The document provides information about osteoporosis including goals of increasing awareness, facts and statistics, risk factors, prevention strategies, and bone density testing. The goals are to educate the public about prevention, diagnosis, and treatment of osteoporosis through a community program. It discusses osteoporosis prevalence, risk factors like age and family history, the importance of calcium and vitamin D, and recommends those at high risk discuss bone density testing with their healthcare provider.

1. INTRODUCTION

2. GOALS & OBJECTIVES
Goal: is to increase awareness of
osteoporosis, the risk factors, steps
to prevent, treatment options, and
suggestions to reduce fractures
Objective: is to provide a broad-
based community education
program to educate the public
about prevention, diagnosis, and
treatment options

3. -PEGGY, AGE 46
“I was absolutely blown
away to discover I had
osteoporosis. And there
are thousands of women
out there in the condition
I was in!”

4. -DIANNE, AGE 61
“I was devastated! I was always
very physically active in school
with hockey and track. I
couldn’t believe it—I was in
shock! My doctor told me not to
pick up my grandchildren, a bag
of groceries, or vacuum. I felt
like I was in a bubble.”

5. -LINDA, AGE 53
“When the doctor revealed the
DXA results, I was stunned. I’d
been drinking lots of milk all my
life, yet I had a full blown case
of osteoporosis. If your doctor
doesn’t suggest it, be assertive.
You’ll be the one to pay the
price if you’re not.”

6. FACTS
AND
FIGURES

7. NATIONAL STATISTICS
Osteoporosis affects more than 28
million Americans; 80% of them
are women and 20% men
1 in 2 women and 1 in 8 men over
the age of 50 will develop
osteoporosis
Thin bones are the cause of 1.5
million fractures a year

8. FLORIDA STATISTICS
Over 2.1 million individuals have
osteoporosis or low bone mass
1998 - 22,630 residents had hip
fractures
1998 - Hospital charges for hip
fractures were $477.8 million with
80% discharged to nursing homes

9. VERTEBRAL FRACTURES
Can lead to chronic back pain, loss of
height, protruding stomach, stooped
posture - back pain is the most common
complaint
At age 50, a woman has a 50% chance of
an osteoporosis-related fracture during
her life
Loss of ability to do daily living activities
(cooking, cleaning, getting dressed, etc.)

10. A woman’s hip fracture risk equals
her combined risk of breast, uterine
and ovarian cancer
15-20% need long-term care
facilities
There is a 20% increased risk of
death during the first year following
a hip fracture
HIP FRACTURES

11. MYTHS OR FACTS
Men do not get osteoporosis
Diet can provide all of the calcium a
body needs
If your grandmother had
osteoporosis, you will get it too
Dairy products are the only source
of calcium
Activity – Myths or Facts About Osteoporosis

12. MYTHS OR FACTS
If you have osteoporosis, you can
do nothing about it
Our bones stop growing when we
reach full height (about age 20)
Susceptibility to fractures can
indicate osteoporosis

13. Low calcium intake during
adolescence can cause osteoporosis
later
Exercise is dangerous for older
people
MYTHS OR FACTS

14. MEN & OSTEOPOROSIS
Lifetime risk of getting
osteoporosis is the same as a
man’s lifetime risk for prostate
cancer
Nationally, one in eight men over
50 will get osteoporosis
By age 75, one in three men will
get osteoporosis

15. ALL
ABOUT
BONES

16. OSTEOPOROSIS: “The Silent Disease”
“Osteo” is Latin for “bone”
“Porosis” means “porous or full
of holes”
“Osteoporosis” means “bones
that are full of holes”
Osteoporosis can develop without
symptoms
You may not know you have the disease
until a bone fractures

17. TYPES OF BONE
(1) Cortical – is hard, compact,
dense bone (example: mid-
section of larger, long-bones of
arms and legs)
(2) Trabecular – is spongy,
porous and flexible bone
(example: end of the wrist, hip
and the spine)
Activity - Understanding Our Bones

18. HEALTHY BONE
Bone is living
tissue, which is
constantly being
broken down and
rebuilt, a process
called remodeling
Bone is renewed
like skin, hair and
nails

19. OSTEOPOROTIC BONE
The loss of
living bone
tissue makes
bones fragile
and more
likely to
fracture
Note: arrow points to micro - fracture

20. BONE “REMODELING”
Resorption-
removes old
bone
Formation-
replaces old bone
with new bone

21. OSTEOCLASTS-PHASE 1
Cells called osteoclasts (think
“C” for chiseler) seek out old
bone or damaged bone tissue
and destroy it, leaving small
spaces (resorption)

