LDPsi Presentation
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This document provides information about osteoporosis, including: - Comments from people with osteoporosis about how the disease has impacted them - Risk factors for osteoporosis like age, family history, smoking, and certain medical conditions - Prevention strategies like getting enough calcium and vitamin D from food and supplements, weight-bearing exercise, and fall prevention - Treatment options like bisphosphonate medications and hormone therapy when appropriate
LDPsi Presentation
- 1. sis ro p o o py te ro n th la s i ph i’s O ps lta De a bd m La
- 2. Typical comments from people with osteoporosis “I’ve lost six inches in height and none of my clothes fit me anymore.”
- 3. “Medications are expensive. But I can’t afford to let my condition get worse and this medicine will help stop or slow down the bone loss.”
- 4. “If somebody had told me sooner what I know now about osteoporosis, none of this might be happening to me!”
- 5. About Osteoporosis Osteoporosis causes weak bones. In this common disease, bones lose minerals like calcium. They Normal Bone Bone with Osteoporosis become fragile and break 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
- 6. Osteoporosis The Most Common Bone Disease • Characterized by low bone mass and deterioration of bone structure • Not a natural part of aging • Increased risk for women, post- menopausal, over age 65 • All races, sexes, and ages are susceptible • Preventable and treatable!
- 7. 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
- 8. The problem in America Major health threat for an estimated 44 million (55%) of people 50 years and older 10 million estimated to have osteoporosis 34 million have low bone mass placing them at risk 1 in 2 women and 1 in 4 men over 50 will have an osteoporosis-related fracture Source: National Osteoporosis Foundation Web site; retrieved July 2005 at http://www.nof.org
- 9. 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
- 10. Hip fractures account for 300,000 hospitalizations annually. & Unfortunately, people who break a hip might not recover for months or even years Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
- 11. The most common breaks in weak bones are in the wrist, spine and 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
- 12. Why Are Healthy Bones Important? Strong bones support us and allow us to move Bones are a storehouse for vital minerals Strong bones protect our heart, lungs, brain and other organs
- 13. After mid-30’s, you begin to slowly lose bone mass. Women lose bone mass faster after menopause. Men lose bone mass too. Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
- 14. You’re never too young or old to improve bone health!
- 15. Risk factors If you have any of these “red flags,” you could be at high risk for weak bones. Talk to your health care professional. Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
- 16. IF you… 1 Are older than 65 Have broken a bone after age 50 Have a close relative that has osteoporosis or has broken a bone smoke are underweight for you’re height
- 17. If you have also… 2 Started menopause before age 45 Have never gotten enough calcium have more than two drinks of alcohol several times a week have poor vision, even with glasses sometimes fall Are not active
- 18. If you have one of these medical 3 conditions: Hyperthyroidism Chronic lung disease Cancer Inflammatory bowel disease Chronic liver or kidney disease Hyperparathyroidism Vitamin D deficiency Cushing's disease Multiple sclerosis Rheumatoid arthritis
- 19. 4 If you take one of these medicines: Oral glucocorticoids (steroids) Cancer treatments (radiation, chemotherapy) Thyroid medicine Antiepileptic medications Gonadal hormone suppression Immunosuppressive agents
- 20. The good news: Osteoporosis is preventable for most people! •Healthy diet and lifestyle are important for BOTH men and women. •If you have osteoporosis, your doctor can detect and treat it
- 21. Simple Prevention Steps The Surgeon General recommends five simple steps to bone health and osteoporosis prevention …
- 22. Step 1 Get your daily recommended amounts of calcium and vitamin D. Use MyPyramid.gov to help plan an overall healthy diet
- 23. Step 2 Be physically active everyday Improve strength and balance Even simple activities such as walking, stair climbing and dancing can strengthen bones.
- 24. Step 3 Avoid smoking and excessive alcohol. 12 oz. 5 oz. 1.5 oz. MyPyramid.gov recommends no more than 1 drink per day for women and 2 for men.
- 25. Step 4 Talk to your doctor about bone health.
- 26. Step 5 Source of photo: USDA ARS Photo Unit Photo by Peggy Greb Have a bone density test and take medication when appropriate. Testing is a simple, painless procedure.
- 27. Food and supplement labels Assess calcium and vitamin D intake by using food and supplement labels.
