Osteoporosis General Audience Adults

Keeping Your Bones Healthy Prevent Osteoporosis Osteoporosis Prevention and Education Program

Slide 2:Today�s presentation . . .

Overview Risk factors Prevention Steps Treatment options Summary

Slide 3:With Osteoporosis your body�s frame (bones) becomes like the frame of a house damaged by termites. Weak bones break easily. Fragile bones are not painful at first. Referred to as 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 Normal Bone: the mircroachitecture of normal trabecular bone from a 30-year-old female. Look at the orientation between the horizontal and vertical trabeculae. This interconnectivity of the three-dimensional lattice of the trabeculae makes the vertebral bodies particularly well suited to support compressive loads. Like our spine endures normally. Bone with osteoporosis: 88-year-old woman. The loss of horizontal or lateral struts occurs before loss of vertical struts, resulting in reduced load-bearing capacity. This helps us to understand why the definition of osteoporosis includes a loss in mass or bone density as well as microarchitectural deterioration. With Osteoporosis your body�s frame (bones) becomes like the frame of a house damaged by termites. Weak bones break easily. Fragile bones are not painful at first. Referred to as 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 Normal Bone: the mircroachitecture of normal trabecular bone from a 30-year-old female. Look at the orientation between the horizontal and vertical trabeculae. This interconnectivity of the three-dimensional lattice of the trabeculae makes the vertebral bodies particularly well suited to support compressive loads. Like our spine endures normally. Bone with osteoporosis: 88-year-old woman. The loss of horizontal or lateral struts occurs before loss of vertical struts, resulting in reduced load-bearing capacity. This helps us to understand why the definition of osteoporosis includes a loss in mass or bone density as well as microarchitectural deterioration.

Slide 4: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 Osteoporosis can strike at any age! It is a myth that osteoporosis is only a problem for older women. 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 Osteoporosis can strike at any age! It is a myth that osteoporosis is only a problem for older women. 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

Slide 5:Women of all ethnic backgrounds White/Asian women most at risk - 1 in 2 African-American women - 1 in 20 Mexican-American women � 1 in 10 Men 80,000 hip fractures/ year

Source: The 2004 Surgeon General�s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth All women are at risk for developing osteoporosis. While White and Asian women have a higher risk for osteoporosis, it affects women of all ethnic backgrounds. White/Asian women over age 50- 52% have early bone loss, and 20 percent have osteoporosis. One in twenty (5%) African-American women over age 50 have osteoporosis; an additional 35% of African-American women have low bone density that increases their risk for fractures. African-American women are more likely than white women to die after suffering a hip fracture. Hispanic women have a slightly lower incidence rate over age 50, one in ten have osteoporosis (10%) Mexican American women, while close to � have low bone density (49%). Men can get osteoporosis too. In fact, more than 2 million American men have osteoporosis and 80,000 suffer hip fractures each year. Another 3.5 million are at risk for fractures. All women are at risk for developing osteoporosis. While White and Asian women have a higher risk for osteoporosis, it affects women of all ethnic backgrounds. White/Asian women over age 50- 52% have early bone loss, and 20 percent have osteoporosis. One in twenty (5%) African-American women over age 50 have osteoporosis; an additional 35% of African-American women have low bone density that increases their risk for fractures. African-American women are more likely than white women to die after suffering a hip fracture. Hispanic women have a slightly lower incidence rate over age 50, one in ten have osteoporosis (10%) Mexican American women, while close to � have low bone density (49%). Men can get osteoporosis too. In fact, more than 2 million American men have osteoporosis and 80,000 suffer hip fractures each year. Another 3.5 million are at risk for fractures.

Slide 6: 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 Fracture risk= The chance she would fracture her hip within her lifetime. This risk is about the same risk as her combined risk of having breast, uterine and ovarian cancer.Fracture risk= The chance she would fracture her hip within her lifetime. This risk is about the same risk as her combined risk of having breast, uterine and ovarian cancer.

Slide 7: Hip fractures account for 300,000 hospitalizations annually.

People who break a hipmight not recover formonths 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

Slide 8: 1 in 5 people with a hip fracture end up in a nursing home within a year.

Some people never walk again. Source: The 2004 Surgeon General�s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth Fractures 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. Fractures 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.

