FYI do not have to announce to group- 1 st picture – 50 year old postmenopausal with hot flashes 2-3 picture postmenopausal- 55+ 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
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
Fragile bones are not painful at first
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
If you break a bone after the age of 50, talk to your health care professional about measuring your bone density
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
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
Be sure to discuss Your risk factors Your medication Calcium & vitamin D intake Do you need a bone density scan
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!
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.
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
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 2 - 7 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
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).
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
This is one of the ways patients fall. Backward and lateral falls also occur and put the patient at risk for fractures. Osteoporotic fractures commonly affect the hip because the elderly tend to fall sideways or backwards, landing on this joint. Younger, more agile persons tend to fall forward, landing on the outstretched wrist, thus fracturing the distal radius
Your dentist will take your medical history, discuss oral health risk factors and review clinical & x-ray examinations at your dental visits.
Healthy Bones help with Healthy Teeth!
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Typical comments from people with osteoporosis “I’ve lost six inches in height and none ofmy clothes fit me anymore.”
“Medicationsare expensive.But I can’t affordto let mycondition getworse and thismedicine willhelp stop or slowdown the boneloss.”
“If somebody hadtold me sooner what Iknow now aboutosteoporosis, none ofthis might behappening to me!”
About OsteoporosisOsteoporosiscauses weak bones.In this commondisease, bones loseminerals likecalcium. They Normal Bone Bone with Osteoporosisbecome fragile andbreak easily.Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
OsteoporosisThe 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!
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
The problem in AmericaMajor health threat for an estimated 44 million(55%) of people 50 years and older10 million estimated to have osteoporosis34 million have low bone mass placingthem at risk1 in 2 women and 1 in 4 men over 50 will have an osteoporosis-related fractureSource: National Osteoporosis Foundation Web site; retrieved July 2005 at http://www.nof.org
Related Risks 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 http://www.nof.org
Hip fracturesaccount for300,000hospitalizationsannually.& Unfortunately,people who break ahip might notrecover for monthsor even years Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
The mostcommonbreaks inweak bonesare in thewrist, spineand hip . Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
Why Are Healthy Bones Important?Strong bones supportus and allow us to moveBones are a storehousefor vital mineralsStrong bones protectour heart, lungs, brainand other organs
After mid-30’s, you beginto slowly lose bonemass.Women lose bone massfaster 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 http://www.surgeongeneral.gov/library/bonehealth
You’re never too young or old to improve bonehealth!
Risk factorsIf you have any ofthese “red flags,”you could be at highrisk for weak bones.Talk to your healthcare professional.Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
IF you… 1 Are older than 65 Have broken a bone after age 50 Have a close relative that hasosteoporosis or has broken a bonesmoke are underweight for you’re height
If you have also… 2Started menopause before age 45 Have never gotten enough calcium have more than two drinks of alcoholseveral times a week have poor vision, even with glasses sometimes fall Are not active
If you have one of these medical 3conditions: Hyperthyroidism Chronic lung disease Cancer Inflammatory bowel disease Chronic liver or kidney disease Hyperparathyroidism Vitamin D deficiency Cushings disease Multiple sclerosis Rheumatoid arthritis
4If you take one of thesemedicines: Oral glucocorticoids (steroids) Cancer treatments (radiation, chemotherapy) Thyroid medicine Antiepileptic medications Gonadal hormone suppression Immunosuppressive agents
The good news: Osteoporosis ispreventable 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
Simple Prevention Steps The Surgeon General recommends five simple steps to bone health and osteoporosis prevention …
Step 1Get your dailyrecommendedamounts of calciumand vitamin D. Use MyPyramid.gov to help plan an overall healthy diet
Step 2Be physicallyactive everydayImprove strengthand balance Even simple activities such as walking, stair climbing and dancing can strengthen bones.
Step 3Avoid smoking andexcessive alcohol. 12 oz. 5 oz. 1.5 oz. MyPyramid.gov recommends no more than 1 drink per day for women and 2 for men.
Step 5 Source of photo: USDA ARS Photo Unit Photo by Peggy GrebHave a bone density testand take medicationwhen appropriate. Testing is a simple, painless procedure.
