is the first indication of thinning bones.
  • NOTE TO PRESENTER: READ SLIDE (NEXT SLIDE) There is no relationship between osteoporosis and arthritis. Osteoporosis is a generalized bone disease that causes porous bones. Arthritis refers to a group of diseases and conditions that affect the joints and are usually painful. Osteoarthritis is a degenerative type of arthritis affecting the hip, knees and tips of fingers-no relationship to osteoporosis.
  • Note to presenter: READ SLIDE (NEXT SLIDE) Steroids are sometimes used to treat arthritis, and using steroids may put a person at risk for osteoporosis. There is no clear relationship between dental cavities and osteoporosis. Someone with osteoporosis may have weakened jawbones and be prone to losing teeth. 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! Your dentist will take your medical history, discuss oral health risk factors and review clinical &amp; x-ray examinations at your dental visits. Recent studies show that women with osteoporosis have been reported to have 3 x more tooth loss than women without the disease. Note reference material on Oral health on the CD related to oral health.
  • Note to presenter: Advise your audience that you will now discuss the impact of osteoporosis. (NEXT SLIDE)
  • NOTE TO PRESENTER: Be familiar with this chart and able to point out the impact of osteoporosis. **Please note that the chart is based on number of incidents and not on $$$dollars. You may want to add that medical expenses from osteoporosis-related bones fractures costs $18 billion annually. (NEXT SLIDE) (2002 $ figure) ** Chart made available from the Surgeon General’s Report on Bone Health and Osteoporosis.
  • NOTE TO PRESENTER: Explain to your audience that the latest figures show that in 2002, 43.7 million people had low bone mass and osteoporosis. Be able to explain the expected growth rates. Emphasize the need for prevention and why this program is so important to them and their family members. Reiterate that you are never too old or too young to improve your bone health. (NEXT SLIDE) ** Chart made available from the Surgeon General’s Report on Bone Health and Osteoporosis.
  • NOTE TO PRESENTER: Read slide (NEXT SLIDE) Statistics from National Osteoporosis Foundation 2002 data Picture: Frankfort, KY downtown in the fall. In Kentucky, the statistics from the National Osteoporosis Foundation’s figures for 2002, 128,000 women in this state had osteoporosis and 342,000 had low bone mass. Another 37,300 men had the disease and 223,400 had low bone mass. The foundation’s projections for 2010 don’t look bright. Trends indicate that 152,100 Kentucky women will have osteoporosis and 407,400 will have low bone mass. The number of men with the disease is estimated to be 45,800 with 229,100 experiencing low bone mass. Overall, 834,000 Kentuckians (Population of Kentucky = little over 4. Million so less that ¼ of population) are expected to be affected by this disease, which can have both painful and life-altering consequences, particularly among those who suffer hip fractures. In many cases, people who suffer this type of injury die within 12 months, usually from complications such as pneumonia or blood clots in the lung.
  • NOTE TO PRESENTER: Advise your audience that you will now discuss some of the risk factors for osteoporosis. (NEXT SLIDE)
  • NOTE TO PRESENTER: SEE NEXT PAGE FOR SPEAKER NOTES FOR THIS SLIDE.
  • NOTE TO PRESENTER: Continue to read through the risk factors using speaker notes below for emphasis: I sometimes fall- Falls are not just the result of getting older. But as you age, falls become more dangerous. Most falls can be prevented. We will look at some fall prevention tips later in this presentation. I’m not physically active -Weight bearing exercises like walking, running, biking, dancing, and gardening are all excellent sources to building stronger healthier bones. We will discuss exercise later in this presentation. Hyperthyroidism: Long term treatment with excessive amounts of thyroid hormone can cause an increased risk of bone loss as treatments for many of the conditions shown here act on bone cells to increase the break down of bone. (NEXT SLIDE)
  • NOTE TO PRESENTER: Continue to read through the slide using speaker notes for emphasis: Oral glucocorticoids- Steroids are the most common form of drug-induced osteoporosis. They are often used to treat diseases such as asthma, lupus, and arthritis. Used over a long period of time (more than three months), steroids can cause rapid bone loss in two ways. They cause bone to break down faster and they inhibit the absorption of calcium in the small intestine. On average, a person being treated with steroids will lose about 5% of bone mass in the first year of treatment. This loss will increase the risk of osteoporosis and broken bones. For example: 30 to 50% of patients receiving inhaled steroids and/or prednisone, in doses of 2.5 to 7.5 mg. a day, have osteoporotic fractures. However, there is a sharp decline in fracture risk after the medication is discontinued. NOTE TO PRESENTER: Encourage the audience to talk with their doctor about alternative medications. If there isn’t one, advise them to ask for help from their doctor in preventing bone loss from their medication. (NEXT SLIDE)
  • NOTE TO PRESENTER: See next page for speaker notes.