22. OSTEOBLASTS – PHASE 2
Cells called osteoblasts (think
“B” for builder) use minerals
like calcium, phosphorus, and
vitamin D to fill in the spaces
with new bone (formation)

23. BUILD YOUR BONE BANK
You build bone until about age 30
Steps to building healthy bones
include:
Calcium & vitamin D
Limit Caffeine & Alcohol
Exercise
Don’t Smoke

24. BONE BANK DEPOSITS
From birth through adolescence, new
bone is built faster than old bone is
removed
In mid-life, depending on lifestyle and
other factors, bone removal can achieve
a balance with bone formation
After menopause, bone removal may
accelerate due to a decrease in
estrogen

25. BONE LOSS & AGING
The first 5-15 years after
menopause a woman can lose
approximately 25 - 30 % of
trabecular bone & approximately
10 – 15 % of cortical bone
Bone loss often occurs
without symptoms or
warning signs

26. CHANGES IN BONE MASS
After menopause, bone removal
accelerates due to a decrease in estrogen

27. EARLY WARNING SIGNS
History of broken bones as an
adult
Unexplained back pain –
subsides after a couple of weeks
Loss of more than an inch in
height
Posture has become stooped

28. OSTEOPOROSIS
Normal Posture Dowager’s Hump

29. CLARIFICATIONS
There is no relationship between
osteoporosis and arthritis
Osteoporosis is a generalized
bone disease that causes porous
bones, usually not causing
symptoms until a fracture occurs

30. 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 the fingers—no
relationship to osteoporosis
CLARIFICATIONS

31. 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
CLARIFICATIONS

32. RISK
FACTORS

33. RISK FACTORS - CAN’T CONTROL
Gender: Females are usually
diagnosed with osteoporosis at four
times the rate of males. Bone mass in
males is approximately 15-20% higher
than females
Small Boned & Thin: may result in
smaller bones with a lower bone
density
Activity - Risk Factor Worksheet

34. RISK FACTORS - CAN’T CONTROL
Race/Ethnicity: Women, especially
Caucasian and Asian women with thin
frames are at greater risk
African American women have a higher
peak bone mass (10%) than Caucasian
women, but other factors such as
nutrition, exercise, certain diseases,
and medications may increase their
risk of osteoporosis

35. RISK FACTORS - CAN’T CONTROL
Heredity: your family history may put
you genetically at risk or may be a result
of family members sharing the same
environment, exercise, and nutritional
habits
Menopause or several months without
periods: bone loss begins to exceed
bone formation, due to a decrease of
estrogen

36. Age: In your 40’s you start to
lose bone faster than you
build new bone. The
accumulated loss of
bone puts an older
person at higher risk
RISK FACTORS - CAN’T CONTROL

37. RISK FACTORS – CAN CONTROL
Calcium Rich Diet:
milk, cheese, yogurt
Weight Bearing Exercise:
walk, bike, run
Vitamin D:
sunshine, multivitamin, fortified food

38. RISK FACTORS – CAN CONTROL
Caffeine: Recommendation-
No more than 2-3 cups of
caffeine beverages per day
Cola, coffee and
chocolate all
contain caffeine

39. Alcohol: consuming more than
one alcoholic drink per day is
associated with risk of low bone
mass
RISK FACTORS – CAN CONTROL
Eating Disorders:
anorexia nervosa or
bulimia can lead to
malnutrition and
bone loss

40. Smoking: causes
lower bone density
Immobility: extreme
lack of exercise can
lead to bone loss
RISK FACTORS – CAN CONTROL

41. OTHER RISK FACTORS
Steroids - cause increased bone
breakdown and decreased bone
replacement
Prolonged hyperthyroidism – can
cause increased risk of bone loss
Thyroid hormone - (in excess) – acts
on bone cells to increase resorption

42. Diuretics – some types of diuretics may
increase excretion of calcium in the urine
Kidney failure – affects the metabolism of
calcium, phosphorous and vitamin D
Chronic hepatitis – chronic liver disease
may cause bone loss in several different
ways
Intestinal disease – some can affect the
absorption of vitamin D & calcium
OTHER RISK FACTORS

43. DRUGS-MAY CAUSE BONE LOSS
Cortisone Isoniazid
Seizure drugs Lithium
Cyclosporine Heparin
Methotrexate
Some Hormones Lupron®
Zoledex®
Ask your healthcare provider

44. PREVENTION

45. CALCIUM’S FUNCTION
Blood clotting (control bleeding)
Regulates heart beat
Muscle function
Nerve transmission
Bone formation