Food and supplement labelsAssess calcium andvitamin D intakeby using food andsupplement labels.
Calcium Requirements for 50+ YearsOver 50 years 1,200 mg GoalSource: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
Nutrition labels & calciumFDA uses “Percent DailyValue” (% DV) to describeamount of calcium needed bygeneral U.S. population daily120% DV for calcium= 1,200 mgLook for this label: “Nutrition Facts” on foods “Supplement Facts” on vitamin/mineral supplements
You need more vitamin D as you ageDailyvitamin D needsin InternationalUnits (IU) Age
Calcium & vitamin D recommendations 51 - 70 years 1,200 mg calcium (120% DV) 400 IU vitamin D (100% DV) 70 and older 1,200 mg calcium (120% DV) 600 IU vitamin D (150% DV)
Percent Daily Value (DV) of calcium in common foodsApproximate % DV for foods based in part on The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
% 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 serveChoose fat-free ½ cup = 10% DV or low fat most often Ice cream, vanilla ½ cup = 8% DV Soy or rice milk, calcium-fortified
% DV calcium: Grain products group Cereal, calcium- fortified Serving size and amount of calcium varies— check label
% DV calcium: Vegetable group Broccoli, raw 1 cup = 9% DV Collards 1/2 cup = 20% DV Turnip greens, boiled 1/2 cup = 10% DV
% DV calcium: Fruit group Orange juice and other calcium-fortified beverages 6 oz. = 20 to 30% DV, varies—check label Look for 100% juice
% 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
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
Vitamin D from sunlight exposureVitamin D is manufactured in yourskin following direct exposure to sun.Amount varies with time of day,season, latitude and skinpigmentation.10–15 minutes exposure of hands,arms and face 2–3 times/week maybe sufficient (depending on skinsensitivity).Clothing, sunscreen, window glassand pollution reduce amountSource: National Osteoporosis Foundation Web site; retrieved July 2005 at http://www.nof.org
Help for the lactose-intolerantSome people lack theenzyme lactaseneeded to digest lactose(milk sugar).
Calcium carbonate vs. citrateCalcium carbonate Calcium citrate•Needs acid to dissolve •Doesn’t require and for absorption stomach acid for absorption•Less stomach acid as we age •May be taken anytime— check with your•Often taken at healthcare provider meals when more stomach acid •May cost more
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.Vitamin D is like a keythat unlocks the door It’s not necessary to consume and lets calcium calcium and vitamin D at the into the body. same time to get the benefit of enhanced calcium absorption.
Limit calcium to 500 mg at atime Our bodies can best handle about 500 mg calcium at one time from food and/ or supplements. Spread your calcium sources throughout the day.
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.
MedicationsBisphosphonates (Fosamax®) - Alendronate & Alendronate with Calcium (Boniva®) - Ibandronate (Updated 2006) (Actonel®) - Risedronate & Risedronate with Calcium(Miacalcin®) CalcitoninEstrogen Therapy/Hormone TherapyParathyroid Hormone (PTH 1-34)Selective Estrogen Receptor Modulator (SERM) (Evista®) RaloxifeneSource:Physician’s Guide to Prevention and Treatment of Osteoporosis. 2nd ed. Washington, DC:National Osteoporosis Foundation; 2003.
OsteoporosisFalls Break Bones You can prevent most falls!!
Hip Fracture Prevention: FallingHow do Younger Adults Fall?
Hip Fracture Prevention: FallingHow do Older Adults Fall?
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
ORAL HEALTH ContinuedThe National Institute of Arthritis and Musculoskeletal and Skin Disease Steps for Healthy BonesEat a well-balanced diet rich in calcium and vitamin D.Live a healthy lifestyle. Don’t smoke, and if you chooseto 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 orreceding gums, and loose or ill-fitting dentures to yourdentist and doctor.
For more informationThe 2004 Surgeon General’s Report on BoneHealth and Osteoporosis: What It Means to Youhttp://www.surgeongeneral.gov/library/bonehealthNational Osteoporosis Foundationhttp://www.nof.orgThanks to University of Nebraska–Lincoln Extension educational programs