  • NOTE TO PRESENTER-USE THE SPEAKER NOTES BELOW FOR THIS SLIDE: Caucasians and Asians are more likely to develop osteoporosis. In fact, Caucasian women suffer two to three times as many fractures as African American and Hispanic women. However, keep in mind that while the risk may be higher for some individuals, women and men of any age and race can and do develop osteoporosis. It should be noted that today, 2 million American men have osteoporosis, and another 12 million are at risk for this disease. Despite these large numbers, osteoporosis in men remains under diagnosed, underreported, and inadequately researched. Much of the information we will discuss here today does apply to the men in our audience as well. (NEXT SLIDE)
  • NOTE TO PRESENTER: Wrap up this section by quickly running through these items and emphasize to your audience that they consult with their doctor/health care provider regarding these risk factors. (NEXT SLIDE)
  • NOTE TO SPEAKER-USE SPEAKER NOTES BELOW TO MOVE INTO THIS SECTION: While you cannot change your genetics or heredity, skeletal frame, gender, race or age, you can control other risk factors. Let’s take a look at what you can do to improve your bone health and the bone health of your family members. (NEXT SLIDE)
  • NOTE TO PRESENTER: Go through each bulleted item using the information listed below : Your overall osteoporosis prevention program should feature a healthy lifestyle including regular exercise and an adequate amount of calcium and vitamin D to preserve bone health. Milk, cheese and yogurt are the easiest and richest sources of calcium. (Lowfat and nonfat products are recommended). Exercise: Weight bearing exercise like walking, running, and biking. Exercise is of primary importance in maintaining healthy bones. Maintain a healthy body weight: Small boned and thin individuals may result in smaller bones with a lower bone density. (NEXT SLIDE)
  • NOTE TO PRESENTER: READ SLIDE AND EMPHASIZE THE SPEAKER NOTES BELOW. Smoking: As we have previously mentioned, studies have shown that smoking lowers estrogen levels and early menopause . Alcohol: Alcohol directly slows down bone formation. Caffeine: Cola, coffee and chocolate all contain caffeine, which increases the amount of calcium excreted in the urine. No more than 2-3 cups of caffeine beverages per day is recommended. (NEXT SLIDE)
  • NOTE TO PRESENTER: POINT OUT THAT SOME GROUPS NEED MORE CALCIUM THAN OTHER GROUPS. USE SPEAKER NOTES FOR EMPHASIS: The stronger your bones are at peak bone mass, the more bone you have to sustain you as you grow older. To build strong bones, you need to get enough calcium. Calcium is important for maintaining bone and preventing fractures. National surveys have shown that many people consume less than half of the daily recommended amount of calcium. Calcium needs vary according to age and health. Growth Periods for bone length and mass are the greatest during adolescence and early adulthood. Adolescents: Frequently eat high-fat snacks with “empty” calories, which may spoil their appetites for healthy foods, and sometimes drink soda, which may replace milk as a beverage. Eating Disorders: Anorexic or bulimic teens lack calcium and may develop osteoporosis at an early age. Also, teen girls often do not get enough calcium because they diet. Older Adults: The calcium requirements in this group increase because individuals, for a variety of reasons, do not absorb calcium as readily as they get older. Pregnant or nursing women: should be certain to achieve the guidelines set forth for their age group. During pregnancy, calcium is needed by both the mother and the baby. Calcium needed by the baby will be taken from the mother’s bones if not enough calcium is supplied, increasing the mother’s risk for osteoporosis later in life. Pregnant teens require even more calcium because their own calcium needs are greater. (NEXT SLIDE)
  • NOTE TO PRESENTER: SEE NEXT PAGE FOR SPEAKER NOTES FOR THIS SLIDE.
  • NOTE TO PRESENTER: READ SLIDE SUPPLEMENTAL INFORMATION: People with lactose intolerance have a lack of the enzyme lactase. Therefore, some of the lactose passes through the digestive system without being digested and absorbed. This can lead to symptoms such a gas, bloating, cramps, and/or diarrhea. Reduced-lactose milk and some cheeses are widely available in local supermarkets. They are pre-treated with the enzyme lactase to reduce the milk sugar content up to 70%. Some also have calcium added. Eat yogurt. Some kinds of yogurt contain active cultures that digest some of the lactose and continue to digest it once inside the digestive tract. Choose aged cheeses such as Swiss, cheddar, and Parmesan. The aging process removes most of the lactose in cheese, making them naturally low in lactose. Convert regular milk into reduced lactose milk by adding drops of a lactase enzyme preparation. Lactase enzymes may be purchased at most pharmacies. Lactase preparations are also available in chewable tablets, which may be consumed before eating foods containing lactose. Lactose intolerant individuals should not use calcium lactate supplements, which may cause side effects.
  • SPEAKER NOTES : If you don’t have enough calcium in your diet, you may need a calcium supplement. NOTE TO PRESENTER: You may want to ask your audience the following, “ How many of you take a supplement? And if you do, What type do you take ?” You may want to take a few responses from your audience. Most of you mentioned brand names. There are many brands of calcium; however, there are three major types of calcium. The three that are most common are calcium carbonate, calcium citrate and calcium phosphate . Calcium Carbonate is perhaps the most common and provides the highest level of “elemental” calcium. How many of you are familiar with the term “elemental calcium”? This is the only portion of the supplement that the body absorbs. The amount of elemental calcium in a supplement will vary depending on the type of compound from which the supplement is manufactured. (NEXT SLIDE)
  • NOTE TO PRESENTER: READ SLIDE AND USE SPEAKER NOTES BELOW FOR EMPHASIS: Calcium Carbonate is 40% elemental calcium. It comes in many forms, including capsules, chewable tablets and soft chews. Because carbonated based calcium needs to be broken down by stomach acid, it is best to take it with food or shortly after you eat. Calcium citrate doesn’t require stomach acid for absorption and can be taken at any time. Because we produce less stomach acid as we age, older people may have fewer side effects, such as constipation and gas if they take Calcium Citrate. Calcium phosphate is easily dissolved and well-absorbed, and generally does not cause gas or constipation. This is the formulation used in calcium-fortified orange juice, soy milk and rice milk. Calcium supplements should always be taken on the advise of your doctor. If you are taking a calcium supplement, be sure and tell your doctor. (NEXT SLIDE)
  • NOTE TO PRESENTER: USE THE INFORMATION BELOW TO EMPHASIZE THIS SLIDE. If you take a calcium supplement, these tips may be helpful: Know the type of calcium compound you are taking. The one you choose will dictate when and how you should take it. Take your calcium in doses to ensure it is absorbed properly. Regardless of its source, your body can absorb only about 500-600 mg. at a time. So it is best to space your calcium intake. Read the label to determine the amount of elemental calcium in your supplement. Remember that the amount is based on a 1,000 mg. dose, and will be expressed in the form of a percentage. For example, if the label says each dose contains 50% of the recommended daily dose, there will be 500 mg. of elemental calcium in that dose. NOTE TO PRESENTER: Calcium supplements may interfere with absorption of some medications, and some medications may interfere with the absorption of calcium. Advise participants to check with their pharmacist if they have any questions. Remember Vitamin D (NEXT SLIDE TO EXPLAIN VITAMIN D)