- 28. Calcium Requirements for 50+ Years Over 50 years 1,200 mg Goal Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
- 29. Nutrition labels & calcium FDA uses “Percent Daily Value” (% DV) to describe amount of calcium needed by general U.S. population daily 120% DV for calcium = 1,200 mg Look for this label: “Nutrition Facts” on foods “Supplement Facts” on vitamin/mineral supplements
- 30. You need more vitamin D as you age Daily vitamin D needs in International Units (IU) Age
- 31. 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)
- 32. Percent Daily Value (DV) of calcium in common foods Approximate % DV for foods based in part on The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
- 33. % DV calcium: Milk group Yogurt 1 cup (8 oz.) = 30% DV Milk 1 cup = 30% DV Cheese 1 ½ oz. natural/2 oz. processed = 30% DV Milk pudding 1/2 cup = 15% DV Frozen yogurt, vanilla, soft serve Choose fat-free ½ cup = 10% DV or low fat most often Ice cream, vanilla ½ cup = 8% DV Soy or rice milk, calcium-fortified
- 34. % DV calcium: Grain products group Cereal, calcium- fortified Serving size and amount of calcium varies— check label
- 35. % DV calcium: Vegetable group Broccoli, raw 1 cup = 9% DV Collards 1/2 cup = 20% DV Turnip greens, boiled 1/2 cup = 10% DV
- 36. % DV calcium: Fruit group Orange juice and other calcium-fortified beverages 6 oz. = 20 to 30% DV, varies—check label Look for 100% juice
- 37. % 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
- 38. 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
- 39. Vitamin D from sunlight exposure Vitamin D is manufactured in your skin following direct exposure to sun. Amount varies with time of day, season, latitude and skin pigmentation. 10–15 minutes exposure of hands, arms and face 2–3 times/week may be sufficient (depending on skin sensitivity). Clothing, sunscreen, window glass and pollution reduce amount Source: National Osteoporosis Foundation Web site; retrieved July 2005 at http://www.nof.org
- 40. Help for the lactose-intolerant Some people lack the enzyme lactase needed to digest lactose (milk sugar).
- 41. When you don ’t like to “drink ” milk
- 43. Calcium carbonate vs. citrate Calcium 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
- 44. 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 key that 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.
- 45. Limit calcium to 500 mg at a time Our bodies can best handle about 500 mg calcium at one time from food and/ or supplements. Spread your calcium sources throughout the day.
- 46. 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.
- 47. Medications Bisphosphonates (Fosamax®) - Alendronate & Alendronate with Calcium (Boniva®) - Ibandronate (Updated 2006) (Actonel®) - Risedronate & Risedronate with Calcium (Miacalcin®) Calcitonin Estrogen Therapy/Hormone Therapy Parathyroid Hormone (PTH 1-34) Selective Estrogen Receptor Modulator (SERM) (Evista®) Raloxifene Source: Physician’s Guide to Prevention and Treatment of Osteoporosis. 2nd ed. Washington, DC: National Osteoporosis Foundation; 2003.
- 48. Osteoporosis Falls Break Bones You can prevent most falls!!
- 49. Hip Fracture Prevention: Falling How do Younger Adults Fall?
- 50. Hip Fracture Prevention: Falling How do Older Adults Fall?
- 51. Bone Health Building Blocks
- 52. 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
- 53. ORAL HEALTH Continued The National Institute of Arthritis and Musculoskeletal and Skin Disease Steps for Healthy Bones Eat a well-balanced diet rich in calcium and vitamin D. Live a healthy lifestyle. Don’t smoke, and if you choose to drink alcohol, do so in moderation. Engage in regular physical activity or exercise. Weight- bearing activities, such as walking, jogging, dancing, and lifting weights, are the best for strong bones. Report any problems with loose teeth, detached or receding gums, and loose or ill-fitting dentures to your dentist and doctor.
- 54. For more information The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You http://www.surgeongeneral.gov/library/bonehealth National Osteoporosis Foundation http://www.nof.org Thanks to University of Nebraska–Lincoln Extension educational programs
Editor's Notes
- #2: 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
- #6: 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
- #8: Fragile bones are not painful at first
- #9: 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
- #12: If you break a bone after the age of 50, talk to your health care professional about measuring your bone density
- #23: 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
- #24: 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
- #26: Be sure to discuss Your risk factors Your medication Calcium & vitamin D intake Do you need a bone density scan
- #27: 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!
- #32: 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.
- #41: 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
- #42: 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
- #48: 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).
- #49: 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
- #51: 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
- #53: Your dentist will take your medical history, discuss oral health risk factors and review clinical & x-ray examinations at your dental visits.
- #54: Healthy Bones help with Healthy Teeth!