Slide 9: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 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

Slide 10: 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 If you break a bone after the age of 50, talk to your health care professional about measuring your bone density If you break a bone after the age of 50, talk to your health care professional about measuring your bone density

Slide 11:Bones are living organs

Calcium is deposited and withdrawn from bones daily. Bones build to about age 30. We need to build up a healthy bone account while young and continue to make deposits with age. Bones are living tissue, they provide structural support, protect vital organs and store calcium. Bones are living tissue, they provide structural support, protect vital organs and store calcium.

Slide 12:After mid-30�s, you begin to slowly lose bone mass. Women lose bone mass faster after menopause, but it happens to men too. Bones can weaken early in life without a healthy diet and the right kinds of physical activity.

Source: The 2004 Surgeon General�s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth 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. Until around age 30, we store and build bone effectively. As part of the aging process, bones begin to break down faster than they are formed. Accelerates after menopause. Estrogen is the hormone that protects against bone loss. After menopause, estrogen production decreases � may lead to rapid bone loss. Rate of Bone Loss in Postmenopausal Women 1% to 2% annual loss for 10 years after menopause Fastest bone loss is in first 3 to 6 years after menopause then it levels off, and gradually assumes the level of premenopausal bone loss. Point out in picture Older woman. When you are young your body makes new bone faster than it breaks down old bones. As you get older, this process slows down and you start losing bone density. The risk for osteoporosis depends on how much bone mass you attained in your twenties and how fast you lose it. Broken bones in your spine - Heal slowly. Weak bones in spine. Gradually lose height, Posture becomes hunched over; Difficult to walk or sit up. At first no pain with these spinal breaks but in late stages can be very painful. 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. Until around age 30, we store and build bone effectively. As part of the aging process, bones begin to break down faster than they are formed. Accelerates after menopause. Estrogen is the hormone that protects against bone loss. After menopause, estrogen production decreases � may lead to rapid bone loss. Rate of Bone Loss in Postmenopausal Women 1% to 2% annual loss for 10 years after menopause Fastest bone loss is in first 3 to 6 years after menopause then it levels off, and gradually assumes the level of premenopausal bone loss. Point out in picture Older woman. When you are young your body makes new bone faster than it breaks down old bones. As you get older, this process slows down and you start losing bone density. The risk for osteoporosis depends on how much bone mass you attained in your twenties and how fast you lose it. Broken bones in your spine - Heal slowly. Weak bones in spine. Gradually lose height, Posture becomes hunched over; Difficult to walk or sit up. At first no pain with these spinal breaks but in late stages can be very painful.

Slide 13: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

Slide 14: I�m older than 65  My mother or grandmother has osteoporosis or has broken a bone  I�ve broken a bone after age 50  My health is �fair� or �poor�  I smoke  I am underweight for my height 

1 Advanced age � bones become less dense and weaker as you age. The older you get the greater the bone loss you will experience Family history of osteoporosis: heredity plays a significant role. If your parents or other blood relatives suffered from osteoporosis or had hip fracture, or you had a broken bone as an adult, you are more likely to develop osteoporosis than people with no family history Broken bone after age 50 (see note above) People who are unhealthy or not as healthy may not have healthy bones Smoking promotes bone loss, especially in someone who has smoked for a long time. Heavy drinking also causes bone loss. Women who have or had eating disorders (anorexia or bulemia) or diet strictly usually do not consume enough calcium and/or vitamin D and this places them at risk. Thin and/or small frame � are at greater risk for fractures since people with slight builds generally have lower bone mass than people with larger build. These are usually women who weigh less than 127#. Advanced age � bones become less dense and weaker as you age. The older you get the greater the bone loss you will experience Family history of osteoporosis: heredity plays a significant role. If your parents or other blood relatives suffered from osteoporosis or had hip fracture, or you had a broken bone as an adult, you are more likely to develop osteoporosis than people with no family history Broken bone after age 50 (see note above) People who are unhealthy or not as healthy may not have healthy bones Smoking promotes bone loss, especially in someone who has smoked for a long time. Heavy drinking also causes bone loss. Women who have or had eating disorders (anorexia or bulemia) or diet strictly usually do not consume enough calcium and/or vitamin D and this places them at risk. Thin and/or small frame � are at greater risk for fractures since people with slight builds generally have lower bone mass than people with larger build. These are usually women who weigh less than 127#.