  • NOTE TO PRESENTER: USE THE SPEAKER NOTES LISTED BELOW TO EXPLAIN THIS SLIDE. Vitamin D plays an important role in the absorption of calcium by the body. The relationship between calcium and vitamin D is similar to that of a locked door and key. Vitamin D is the key that unlocks and opens the door, allowing calcium to enter the bloodstream. Experts recommend a daily vitamin D intake of between 400 and 800 International units. Vitamin D is formed naturally in the body after exposure of bare skin to sunlight. Keep in mind that if you protect your skin from sun damage by completely covering yourself with clothing or sunscreen, vitamin D cannot be manufactured. The major food sources of vitamin D are milk and fortified cereals. Vitamin D also is found in most multivitamins and in some calcium supplements. (NEXT SLIDE)
  • NOTE TO PRESENTER-READ SLIDE (NEXT SLIDE)
  • NOTE TO PRESENTER: START SPEAKER NOTES WHILE FILM CLIP IS LOADING…this sometimes has a small delay to load. If it loads quickly, just use the speaker notes after the clip has finished running. Okay, we have talked about getting enough calcium and vitamin D to prevent osteoporosis. Now lets talk about exercise. If you are one of those people who don’t exercise regularly, osteoporosis offers yet another reason for you to become more active and start an exercise routine. Weight-bearing exercises can help build and maintain strong bones and improve balance and flexibility. Weight-bearing exercises like walking and jogging force your muscles and skeleton to work against gravity, unlike swimming where the body is buoyant in water. Other weight bearing exercises include racquet sports, hiking, dancing and star-climbing. Weight-training exercise also improves your overall balance and flexibility. Even if you have already developed osteoporosis, you can exercise to keep your muscles and bones as strong as possible. You should always consult your doctor before beginning any exercise program. NOTE TO PRESENTER: AFTER FILM CLIP, AS AN ICE BREAKER, YOU CAN STATE THE IMPORTANCE OF KNOWING HOW TO OPERATE YOUR EXERCISE EQUIPMENT. OPTIONAL ACTIVITY: Observe to the audience that they have been sitting for a long time and that they will now have the opportunity to stretch and learn some easy movements that can help improve balance and strengthen their bones. Point out that poor balance is frequently the cause of falls, and that it is helpful to practice improving one’s balance. Ask the audience to stand up slowly. Point out that many falls occur because people stand up and begin walking too quickly. Model and guide the audience through one or more of the exercises located with the tool kit called Exercise Guide.
  • NOTE TO PRESENTER: REITERATE AGAIN THE THREE MAJOR TIPS FOR KEEPING BONES STRONG…..CALCIUM, VITAMIN D AND PHYSICAL ACTIVITY. BY CLICKING THE MOUSE ON THE SOUND ICON, YOU CAN USE THIS AS A CHEER AND AS AN ICE BREAKER WITH YOUR AUDIENCE…..ASK THE QUESTION…… WHAT ARE THE THREE MAJOR TIPS FOR KEEPING BONES STRONG? CLICK ON THE SOUND ICON AND CHEER…..CALCIUM, VITAMIN D AND EXERCISE. (OPTIONAL ACTIVITY WITH SOUND EFFECT) Have fun with your audience. (NEXT SLIDE) ** Chart made available from the Surgeon General’s Report on Bone Health and Osteoporosis.
  • NOTE TO PRESENTER: READ THE BULLETS ONE AT A TIME AND USE THE INFORMATION BELOW FOR EMPHASIS: The National Osteoporosis Foundation recommends that all women 65 years of age and older be tested regularly for osteoporosis. If you are a postmenopausal women, we encourage you to talk with your physician about having a bone density test to ensure you’re not at risk for fractures. The NOF also recommends that women younger than 65, with one or more risk factors (other than being white, postmenopausal and female). Your doctor must request or write a prescription for this test. It will take about 10-20 minutes and is painless, noninvasive and safe. Note to the presenter : You may wish to mention a few of the major risk factors again; low body weight, family and personal history of broken bones, inactive lifestyle, and lifelong low calcium intake. Men age 70 older Postmenopausal women who have had a fracture Women considering therapy for osteoporosis (NEXT SLIDE)
  • NOTE TO PRESENTER- START OFF THIS SLIDE BY DISCUSSING THE FOLLOWING: The only way to determine whether you have osteoporosis is to have your bone mass measured. The measurement is called a bone mineral density test or BMD. Various types of machines using different technology are available for measuring bone density however, the most commonly used today is the DXA or Dual Energy X-Ray Absorptiometry, similar to the one on this slide. INDICATE THAT THIS TYPE OF TEST IS CONSIDERED THE “GOLD STANDARD” TEST TO DETERMINE A DIAGNOSIS. MOVE ON TO NEXT BULLET POINT. The test typically measures your bone density in the most common sites for osteoporotic fractures such as the hip, spine and/or wrist. Note to Presenter: You want to mention that there are other machines that scan sites such as the heel, finger and wrist that can identify individuals that may have low bone density. These machines should not be used for diagnoses or to monitor a person being treated for osteoporosis to evaluate if the treatment is working. You may wish to ask how many in the audience have had screenings on these types of machines. Point out: If they have been screened on this type of a machine and the results indicated low bone density; encourage them to talk with their doctor since low bone density, at any site, can be a red flag for a variety of conditions. MOVE ON TO NEXT BULLETIN. The test is painless, safe and requires no injections. The test takes approximately 5-10 minutes. To predict your fracture risk, test results are compared to the average bone density in a large population of young adults, of the same sex, who have reached peak bone mass. The result is expressed in the form of a T-Score. (NEXT SLIDE)
  • NOTE TO PRESENTER: HOPEFULLY THIS SCALE ALONG WITH THE INFORMATION BELOW WILL ASSIST YOU IN EXPLAINING A T-SCORE. WALK YOUR AUDIENCE THROUGH THE BULLETED POINTS BELOW: On the T-score scale, 0 represents normal, healthy bone density of a 30-year-old person (the age of peak bone density). T-scores above 0 and slightly below 0 are within the normal range. Your score will tell you how far you are above or below peak bone density. Think of it working like a temperature scale. A temperature of -2 is lower than a temperature of -1. In the same way, a T-score of -2.3 shows lower bone density than a score of -1.8. The T-score is a radiographic diagnosis, meaning it is an X-ray diagnosis and doesn’t imply anything about the cause of osteoporosis. (NEXT SLIDE)
  • NOTE TO PRESENTER-READ THE SLIDE USING THE FOLLOWING SPEAKER NOTES FOR EMPHASIS: Medicare covers Food and Drug Administration (FDA) approved bone density testing for individuals meeting one or more of the following criteria: Estrogen-deficient women at clinical risk for osteoporosis An individual with vertebral abnormalities (such as an x-ray showing fractures of the spine) An individual receiving long-term glucocorticoid (steroid) therapy (such as prednisone and cortisone, which are taken for conditions like asthma or arthritis) An individual with primary hyperparathyroidism (excess parathyroid hormone); or An individual being monitored to assess the response to an FDA-approved osteoporosis drug. (NEXT SLIDE) SUPPLEMENTAL INFORMATION: Florida’s Medicaid program will cover “medically necessary” osteoporosis coverage for “high risk” individuals. Many private insurance plans also cover this test, however, it is not performed routinely in annual checkups, and must be ordered for diagnostic purposes according to accepted criteria.