46. Age
1-3 years
4-8 years
9-18 years
19-50 years
over 50 years
Milligrams (mg)
500
800
1,300
1,000
1,200- 1,500
DAILY CALCIUM REQUIREMENTS
National Academy of Science

47. CALCIUM NEEDS
Adolescents-may lack calcium due to
high fat snacks with empty calories,
soda and dieting
Eating Disorders-anorexic or bulimic
teens lack calcium and may develop
osteoporosis at an early age
Older Adults-may have increased
calcium need due to poor absorption

48. SERVING SIZE
1 ½ cup (12 oz) of liquid is the size of soda-
pop can
1 cup (8 oz) of food is the size of large handful
½ cup (4 oz) of food is about half a large
handful
3 (oz) of cooked meat, fish, poultry is about
the size of a deck of cards
A serving size is the amount of the food after it
is cooked

49. Fat: Sparingly
Dairy: 2-3
Protein 2-3
Vegetable: 3-5
Fruit: 2-4
Grains: 6-11
SERVINGS-INCLUDE CALCIUM
Activity - Calcium Worksheet or Calcium Card Game
Food Serving

50. 1 oz cream cheese: 20 mg
1 hard boiled egg: 30 mg
½ cup cooked broccoli: 40 mg
½ cup cottage cheese: 80 mg
1 oz cheddar cheese: 205 mg
6 oz calcium-fortified OJ: 250 mg
1 cup milk: 300 mg
1 cup fruit yogurt: 345 mg
3 oz sardines with bones: 370 mg
8 oz vegetable lasagna: 450 mg Activity - Results to
Calcium Card Game
CALCIUM IN FOODS

51.
Serving size & number
of servings
FOOD LABELS
Calories, Total &
Saturated fat in grams,
Cholesterol & Sodium,
Fiber, Sugars, & Protein
in grams
% Daily Value (DV)
Daily Amount

52. READING FOOD LABELS
Calcium content may vary greatly
between different brands of food
The percentage of calcium in a food is
based on 1000 milligrams. A food
containing 20% calcium = 200 mg
A food containing 10-19% of calcium
is a good source; 20% of calcium or
higher is a very good source
Activity – Nutrition Facts

53. % DAILY VALUE OF CALCIUM
FOOD %DV
Fruit yogurt 35%
Oatmeal 10%
Turnip Greens 20%
Total % DV = 65%
Add % DV by reading food labels to ensure
you get the recommended daily calcium
Activity - Foods and Calcium

54. LACTOSE-INTOLERANCE
Individuals who have difficulty
digesting the sugar found in
milk, called lactose
Start with small portions of
food such as milk--gradually
Increase portions
Eat dairy foods in combination with other foods
Many hard cheeses have less lactose than milk
Commercial lactase preparations aid digestion

55. CALCIUM SUPPLEMENTS
Read Labels--several different
types of calcium supplements
available
Avoid -“natural” calcium such as
bone meal or dolomite-some
contain toxic lead or mercury
“Elemental calcium” - is the type of
calcium the body absorbs

56. ELEMENTAL CALCIUM
Kinds of Calcium % Elemental Calcium
Calcium carbonate 40%
Calcium phosphate (tribasic) 39%
Calcium phosphate (dibasic) 30%
Calcium citrate 21%
Calcium lactate 13%
Calcium gluconate 9%
Example, a 500 mg calcium tablet may only contain
45-200 mg of elemental calcium

57. CALCIUM TIPS
Do not take more than 500 mg
of calcium at a time or 2000 mg
total per day
Your body can absorb only
about 500 to 600 mg at a time
Example: take one tablet at
breakfast and another at
dinner

58. CARBONATE CITRATE
Needs acid to
dissolve and for
absorption
Less stomach
acid as we age
Take “at” or
“after” meals when
more stomach acid
Doesn’t require
stomach acid for
absorption
May be taken
between meals
May cost more

59. TEST YOUR CALCIUM TABLET
Put a calcium tablet in a
cup of half water and
half vinegar. Stir
every 5 minutes.
If it doesn’t dissolve
in 30 minutes, it probably
won’t dissolve in your
stomach

60. VITAMIN D
CALCIUM
VITAMIN
•Vitamin D is
necessary for
calcium to be
absorbed
•Multivitamin or
calcium tablets may
contain 400 IU daily
(don’t exceed 800)
•Vitamin D is in milk
(100 IU in 1 cup)