Slide 15: I started menopause before age 45  I've never gotten enough calcium I have more than two drinks of alcohol several times a week  I have poor vision, even with glasses  I sometimes fall  I'm not physically active (exercise < 3 X wk)

2 Menopause before age 45 - naturally or surgically (ovaries removed). Women can lose up to 20% of their bone mass in the 5-7 years after menopause. Women who have early menopause may start to lose bone early. These risks can usually be helped with hormone treatment; often hormone treatment can help some women regain bone or slow or prevent bone loss. (as stated above, they often have menstrual irregularities). Low calcium life long especially in the adolescent years- builds less peak bone mass so when estrogen declines bones are not as dense as they should be. Low calcium intake before age 30-35 can make bones not as dense; low calcium intake after age 35 may lead to faster bone loss. People who are lactose intolerant often avoid milk products and do not consume enough calcium Smoking is very harmful to your bones. Research shows women who smoke are much more likely to experience osteoporotic fractures than women who do not smoke. Smoking, excessive use of alcohol, increases your risk for an osteoporotic fracture. Vision: More apt to fall with poor vision � eye exams important! Falling more frequently as we age increases the chances of fractures.Regular weight-bearing exercise/activity stimulates bones. You are at a greater risk for osteoporosis if you are not active or if you have ever had an extended period of bed rest. Question may come up about caffeine: Consuming large amounts of caffeine - equal to the amount in more than 4 cups of coffee - can cause you to lose calcium in the urine. If you drink coffee, be sure you also drink enough milk and do not consume more than 4 cups coffee daily and/or more than 8 cups of tea or 8 caffeinated soft drinks daily. Menopause before age 45 - naturally or surgically (ovaries removed). Women can lose up to 20% of their bone mass in the 5-7 years after menopause. Women who have early menopause may start to lose bone early. These risks can usually be helped with hormone treatment; often hormone treatment can help some women regain bone or slow or prevent bone loss. (as stated above, they often have menstrual irregularities). Low calcium life long especially in the adolescent years- builds less peak bone mass so when estrogen declines bones are not as dense as they should be. Low calcium intake before age 30-35 can make bones not as dense; low calcium intake after age 35 may lead to faster bone loss. People who are lactose intolerant often avoid milk products and do not consume enough calcium Smoking is very harmful to your bones. Research shows women who smoke are much more likely to experience osteoporotic fractures than women who do not smoke. Smoking, excessive use of alcohol, increases your risk for an osteoporotic fracture. Vision: More apt to fall with poor vision � eye exams important! Falling more frequently as we age increases the chances of fractures.Regular weight-bearing exercise/activity stimulates bones. You are at a greater risk for osteoporosis if you are not active or if you have ever had an extended period of bed rest. Question may come up about caffeine: Consuming large amounts of caffeine - equal to the amount in more than 4 cups of coffee - can cause you to lose calcium in the urine. If you drink coffee, be sure you also drink enough milk and do not consume more than 4 cups coffee daily and/or more than 8 cups of tea or 8 caffeinated soft drinks daily.

Slide 16:I have one of these medical conditions: Hyperthyroidism Hyperparathyroidism Rheumatoid arthritis Chronic lung disease Cancer Inflammatory bowel disease or digestion problems Chronic liver or kidney disease Vitamin D deficiency Cushing's disease Multiple sclerosis Low testosterone (Men)

3 Some medical conditions can harm your bones. These include: Thyroid disorders, parathyroid disorders and rheumatoid arthritis can cause bone loss Chronic lung disease and cancers: Body is in a debilitated state, can affect the absorption of calcium and also decrease bone formation or an increase in bone breaking down. Inflammatory bowel disease or digestion problems, like colitis, Crohn�s disease or Celiac sprue may not absorb calcium very well. Chronic Liver or kidney disease Low Vitamin D is needed for our body to absorb calcium- as we age we need more Cushing�s M S Men who have low testosterone levels (called hypogonadism) are at greater risk for osteoporosis. In fact, it is the cause for about 1/3 to � of the osteoporosis diagnoses in men. If you have any of these disorders you should talk to your doctor or health care provider about your bone health. Some medical conditions can harm your bones. These include: Thyroid disorders, parathyroid disorders and rheumatoid arthritis can cause bone loss Chronic lung disease and cancers: Body is in a debilitated state, can affect the absorption of calcium and also decrease bone formation or an increase in bone breaking down. Inflammatory bowel disease or digestion problems, like colitis, Crohn�s disease or Celiac sprue may not absorb calcium very well. Chronic Liver or kidney disease Low Vitamin D is needed for our body to absorb calcium- as we age we need more Cushing�s M S Men who have low testosterone levels (called hypogonadism) are at greater risk for osteoporosis. In fact, it is the cause for about 1/3 to � of the osteoporosis diagnoses in men. If you have any of these disorders you should talk to your doctor or health care provider about your bone health.