  • NOTE TO PRESENTER: This section of the presentation can be long and complex. Judge your audience and determine the length of time to be spent on this section. (NEXT SLIDE)
  • NOTE TO PRESENTER- SPEAKER NOTES: As an ice breaker, you may want to offer an incentive item to an audience member who can pronounce every one of these medications. Be prepared to offer an incentive item and remember to enjoy your audience. The Food and Drug Administration has approved these medications for the prevention and/or treatment of osteoporosis. Ibandronate Sodium is the most recently approved drug by the FDA. Let’s take a look at each one of these treatments individually but remember to always consult with your healthcare provider about the possible benefits and risks as they relate to your specific situation. (NEXT SLIDE)
  • NOTE TO PRESENTER: USE THE INFORMATION BELOW TO PRESENT THIS SLIDE: Indicate that these are the commonly used names Fosamax and Actonel. Fosamax and Actonel are from a class of drugs called bisphosphonates. They have been shown to slow down or stop bone loss. They have been shown to increase bone density and, Reduce the risk of future fractures in the hip and spine. SUPPLEMENTAL INFORMATION THAT PRESENTER SHOULD BE AWARE OF AND ABLE TO PRESENT TO THE AUDIENCE: Fosamax is prescribed for both the prevention and treatment of postmenopausal osteoporosis and treatment of steroid-induced osteoporosis in women and men. Actonel also is prescribed for the prevention and treatment of postmenopausal osteoporosis and is approved for the prevention and treatment of steroid-induced osteoporosis resulting from long-term use of medications such as prednisone or cortisone in women and men. While the incidence of side effects are few, the most common side effects with Actonel &amp; Fosamax can include stomach irritation, severe heartburn, musculoskeletal pain or esophageal burning. Fosamax and Actonel are available in daily and once-weekly doses. Fosamax is now available in a weekly liquid form. They must be taken first thing in the morning on an empty stomach with a full glass of water. To absorb the medication properly, you must remain upright and have nothing more to eat or drink for a half-hour. (NEXT SLIDE)
  • NOTE TO PRESENTER: USE THE INFORMATION BELOW TO PRESENT THIS SLIDE: Boniva was recently approved by the Food and Drug Administration (FDA) to treat or prevent osteoporosis in women after menopause. Boniva may increase bone mass by slowing loss of bone and may help lower the chances of breaking bones. Boniva is the first-ever once-a-month drug treatment for postmenopausal osteoporosis. For more detailed information about Boniva, ask your health care provider or pharmacist. (NEXT SLIDE)
  • NOTE TO PRESENTER-USE THE INFORMATION BELOW TO EXPLAIN THIS SLIDE. Calcitonin sold under the brand name, Miacalcin is a naturally occurring hormone involved in calcium regulation. In research, Miacalcin appeared to slow bone loss (especially in the spine), reduce the risk of spinal fractures and, in some cases, provide relief from the pain associated with osteoporosis-related spinal fractures. Calcitonin is available either as a nasal spray or injection. Possible side effects include a runny nose, nasal irritation or an allergic reaction. (NEXT SLIDE)
  • NOTE TO PRESENTER-READ SLIDE AND MOVE TO NEXT SLIDE FOR MORE EXPLANATION OF ESTROGEN THERAPY (ET) Estrogen therapy is FDA approved for the prevention of osteoporosis in postmenopausal women. Estrogen therapy increases bone density and reduces the risk of hip and spine fractures. (NEXT SLIDE)
  • NOTE TO PRESENTER-READ THIS SLIDE Women who still have their uterus can protect the endometrial lining by taking a second hormone, progestin or progesterone, in combination with estrogen (HT). ET/HT relieves menopausal symptoms and has a beneficial effect on bone health. Side effects may include vaginal bleeding, breast tenderness, mood disturbances and gall bladder disease. (NEXT SLIDE)
  • NOTE TO PRESENTER- USE THE INFORMATION BELOW TO EXPLAIN THIS SLIDE: The Women’s Health Initiative study confirmed that one type of HT, Prempro®, reduced the risk of hip and other fractures Reduced colon cancer, BUT, Increased a woman’s risk of breast cancer, heart attacks and venous blood clots. (NEXT SLIDE)
  • NOTE TO PRESENTER-USE THE INFORMATION BELOW TO EXPLAIN THIS SLIDE: Following this report, the Food and Drug Administration made the following recommendations for all ET/HT preparations: Prescribe the lowest possible doses of ET/HT for the shortest period of time to manage symptoms of menopause Discuss alternative osteoporosis medications for women at risk for or diagnosed with osteoporosis. The FDA recommended that any woman who is using or considering ET/HT treatment consult with her healthcare provider about the possible benefits and risks as they relate to her specific situation. (NEXT SLIDE)
  • NOTE TO PRESENTER: Use the information below to explain this slide: A form of human parathyroid hormone, teriparatide is the newest medication approved by the FDA for the treatment of osteoporosis in postmenopausal women and men who are at high risk of fracture. Teriparatide builds new bone and greatly reduces the risk of spine and other fractures. It is self-administered as a daily injection. SUPPLEMENTAL INFORMATION WHICH SHOULD BE PROVIDED TO YOUR AUDIENCE: Side effects may include nausea, leg cramps and dizziness. Because long-term safety is unknown, teriparatide use should be limited to two years. (NEXT SLIDE)