61. EXERCISE!
Walking
Dancing
Gardening
Tennis
Jump Rope
Volleyball
Skating
Activity – Exercise Guide

62. ENVIRONMENTAL SAFETY
PREVENT
PAINFUL
FALLS
Activity –
Environmental Safety
Cartoon

63. BONE
DENSITY
TESTING

64. WHO NEEDS TESTING?
If you have major risk factors for
osteoporosis
If you have a family history of osteoporosis
If you have a personal history of fractures
after age 45
If you are on prolonged use of steroids
If you are postmenopausal, and not on
estrogen replacement therapy
Consult your healthcare provider

65. SCREENING TESTS
Portable scanners:
SXA - (Single Energy X-ray
Absorptiometry), measures wrist
or heel
pDXA - (Peripheral Dual Energy
X-ray), measures wrist or heel

66. RA - (Radiographic Absorptiometry),
x-ray of hand that is compared to a
small metal wedge
QCT - (Quantitative Computed
Tomography), measures the spine
Ultrasound - sound waves to
measure the heel, shin, and kneecap
SCREENING TESTS

67. DXA-BONE DENSITY TESTING

68. WHAT IS A DXA?
DXA (Dual Energy X-ray
Absorptiometry) is the “gold
standard”
Measures bone density in the hip,
spine, and forearm
Painless, non-invasive, requires no
injections
Takes 10 - 20 minutes

69. WHAT IS A T-SCORE?
World Health Organization T-score is
comparing the average bone density to
that of healthy young Caucasian women
T-Score Diagnosis
0 to –1 “Normal”
-1 to –2.5 “Osteopenic”-
low bone mass
-2.5 or lower “Osteoporotic”

70. INSURANCE

71. INSURANCE
Most insurance
policies cover bone
density testing for
diagnostic
purposes only, not
as a screening test

72. MEDICAID
Medicaid will usually cover
“medically necessary”
osteoporosis testing for
“high risk” individuals
Consult with your healthcare
provider

73. MEDICARE
Women over age 65
Men and women with previous
spinal fractures
Men and women on prednisone
or other steroid-type
medications or who are
planning to begin such
medications

74. MEDICARE
Men and women with primary
hyperparathyroidism
Men and women being treated with
drugs for osteoporosis to see if the
therapy is working
Deductibles & co-pays may apply
Covered every 2 years, if ordered by
healthcare professional

75. MEDICATION

76. MEDICATIONS
Estrogen - “ERT”
Fosamax® - Alendronate
Actonel® - Risedronate
Evista® - Raloxifene
Miacalcin® - Calcitonin

77. ESTROGEN
Most cost-effective prevention
for osteoporosis
Slows bone loss and may
slightly increase bone mass
Estimated to reduce hip
fracture by 30-50%

78. EVISTA (Raloxifene)
SERMS-Selective Estrogen Receptor
Modulators-designer drugs
SERMS act like estrogen but doesn’t
stimulate breast or uterine tissue
Evista is the first and only SERM
approved for the prevention and
treatment of osteoporosis

79. BISPHOSPHONATES
Fosamax and Actonel
Specifically designed to affect the
skeleton, increase bone density &
reduce number of fractures
Must be taken correctly - on an empty
stomach, first thing in the morning
with glass of plain water, fasting, &
remain upright for 30 minutes

80. FOSAMAX ® (Alendronate)
Approved for prevention and treatment
Approved for treatment of steroid-
induced osteoporosis in men and
women
Prevention – 5 mg daily
Treatment – 10 mg daily or
70 mg once weekly
(for men and postmenopausal women)

81. ACTONEL ® (Risedronate)
Weekly 35 mg is approved for prevention
and treatment of osteoporosis in
postmenopausal women, and for women
who have osteopenia, but are not yet
postmenopausal
Daily 5 mg dose is approved for prevention
and treatment of glucocorticoid-induced
osteoporosis in women
Actonel may be given to males at the
discretion of the Health Care Provider

82. MIACALCIN (Calcitonin)
Is a naturally occurring
hormone involved in calcium
regulation and bone
metabolism
Available by injection or nasal
spray

83. PUTTING
IT ALL
TOGETHER

84. SUMMARY
Calcium Rich Diet
Vitamin D
Prevent Falls
Weight-Bearing Exercise

85. Don’t Smoke
Minimize Caffeine &
Alcohol
Testing & Medication if
Needed
SUMMARY

86. HEALTHCARE PROVIDERS
Healthcare
providers are the
best source of
information about
osteoporosis and
medical options
Please complete evaluation form-thank you!
Activity – Affirming a Positive Change