Slide 17:I take one of these medicines: Oral glucocorticoids (steroids) Cancer treatments (radiation, chemotherapy) Thyroid medicine Antiepileptic medications Gonadal hormone suppression Immunosuppressive agents

4 Some medications can harm your bones. Some cause your bones to break down faster than they build up. Others cause you to not absorb calcium or use calcium very well. Oral or inhaled corticosteroids, like prednisone, cortisone, dexamethasone or triamcinolone, are often used to treat asthma, rheumatoid arthritis, lupus, colitis and other inflammatory conditions. Regular, long-term use of these can lead to bone loss. Radiation/Chemotherapy have an effect on negative effect on bone health - High doses of thyroid hormone used to treat thyroid disorders can cause bone loss. Properly adjusted doses are not a problem. - Anti-seizure or epilepsy medications (like Dilantin/phenytoin or phenobarbitol) can interfere with calcium absorption. - Gonadotrophin (go-nad-oh-tro-fin)-releasing hormone agonist is used to treat prostate cancer in men and fibroid tumors and endometriosis in women. It can cause bone loss because it interferes with estrogen/testosterone. If you are taking any of the medications, it is very important that you do NOT stop taking them. You do not want to make your condition worse. Talk to your doctor about how to protect your bones while on this medicine or if there is a safer medicine available. You have to work harder to build/keep strong bones. *You may get questions related to diuretics or antacids/- Diuretics other than thiazide (thi-uh-zide) diuretics cause you to lose calcium in your urine. Thiazide diuretics spare calcium. - The aluminum in some antacids interferes with calcium absorption when used in excessive amounts (take all the time for heartburn, etc.). Some medications can harm your bones. Some cause your bones to break down faster than they build up. Others cause you to not absorb calcium or use calcium very well. Oral or inhaled corticosteroids, like prednisone, cortisone, dexamethasone or triamcinolone, are often used to treat asthma, rheumatoid arthritis, lupus, colitis and other inflammatory conditions. Regular, long-term use of these can lead to bone loss. Radiation/Chemotherapy have an effect on negative effect on bone health - High doses of thyroid hormone used to treat thyroid disorders can cause bone loss. Properly adjusted doses are not a problem. - Anti-seizure or epilepsy medications (like Dilantin/phenytoin or phenobarbitol) can interfere with calcium absorption. - Gonadotrophin (go-nad-oh-tro-fin)-releasing hormone agonist is used to treat prostate cancer in men and fibroid tumors and endometriosis in women. It can cause bone loss because it interferes with estrogen/testosterone. If you are taking any of the medications, it is very important that you do NOT stop taking them. You do not want to make your condition worse. Talk to your doctor about how to protect your bones while on this medicine or if there is a safer medicine available. You have to work harder to build/keep strong bones. *You may get questions related to diuretics or antacids/- Diuretics other than thiazide (thi-uh-zide) diuretics cause you to lose calcium in your urine. Thiazide diuretics spare calcium. - The aluminum in some antacids interferes with calcium absorption when used in excessive amounts (take all the time for heartburn, etc.).

Slide 18:The good news: Osteoporosis is preventable for most people!

Start building healthy bones while young. Healthy diet and lifestyle are important for BOTH men and women.

Slide 19:Simple Prevention Steps

Slide 20:Step 1

Get your daily recommended amounts of calcium and vitamin D.  Use MyPyramid.gov to help plan an overall healthy diet Calcium is critically important to bone health. Role of calcium in our bodies: Needed to control bleeding (Blood clotting); Helps to regulate our heart beat; Needed for all our muscles to function and work properly; Needed for our nerves to transmit messages to other parts of our bodies (including our brain) and Bone formation. Vitamin D helps your body absorb calciumCalcium is critically important to bone health. Role of calcium in our bodies: Needed to control bleeding (Blood clotting); Helps to regulate our heart beat; Needed for all our muscles to function and work properly; Needed for our nerves to transmit messages to other parts of our bodies (including our brain) and Bone formation. Vitamin D helps your body absorb calcium