  • NOTE TO PRESENTER-USE THE INFORMATION BELOW TO EXPLAIN THIS SLIDE: Raloxifene, a medication from a new class of drugs called selective estrogen receptor modulators or (SERMS) Raloxifene protects bone mass throughout the skeleton and reduces the risk of vertebral fractures. It also appears to reduce the risk of breast cancer. Possible side effects include hot flashes and blood clots. (NEXT SLIDE)
  • NOTE TO PRESENTER-USE THE INFORMATION BELOW TO EXPLAIN THIS SLIDE: Although osteoporosis is often thought of as a woman’s disease, more than 2 million men are estimated to have the disease and another 12 million are believed to be at risk. The U.S. Food and Drug Administration has approved alendronate and PTH for the treatment of osteoporosis in men. (NEXT SLIDE)
  • NOTE TO PRESENTER: Music will automatically start. After music stops, read slide to audience. (NEXT SLIDE)
  • NOTE TO PRESENTER- USE THE INFORMATION BELOW TO EXPLAIN THIS SLIDE: GO OVER SOME OF THE ITEMS LISTED ON THIS SLIDE AND THE NEXT SLIDE FOR EMPHASIS. If you have osteoporosis, changing your environment can reduce your risk of falling and suffering a fracture. Or maybe you have an older family member or friend who could benefit from these same tips. Look around your home or home of a family member or friend. (NEXT SLIDE)
  • NOTE TO PRESENTER- AGAIN, EMPHASIZE THE FOLLOWING STATEMENT: When you visit an elderly family member or friend, remember these tips and take a look around and don’t be afraid to make suggestions. (NEXT SLIDE)
  • Your dentist will take your medical history, discuss oral health risk factors and review clinical &amp; x-ray examinations at your dental visits.
  • NOTE TO PRESENTER-RECAP THE BULLETED ITEMS ON THIS SLIDE (NEXT SLIDE)
  • NOTE TO PRESENTER-RECAP THE BULLETED ITEMS ON THIS SLIDE AND EMPHASIZE THE NEED FOR PHYSICAL ACTIVITY FOR BUILDING STRONG BONES. (NEXT SLIDE)
  • NOTE TO PRESENTER- EMPHASIZE THE FOLLOWING STATEMENT TO YOUR AUDIENCE: Remember that building strong bones is a lifelong process, make it a family routine. (NEXT SLIDE)
  • NOTE TO PRESENTER- READ THE FOLLOWING STATEMENT TO YOUR AUDIENCE AND HOLD UP THE BOOKLET PROVIDED WITH THIS CURRICULUM: The booklet that the surgeon general is displaying was prepared by the Surgeon Generals office and has been provided to you compliments of the Florida Department of Health’s Osteoporosis Prevention and Education Program. A lot of what we have discussed here today is available in this booklet. I encourage all of you to take this booklet home, read it and share it. As another ice breaker, you may want to offer an incentive item to anyone in the audience who can name our current Surgeon General. Answer: Richard Carmona (NEXT SLIDE)
  • NOTE TO PRESENTER: READ THE SLIDE (NEXT SLIDE)
  • Involve the audience. Who could you share this information with on Keeping Kentuckians Bone Health? List..
  • NOTE TO PRESENTER: Closing Slide (NEXT SLIDE)
  • NOTE TO PRESENTER: ASK YOUR AUDIENCE IF THEY HAVE ANY QUESTIONS.
  • NOTE TO PRESENTER-END OF PRESENTATION. Thank your audience for coming. Display this slide while your audience is leaving the room.
  • Kentucky Osteoporosis Curriculum Adults Long version

    1. 1. Prevent Osteoporosis… GET HEALTHY KENTUCKY
    2. 2. SPONSORED BY: <ul><li>Kentucky Department for Public Health </li></ul><ul><li>Osteoporosis </li></ul><ul><li>Prevention and Education Program </li></ul>
    3. 3. PRESENTED BY:
    4. 5. WHAT ARE WE GOING TO LEARN TODAY ??? <ul><li>What Is Osteoporosis ? </li></ul><ul><li>What Happens When Bones Break ? </li></ul><ul><li>How Common Is It ? </li></ul><ul><li>What Are The Risk Factors ? </li></ul><ul><li>Steps To Prevention </li></ul><ul><li>Bone Density Testing </li></ul><ul><li>Treatment Options </li></ul><ul><li>Fall Prevention </li></ul><ul><li>How You Can Help? </li></ul>
    5. 6. WHAT IS OSTEOPOROSIS ? <ul><li>Osteo = bone </li></ul><ul><li>Porosis = full of holes </li></ul><ul><li>Osteoporosis = means bones that are full of holes </li></ul>
    6. 7. Normal Bone
    7. 8. Osteoporosis
    8. 9. NORMAL HEALTHY BONE OSTEOBLASTS OSTEOCLASTS
    9. 10. OSTEOPOROTIC BONE <ul><li>The loss of living bone tissue makes </li></ul><ul><li>bones fragile and more likely to fracture. </li></ul>
    10. 12. Role of Estrogen <ul><li>Hormone that protects against bone loss </li></ul><ul><li>After menopause, estrogen production decreases – may lead to rapid bone loss </li></ul><ul><li>Rate of Bone Loss in Postmenopausal Women </li></ul><ul><ul><li>1% to 2% annual loss for 10 years after menopause </li></ul></ul><ul><ul><li>Fastest in first 3 to 6 years </li></ul></ul>
    11. 13. WHAT HAPPENS WHEN BONES BREAK
    12. 14. Osteoporosis When Bones Break <ul><li>The most common breaks in weak bones are in the: </li></ul><ul><ul><li>Wrist </li></ul></ul><ul><ul><li>Spine </li></ul></ul><ul><ul><li>Hip </li></ul></ul><ul><li>If you break a bone after the age of 50, talk to your health care professional about measuring your bone density </li></ul>
    13. 15. Osteoporotic Spine Fracture Compressed bone Fractured Normal
    14. 17. Osteoporosis When Bones Break <ul><li>Hip fractures are the most devastating </li></ul><ul><ul><li>One in five elderly people die within a year of the fracture </li></ul></ul><ul><ul><li>One in five must move to a nursing home within a year </li></ul></ul><ul><ul><li>One in four become disabled </li></ul></ul><ul><ul><li>Many become isolated and depressed </li></ul></ul>
    15. 18. TRUE OR FALSE GAME <ul><li>Men do not get osteoporosis. </li></ul><ul><li>Diet can provide all of the calcium a body needs. </li></ul><ul><li>If your grandmother had osteoporosis, you will get it also. </li></ul><ul><li>Dairy products are the only source of calcium. </li></ul><ul><li>If you have osteoporosis, you can do nothing about it. </li></ul><ul><li>Our bones stop growing when we reach full height (about 20). </li></ul><ul><li>Susceptibility to fractures can indicate osteoporosis. </li></ul>Activity – True or False Game
    16. 19. CLARIFICATIONS <ul><li>There is no relationship between osteoporosis and arthritis. </li></ul><ul><li>Osteoporosis is a generalized bone disease that causes porous bones. </li></ul><ul><li>Arthritis refers to a group of diseases and conditions that affect the joints and are usually painful. </li></ul><ul><li>Osteoarthritis is a degenerative type of arthritis affecting the hip, knees and tips of the fingers—no relationship to osteoporosis. </li></ul>
    17. 20. CLARIFICATIONS <ul><li>Steroids are sometimes used to treat arthritis, and using steroids may put a person at risk for osteoporosis </li></ul><ul><li>There is no clear relationship between dental cavities and osteoporosis </li></ul><ul><li>Someone with osteoporosis may have weakened jawbones and be prone to losing teeth </li></ul><ul><li>Report any problems with loose teeth, detached or receding gums, and loose or ill-fitting dentures to your dentist and doctor. </li></ul><ul><li>Recent studies show women with osteoporosis have been reported to have 3 times more tooth loss than women without the disease. </li></ul>
    18. 21. HOW COMMON IS OSTEOPOROSIS?
    19. 24. KENTUCKY STATISTICS (2002) <ul><li>Projections for 2010 </li></ul><ul><li>834,000 Kentuckians age 50 & over will be affected. </li></ul>National Osteoporosis Foundation Women 128,000 osteoporosis 342,000 low bone mass Men 37,300 osteoporosis 223,400 low bone mass
    20. 25. RISK FACTORS
    21. 26. Are You at Risk for Weak Bones? Check Any of These that Apply to You <ul><li>I’m older than 65 </li></ul><ul><li>I’ve broken a bone after age 50 </li></ul><ul><li>My close relative has osteoporosis or has broken a bone </li></ul><ul><li>My health is “fair” or “poor” </li></ul><ul><li>I smoke </li></ul><ul><li>I am underweight for my height </li></ul><ul><li>I started menopause before age 45 </li></ul><ul><li>I’ve never gotten enough calcium </li></ul><ul><li>I have more than two drinks of alcohol several times a week </li></ul><ul><li>I have poor vision, even with glasses </li></ul>Activity – Risk Factor Worksheet
    22. 27. Are You at Risk for Weak Bones? Check Any of These that Apply to You <ul><li>I sometimes fall </li></ul><ul><li>I’m not physically active </li></ul><ul><li>I have one of the these medical conditions: </li></ul><ul><ul><li>Hyperthyroidism </li></ul></ul><ul><ul><li>Chronic lung disease </li></ul></ul><ul><ul><li>Cancer </li></ul></ul><ul><ul><li>Inflammatory bowel disease </li></ul></ul><ul><ul><li>Chronic hepatic or renal disease </li></ul></ul><ul><ul><li>Vitamin D deficiency </li></ul></ul><ul><ul><li>Cushing’s disease </li></ul></ul><ul><ul><li>Multiple sclerosis </li></ul></ul><ul><ul><li>Rheumatoid arthritis </li></ul></ul>Activity – Risk Factor Worksheet
    23. 28. Are You at Risk for Weak Bones? Check Any of These that Apply to You <ul><li>I take one of these medications: </li></ul><ul><ul><li>Oral glucocorticoids (steroids) </li></ul></ul><ul><ul><li>Cancer treatments (radiation, chemotherapy) </li></ul></ul><ul><ul><li>Thyroid medicine </li></ul></ul><ul><ul><li>Antiepileptic medications </li></ul></ul><ul><ul><li>Gonadal hormone suppression </li></ul></ul><ul><ul><li>Immunosuppressive agents </li></ul></ul>Activity – Risk Factor Worksheet
    24. 29. Osteoporosis & Persons with Disabilities <ul><li>Low intake of dietary calcium </li></ul><ul><li>Medications </li></ul><ul><li>Weak or unused muscles </li></ul><ul><li>Lack of accessibility to exercise facilities </li></ul>
    25. 30. Osteoporosis Affects Women & Men of All Ethnicities
    26. 31. RISK FACTOR REVIEW <ul><li>Discuss significant risks with a health care professional </li></ul><ul><ul><li>Gender </li></ul></ul><ul><ul><li>Nutrition/Calcium Intake </li></ul></ul><ul><ul><li>Age </li></ul></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><li>Family history </li></ul></ul><ul><ul><li>Recent falls or broken bones </li></ul></ul>
    27. 32. STEPS TO PREVENTION
    28. 33. STEPS TO PREVENTION <ul><li>Live a Healthy Lifestyle </li></ul><ul><li>Eat foods rich in calcium and vitamin D </li></ul><ul><ul><li>Follow recommended daily amounts </li></ul></ul><ul><li>Be physically active every day </li></ul><ul><ul><li>Include activities to improve strength and balance </li></ul></ul><ul><li>Maintain a healthy body weight </li></ul>
    29. 34. STEPS TO PREVENTION <ul><li>Don’t smoke </li></ul><ul><li>Limit alcohol intake </li></ul><ul><li>Limit caffeine </li></ul>
    30. 35. A cup = 8 ounces.