Slide 21:Points to remember about Calcium and vitamin D: Vitamin D is like a key that unlocks the door that lets calcium into the body. Some age groups need MORE or LESS than 100% DV for calcium and vitamin D. 100% DV for calcium and Vitamin D are based on 1,000 mg calcium and 400 IU vitamin D. Calcium requirements vary by age: More is needed as we grow older Need is highest during rapid growth of adolescence. Vitamin D requirements increase as we age. Points to remember about Calcium and vitamin D: Vitamin D is like a key that unlocks the door that lets calcium into the body. Some age groups need MORE or LESS than 100% DV for calcium and vitamin D. 100% DV for calcium and Vitamin D are based on 1,000 mg calcium and 400 IU vitamin D. Calcium requirements vary by age: More is needed as we grow older Need is highest during rapid growth of adolescence. Vitamin D requirements increase as we age.

Slide 22:Calcium requirements vary by age

Source: The 2004 Surgeon General�s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth Growthspurt This slide shows the increased need for calcium as we age. Our youth and adolescent years are critical to building a better bone mass so an increase in calcium is needed. Building a better bone mass affects our bones for the rest of our lives so we need to concentrate on letting teens know the importance of the bone building years. Prevention is better than treatments and pain in later years! Low calcium intake before age 30-35 can make bones not as dense as they should be; low calcium intake after age 35 may lead to faster bone loss. This slide shows the increased need for calcium as we age. Our youth and adolescent years are critical to building a better bone mass so an increase in calcium is needed. Building a better bone mass affects our bones for the rest of our lives so we need to concentrate on letting teens know the importance of the bone building years. Prevention is better than treatments and pain in later years! Low calcium intake before age 30-35 can make bones not as dense as they should be; low calcium intake after age 35 may lead to faster bone loss.

Slide 23: Calcium An easy way to meet calcium needs is consuming 3 cups (8 oz.) each day of fat-free or low-fat* milk or equivalent milk products in combination with a healthy diet. Children ages 2�8 years need 2 cups.

MyPyramid equivalents: 8 oz. milk 1 cup yogurt 1-1/2 oz. natural ..or 2 oz. processed ..cheese * Fat-free and low-fat are for health but not for calcium differences

Slide 24:Yogurt1 cup (8 oz.) = 30% DV Milk1 cup = 30% DV Cheese1 � oz. natural/2 oz. processed = 30% DV Milk pudding1/2 cup = 15% DV Frozen yogurt, vanilla, soft serve� cup = 10% DV Ice cream, vanilla� cup = 8% DV Soy or rice milk, calcium-fortified1 cup = varies�check label

Choose fat-free or low fat most often Food Sources of Calcium

Slide 25:Vitamin D from sunlight exposure

Vitamin D is manufactured in your skin following direct exposure to sun. Amount varies with time of day, season, latitude and skin pigmentation.  10�15 minutes exposure of hands, arms and face 2�3 times/week may be sufficient (depending on skin sensitivity). Clothing, sunscreen, window glass and pollution reduce amount produced. Source: National Osteoporosis Foundation Web site; retrieved July 2005 at http://www.nof.org Sun exposure is a significant source of vitamin D for young people; it causes your skin to make its own vitamin D. As we age our ability to manufacture vit D decreases. Without adequate amounts of Vit D, if we do get our calcium- it will not be used in our bones unless vit D is in adequate amounts too. We must have both! Sun exposure is a significant source of vitamin D for young people; it causes your skin to make its own vitamin D. As we age our ability to manufacture vit D decreases. Without adequate amounts of Vit D, if we do get our calcium- it will not be used in our bones unless vit D is in adequate amounts too. We must have both!

Slide 26:You need more vitamin D as you age

Age Daily vitamin D needs in International Units (IU) Between 51 and 70 � need 400 International Units (IU) of vitamin D Over 70 � need 600 IU of Vitamin D. Some experts recommend 800 IU > 70 yr.Between 51 and 70 � need 400 International Units (IU) of vitamin D Over 70 � need 600 IU of Vitamin D. Some experts recommend 800 IU > 70 yr.