    31. 36. Activity – Calcium Card (Optional)
    32. 37. LACTOSE INTOLERANCE <ul><li>Individuals who have difficulty digesting the sugar found in milk, called lactose </li></ul><ul><li>Start with small portions of food such as milk--gradually increase portions </li></ul><ul><li>Eat dairy foods in combination with other foods </li></ul><ul><li>Many hard cheeses have less lactose than milk </li></ul><ul><li>Commercial lactase preparations aid digestion </li></ul>
    33. 38. CALCIUM SUPPLEMENTS <ul><li>Read Labels--several different types of calcium supplements available </li></ul><ul><li>Avoid -“natural” calcium such as bone meal or dolomite-some contain toxic lead or mercury </li></ul>
    34. 39. Supplements: Calcium carbonate vs. citrate <ul><li>Calcium carbonate </li></ul><ul><ul><li>Needs acid to dissolve and for absorption </li></ul></ul><ul><ul><li>Less stomach acid as we age </li></ul></ul><ul><ul><li>Often taken at meals when more stomach acid </li></ul></ul><ul><ul><li>Brand names-Tums, Maalox, Mylanta, Oscal, Viactiv, Caltrate </li></ul></ul><ul><li>Calcium citrate </li></ul><ul><ul><li>Doesn’t require stomach acid for absorption </li></ul></ul><ul><ul><li>May be taken anytime—check with your healthcare provider </li></ul></ul><ul><ul><li>May cost more </li></ul></ul><ul><ul><li>Brand names-Citracal, store brands of Calcium Citrate </li></ul></ul>
    35. 40. CALCIUM SUPPLEMENT TIPS <ul><li>Be knowledgeable about the type of calcium you are taking </li></ul><ul><li>Space out your calcium intake </li></ul><ul><li>Determine the “elemental” calcium in your chosen supplement. </li></ul><ul><li>Remember Vitamin D </li></ul>
    36. 42. TEST YOUR CALCIUM SUPPLEMENT <ul><li>Put a calcium tablet in a cup of half water and half vinegar. </li></ul><ul><li>Stir every 5 minutes. </li></ul><ul><li>If it doesn’t dissolve in 30 minutes, it probably won’t dissolve in your stomach </li></ul>
    37. 43. Activity – Exercise Guide (optional)
    38. 45. BONE DENSITY TESTING
    39. 46. WHO SHOULD GET TESTED <ul><ul><li>All women age 65 and older </li></ul></ul><ul><ul><li>All postmenopausal women under 65 </li></ul></ul><ul><ul><li>with 1 or more risk factors </li></ul></ul><ul><ul><li>Men aged 70 and older </li></ul></ul><ul><ul><li>Postmenopausal women who have had a fracture </li></ul></ul><ul><ul><li>Women considering therapy for osteoporosis </li></ul></ul>
    40. 47. Dual-Energy X-Ray Absorptiometry <ul><li>“ Gold Standard” test to determine a diagnosis </li></ul><ul><li>Measures hip & spine </li></ul><ul><li>Painless, safe and requires no injections </li></ul><ul><li>Takes 5-10 minutes </li></ul><ul><li>Determines risk for fracture </li></ul>
    41. 48. UNDERSTANDING YOUR T-SCORE
    42. 49. Medicare Criteria for Bone Mineral Density Testing <ul><li>Women who are estrogen deficient </li></ul><ul><li>Individuals with vertebral abnormalities </li></ul><ul><li>Individuals with hyperparathyroidism </li></ul><ul><li>Individuals receiving steroid therapy </li></ul><ul><li>Monitoring drug therapy </li></ul>
    43. 50. TREATMENT OPTIONS
    44. 51. Medication For Prevention and/or Treatment In post-menopausal women 1. BISPHOSPHONATES a. Alendronate, Risedronate & Ibandronate Sodium 2. CALCITONIN 3. ESTROGEN THERAPY/HORMONE THERAPY 4. PARATHYROID HORMONE OR PTH (1-34) 5. SELECTIVE ESTROGEN RECEPTOR MODULATOR (SERM) a. Raloxifene
    45. 52. BISPHOSPHONATES Alendronate-Brand Name-Fosamax® Risedronate-Brand Name-Actonel® <ul><li>Slows or Stops Bone Loss </li></ul><ul><li>Increases Bone Density </li></ul><ul><li>Reduces Risk for Fracture </li></ul>
    46. 53. <ul><li>Ibandronte Sodium-Brand Name-Boniva® </li></ul><ul><li>Slows Bone Loss </li></ul><ul><li>Increases Bone Density </li></ul><ul><li>Reduces Risk for Fracture </li></ul><ul><li>Once a month treatment </li></ul>
    47. 54. <ul><li>BRAND NAME: MIACALCIN® </li></ul><ul><li>Naturally occurring hormone involved in calcium regulation </li></ul><ul><li>Reduces bone loss, especially in the spine </li></ul><ul><li>Available as an injection or nasal spray </li></ul>CALCITONIN
    48. 55. ESTROGEN THERAPY (ET) <ul><li>Approved for the prevention of osteoporosis in postmenopausal women </li></ul><ul><li>Increases bone density and reduces the risk of fracture </li></ul>
    49. 56. ESTROGEN THERAPY (ET) HORMONE THERAPY (HT) <ul><li>Women who still have their uterus can protect the endometrial lining by taking a second hormone, progestin or progesterone in combination with estrogen (HT) </li></ul><ul><li>ET/HT relieves menopausal symptoms and has a beneficial effect on bone health. </li></ul><ul><li>Side effects may include vaginal bleeding, breast tenderness, mood disturbances and gall bladder disease. </li></ul>
    50. 57. WOMEN’S HEALTH INITIATIVE STUDY <ul><li>Study confirmed that one type of HT, Prempro®, reduced the risk of hip and other fractures </li></ul><ul><li>Reduced colon cancer, BUT, </li></ul><ul><li>Increased a woman’s risk of breast cancer, heart attacks and venous blood clots. </li></ul>
    51. 58. WOMEN’S HEALTH INITIATIVE STUDY <ul><li>Prescribe the lowest possible doses of ET/HT for the shortest period of time to manage symptoms of menopause </li></ul><ul><li>Discuss alternative osteoporosis medications for women at risk for or diagnosed with osteoporosis </li></ul><ul><li>Consult with her healthcare provider about the possible benefits and risks </li></ul>
    52. 59. PARATHYROID HORMONE OR PTH (1-34) <ul><li>Approved for the treatment of osteoporosis in postmenopausal women and men at increased risk for fracture </li></ul><ul><li>Builds new bone and, </li></ul><ul><li>Significantly reduces the risk of spine and other fractures </li></ul><ul><li>Self-administered as a daily injection </li></ul>
    53. 60. SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMs) <ul><li>Raloxifene-Brand Name-Evista® </li></ul><ul><li>Prevents Bone Loss </li></ul><ul><li>Appears to reduce the risk of breast cancer </li></ul><ul><li>Possible side effects include hot flashes and blood clots </li></ul>
    54. 61. MEN <ul><li>More than 2 million men have the disease and nearly 12 million more are at risk </li></ul><ul><li>Alendronate and PTH are approved for treatment of osteoporosis in men </li></ul>
    55. 62. FALL PREVENTION
    56. 63. Osteoporosis Falls Break Bones <ul><li>You can prevent most falls </li></ul><ul><ul><li>Improve your balance, coordination, and strength through weight-bearing physical activity such as dancing or Tai Chi </li></ul></ul><ul><ul><li>Review medicines with a health care professional (some medicines may cause drowsiness or dizziness) </li></ul></ul><ul><ul><li>Have your vision checked </li></ul></ul><ul><ul><li>Make your home safer </li></ul></ul>
    57. 64. Protect Your Bones Ways to Make Your Home Safer 1 2 3 4 5 6 7 8 9 10 11 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. Make sure your walkways are wide enough. Remove all small rugs. They can make you trip. 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. Remove things that you may trip over from stairs and places where you walk.
    58. 65. Protect Your Bones Ways to Make Your Home Safer 12 5 Remove all small rugs. They can make you trip. Use non-slip mats in the bathtub or shower. Have grab bars put in next to your toilet and in the bathtub or shower.
    59. 66. Bone Health & Oral Health <ul><li>Oral health care is important. </li></ul><ul><li>Bone loss in the jaw and osteoporosis have been linked </li></ul><ul><li>The loss of bone supporting the jaw and anchoring our teeth can lead to loose teeth, tooth loss and ill fitting dentures. </li></ul><ul><li>Your dentist may be the first health professional to suspect osteoporosis. </li></ul><ul><li>Women with osteoporosis have been reported to have 3 x more tooth loss than women without the disease. </li></ul>
    60. 67. Summary You are never too old or too young to improve your bone health <ul><li>Adults </li></ul><ul><ul><li>At least 30 minutes of moderate physical activity a day </li></ul></ul><ul><ul><li>Strength and balance training </li></ul></ul><ul><ul><li>Protect from falls </li></ul></ul><ul><ul><li>Eye exam to check for visual impairments </li></ul></ul><ul><ul><li>Bone density test with a fracture after age 50, and for everyone with risk factors </li></ul></ul><ul><ul><li>Bone density test for all women over age 65 </li></ul></ul><ul><ul><li>Extra calcium and vitamin D over age 50 </li></ul></ul><ul><ul><li>Medication, if indicated, to prevent bone loss or build new bone </li></ul></ul>
    61. 68. <ul><li>Children & Teens </li></ul><ul><ul><li>Teens are at greater risk for poor bone health because of rapidly growing bones and poor diet </li></ul></ul><ul><ul><li>At least one hour of physical activity a day </li></ul></ul><ul><ul><li>Increase calcium during teens </li></ul></ul><ul><li>Babies </li></ul><ul><ul><li>Bone health begins before birth </li></ul></ul>Summary You are never too old or too young to improve your bone health
    62. 70. Everyone has a Role to Play in Improving Bone Health This report is a starting point for national action
    63. 71. How Can You Help? Educate Others <ul><li>Know your own risks </li></ul><ul><li>Improve your bone health habits and those of your family </li></ul><ul><li>Tell your family and friends about the importance of bone health </li></ul><ul><li>And remember…you are never too young or too hold to improve your bone health. </li></ul>
    64. 72. How Can You Help? Educate Others
    65. 73. Let’s Work Together to Get Kentucky Bone Healthy!
    66. 74. Acknowledgements <ul><li>Thanks to: </li></ul><ul><li>Florida Department of Health </li></ul><ul><li>Osteoporosis Prevention & Education Program </li></ul><ul><li>(Slides adapted from Florida Department of Health’s Osteoporosis Prevention Curriculum for Adults) </li></ul>
    67. 75. Resources <ul><li>The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You http://www.surgeongeneral.gov/library/bonehealth </li></ul><ul><li>National Osteoporosis Foundation http://www.nof.org </li></ul><ul><li>American Dental Association http://www.ada.org/public/media/releases/0210_release08.asp </li></ul><ul><li>American Dietetic Association: http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/advocacy_1743_ENU_HTML.htm </li></ul><ul><li>Center for Disease Control and Prevention: http://www.cdc.gov/brfss ; http://www.cdc.gov/nhanes </li></ul><ul><li>National Institute of Arthritis and Musculoskeletal and Skin Disease. Health Topics: Oral Health and Bone Disease. http://www.niams.nih.gov/bone/hi/oralhealth_bone.htm </li></ul>
    68. 76. QUESTIONS ?
    69. 77. <ul><li>Kentucky Department for Public Health </li></ul><ul><li>Osteoporosis </li></ul><ul><li>Prevention and Education Program </li></ul><ul><li>502-564-7996 ext. 3777 </li></ul>

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