Slide 27:Sources of 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 Calcium supplements: Calcium supplements: Carbonate VS. Citrate- Calcium carbonate: Needs acid to dissolve and for absorption; less stomach acid as we age; Often taken at meals when more stomach acid. Calcium citrate: Doesn�t require stomach acid for absorption; May be taken anytime�check with your healthcare provider; May cost more. Choose a supplement with vitamin D unless obtaining vitamin D from other sources. It�s not necessary to consume calcium and vitamin D at the same time to get the benefit of enhanced calcium absorption. The body does not use more than 500 mg. If you are taking supplements and they are 1000 mg tablets-your body will only utilize about 500mg, the rest is excreted in the urine. Divide the dosage and take part in the morning and at night. Follow age group recommendation. Avoid going over a daily combined total of 2,000 IU or 50 mcg from food and supplements. Calcium supplements: Calcium supplements: Carbonate VS. Citrate- Calcium carbonate: Needs acid to dissolve and for absorption; less stomach acid as we age; Often taken at meals when more stomach acid. Calcium citrate: Doesn�t require stomach acid for absorption; May be taken anytime�check with your healthcare provider; May cost more. Choose a supplement with vitamin D unless obtaining vitamin D from other sources. It�s not necessary to consume calcium and vitamin D at the same time to get the benefit of enhanced calcium absorption. The body does not use more than 500 mg. If you are taking supplements and they are 1000 mg tablets-your body will only utilize about 500mg, the rest is excreted in the urine. Divide the dosage and take part in the morning and at night. Follow age group recommendation. Avoid going over a daily combined total of 2,000 IU or 50 mcg from food and supplements.

Slide 28: What if? I can�t drink milk or  I don�t like milk?

Some people lack the enzyme lactase needed to digest lactose (milk sugar). Suggestions: Don�t like milk? Suggestions: Lactose Intolerant: 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. Don�t like milk? Make oatmeal and cream-type soups with milk instead of water. Add powdered milk to food. (1 tablespoon = 50 mg calcium); Add milk to coffee; Serve milk-based desserts (puddings, tapioca, frozen yogurt, custard, ice cream). Limit fat and sugar. Try chocolate milk- 8-oz. has only 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. Use flavored yogurt as a fruit salad dressing; experiment with substituting plain yogurt for some or all of the sour cream in vegetable salad dressings. Lactose Intolerant: 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. Don�t like milk? Make oatmeal and cream-type soups with milk instead of water. Add powdered milk to food. (1 tablespoon = 50 mg calcium); Add milk to coffee; Serve milk-based desserts (puddings, tapioca, frozen yogurt, custard, ice cream). Limit fat and sugar. Try chocolate milk- 8-oz. has only 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. Use flavored yogurt as a fruit salad dressing; experiment with substituting plain yogurt for some or all of the sour cream in vegetable salad dressings.

Slide 29:Step 2

Engage in regular weight-bearing exercise. Even simple activities such as walking, stair climbing and dancing can strengthen bones. Benefits of exercise only last as long as the exercise is part of a regular routine. Physical activity: prevents bone loss; strengthens the bones; improves muscle tone and strength; improves cardiovascular health 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 Physical activity strengthens your muscles and improves balance leading to reducing falls. Strength training, including light weights, 2 � 3 times per week Benefits of exercise only last as long as the exercise is part of a regular routine. Physical activity: prevents bone loss; strengthens the bones; improves muscle tone and strength; improves cardiovascular health 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 Physical activity strengthens your muscles and improves balance leading to reducing falls. Strength training, including light weights, 2 � 3 times per week

Slide 30:Physical Activity

Adults: At least 30 minutes of physical activity per day for adults. Start slowly if you have not been physically active and consult your physician before making any major changes. (Depends on the age of audience) Be physically active every day Include activities to improve strength and balance Weight bearing exercise like walking, running, and biking. Exercise is of primary importance in maintaining healthy bones. Adults: At least 30 minutes of physical activity per day for adults. Start slowly if you have not been physically active and consult your physician before making any major changes. (Depends on the age of audience) Be physically active every day Include activities to improve strength and balance Weight bearing exercise like walking, running, and biking. Exercise is of primary importance in maintaining healthy bones.

Slide 31: Step 3

Avoid smoking and excessive alcohol. MyPyramid.gov recommends no more than 1 drink per day for women and 2 for men. Smoking: 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.Smoking: 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.

Slide 32:Step 4

Talk to your doctor about bone health. Be sure to discuss Your risk factors Your medication Calcium & vitamin D intake Do you need a bone density scan? Recent falls or broken bones Be sure to discuss Your risk factors Your medication Calcium & vitamin D intake Do you need a bone density scan? Recent falls or broken bones

Slide 33:Step 5

Have a bone density test and take medication when appropriate. Source of photo: USDA ARS Photo Unit Photo by Peggy Greb Testing is a simple, painless procedure. The diagnosis of osteoporosis is made with a bone scan and an evaluation by a health care provider. You need to see a health care provider where your history and physical exam along with necessary tests can be conducted. Not everyone needs a DEXA scan and it is not recommended to scan everyone. DXA is the goal standard for diagnosis of this disease. Heel, finger and wrist scans which are done at your health fairs are a screening tool that is portable and used at health fairs etc. These screening tests are like the screening tests for diabetes. One fingerstick glucose that is elevated at a health fair does mean you have diabetes. But any abnormal screening test would need to be evaluated by your physician. Discuss screening verses diagnostic tests etc, if necessary.The diagnosis of osteoporosis is made with a bone scan and an evaluation by a health care provider. You need to see a health care provider where your history and physical exam along with necessary tests can be conducted. Not everyone needs a DEXA scan and it is not recommended to scan everyone. DXA is the goal standard for diagnosis of this disease. Heel, finger and wrist scans which are done at your health fairs are a screening tool that is portable and used at health fairs etc. These screening tests are like the screening tests for diabetes. One fingerstick glucose that is elevated at a health fair does mean you have diabetes. But any abnormal screening test would need to be evaluated by your physician. Discuss screening verses diagnostic tests etc, if necessary.

Slide 34:Good News!

Osteoporosis can be prevented! Osteoporosis can be detected. Osteoporosis can be treated. Medications for postmenopausal women are available for prevention and treatment of osteoporosis. FDA has approved several medications for men. Consult with your health care provider.

Slide 35:Prevention and TreatmentYou are never too old or too young to improve your bone health

Adults At least 30 minutes of moderate physical activity a day Strength and balance training Protect from falls* Eye exam to check for visual impairments Bone density test with a fracture after age 50, and for everyone with risk factors Bone density test for all women over age 65 Extra calcium and vitamin D over age 50 Medication, if indicated, to prevent bone lossor build new bone. Physical activity strengthens your muscles and improves balance leading to reducing falls. * Prevent Falls Have handrails and plenty of light in all stairways. Wear shoes that give good support and have non-slip soles. Don�t use stepstools. Keep items you need within easy reach. Maintain a clear path to the bathroom. Remove all small rugs. They can make you trip. Make sure your walkways are wide enough. Remove things that you may trip over from stairs and places where you walk. Move phone and electrical cords away from walkways and open areas. Make sure that all areas are well lit. Use bright light bulbs. Be aware that some medications, including over-the-counter medicines, can make you dizzy or sleepy. Get your vision checked. Remove small rugs. Have grab bars put next to toilet, in bathtub or shower. Use non-slip mats in the bathrub and shower. Use brighter lights Wear shoes and slippers that give good support and have non-slip soles Physical activity strengthens your muscles and improves balance leading to reducing falls. * Prevent Falls Have handrails and plenty of light in all stairways. Wear shoes that give good support and have non-slip soles. Don�t use stepstools. Keep items you need within easy reach. Maintain a clear path to the bathroom. Remove all small rugs. They can make you trip. Make sure your walkways are wide enough. Remove things that you may trip over from stairs and places where you walk. Move phone and electrical cords away from walkways and open areas. Make sure that all areas are well lit. Use bright light bulbs. Be aware that some medications, including over-the-counter medicines, can make you dizzy or sleepy. Get your vision checked. Remove small rugs. Have grab bars put next to toilet, in bathtub or shower. Use non-slip mats in the bathrub and shower. Use brighter lights Wear shoes and slippers that give good support and have non-slip soles

Slide 36:Prevention and TreatmentYou are never too old or too young to improve your bone health

Babies Bone health begins before birth Children & Teens Teens are at greater risk for poor bone health because of rapidly growing bones and poor diet At least one hour of physical activity a day Increase calcium during teens

Slide 38:Sources of Information

The 2004 Surgeon General�s Report on Bone Health and Osteoporosis: What It Means to Youhttp://www.surgeongeneral.gov/library/bonehealth National Osteoporosis Foundation http://www.nof.org Thanks to University of Nebraska�Lincoln Extension educational programs

Slide 39:Additional Websites

http://chfs.ky.gov/dph/ach/osteo http://www.osteofound.org/ http://www.arthritis.org/ http://www.niams.nih.gov/bone/ http://www.strongwomen.com/