Prevent Osteoporosis…

GET HEALTHY KENTUCKY

SPONSORED BY:Kentucky Department for Public Health

Osteoporosis Prevention and Education Program

PRESENTED BY:

WHAT ARE WE GOING TO LEARN TODAY ???

• What Is Osteoporosis ?• What Happens When Bones

Break ?• How Common Is It ?• What Are The Risk Factors ?• Steps To Prevention• Bone Density Testing• Treatment Options• Fall Prevention• How You Can Help?

WHAT IS OSTEOPOROSIS ?

• Osteo = bone

• Porosis = full of holes

• Osteoporosis = means bones that are full of holes

Normal Bone

Osteoporosis

NORMAL HEALTHY BONE

OSTEOBLASTS

OSTEOCLASTS

OSTEOPOROTIC BONE

The loss of living bone tissue makesbones fragile and more likely to fracture.

Role of Estrogen

• 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 in first 3 to 6 years

WHAT HAPPENS WHEN BONES

BREAK

OsteoporosisWhen Bones Break

• The most common breaks in weak bones are in the:– Wrist– Spine– Hip

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

Osteoporotic Spine Fracture

Normal

Compressed bone

Fractured

OsteoporosisWhen Bones Break

• Hip fractures are the most devastating– One in five elderly people die within a year of the

fracture– One in five must move to a nursing home within a

year– One in four become disabled – Many become isolated and depressed

TRUE OR FALSE GAME

• Men do not get osteoporosis.• Diet can provide all of the calcium a body needs.• If your grandmother had osteoporosis, you will get it also.• Dairy products are the only source of calcium.• If you have osteoporosis, you can do nothing about it.• Our bones stop growing when we reach full height (about 20).• Susceptibility to fractures can indicate osteoporosis.

Activity – True or False Game

CLARIFICATIONS

• There is no relationship between osteoporosis and arthritis.

• Osteoporosis is a generalized bone disease that causes porous bones.

• Arthritis refers to a group of diseases and conditions that affect the joints and are usually painful.

• Osteoarthritis is a degenerative type of arthritis affecting the hip, knees and tips of the fingers—no relationship to osteoporosis.

CLARIFICATIONS• Steroids are sometimes used to treat arthritis, and using

steroids may put a person at risk for osteoporosis • There is no clear relationship between dental cavities and

osteoporosis• Someone with osteoporosis may have weakened jawbones

and be prone to losing teeth• Report any problems with loose teeth, detached or receding

gums, and loose or ill-fitting dentures to your dentist and doctor.

• Recent studies show women with osteoporosis have been reported to have 3 times more tooth loss than women without the disease.

HOW COMMON IS OSTEOPOROSIS?

KENTUCKY STATISTICS (2002)

Projections for 2010

834,000 Kentuckians age 50 & over will be affected.

National Osteoporosis Foundation

Women

128,000 osteoporosis

342,000 low bone mass

Men

37,300 osteoporosis

223,400 low bone mass

RISK FACTORS

Are You at Risk for Weak Bones?Check Any of These that Apply to You

I’m older than 65 I’ve broken a bone after age 50 My close relative has osteoporosis or has broken a bone My health is “fair” or “poor” I smoke I am underweight for my height 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

Activity – Risk Factor Worksheet

Are You at Risk for Weak Bones?Check Any of These that Apply to You

I sometimes fall I’m not physically active I have one of the these medical conditions:

HyperthyroidismChronic lung diseaseCancerInflammatory bowel diseaseChronic hepatic or renal diseaseVitamin D deficiencyCushing’s diseaseMultiple sclerosisRheumatoid arthritis

Activity – Risk Factor Worksheet

Are You at Risk for Weak Bones?Check Any of These that Apply to You

I take one of these medications:Oral glucocorticoids (steroids)

Cancer treatments (radiation, chemotherapy)

Thyroid medicine

Antiepileptic medications

Gonadal hormone suppression

Immunosuppressive agents

Activity – Risk Factor Worksheet

Osteoporosis & Persons with Disabilities

• Low intake of dietary calcium• Medications• Weak or unused muscles• Lack of accessibility to exercise facilities

Osteoporosis Affects Women & Men of All Ethnicities

RISK FACTOR REVIEW

• Discuss significant risks with a health care professional– Gender – Nutrition/Calcium Intake– Age– Medications– Family history– Recent falls or broken bones

STEPS TO PREVENTION

STEPS TO PREVENTIONLive a Healthy Lifestyle

• Eat foods rich in calcium and vitamin D– Follow recommended daily amounts

• Be physically active every day– Include activities to improve strength and balance

• Maintain a healthy body weight

STEPS TO PREVENTION

• Don’t smoke

• Limit alcohol intake

• Limit caffeine

A cup = 8 ounces.

Activity – Calcium Card (Optional)

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

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

Supplements:Calcium 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

– Brand names-Tums, Maalox, Mylanta, Oscal, Viactiv, Caltrate

• Calcium citrate– Doesn’t require stomach

acid for absorption– May be taken anytime—

check with your healthcare provider

– May cost more– Brand names-Citracal,

store brands of Calcium Citrate

CALCIUM SUPPLEMENT TIPS

• Be knowledgeable about the type of calcium you are taking

• Space out your calcium intake

• Determine the “elemental” calcium in your chosen supplement.

• Remember Vitamin D

CALCIUM

VITAMIN

TEST YOUR CALCIUM SUPPLEMENT

• 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

Activity – Exercise Guide (optional)

BONE DENSITYTESTING

WHO SHOULD GET TESTED

• All women age 65 and older • All postmenopausal women under 65

with 1 or more risk factors• Men aged 70 and older • Postmenopausal women who have had a

fracture• Women considering therapy for osteoporosis

Dual-Energy X-RayAbsorptiometry

• “Gold Standard” test to determine a diagnosis

• Measures hip & spine • Painless, safe and requires no

injections• Takes 5-10 minutes• Determines risk for fracture

UNDERSTANDING YOUR T-SCORE

Medicare Criteria for Bone Medicare Criteria for Bone Mineral Density TestingMineral Density Testing

• Women who are estrogen deficient • Individuals with vertebral abnormalities • Individuals with hyperparathyroidism• Individuals receiving steroid therapy• Monitoring drug therapy

TREATMENT OPTIONS

Medication For Prevention and/or Treatment

In post-menopausal women

1. BISPHOSPHONATES

a. Alendronate, Risedronate & Ibandronate Sodium

2. CALCITONIN

3. ESTROGEN THERAPY/HORMONE THERAPY

4. PARATHYROID HORMONE OR PTH (1-34)

5. SELECTIVE ESTROGEN RECEPTOR MODULATOR (SERM) a. Raloxifene

BISPHOSPHONATESBISPHOSPHONATES

Alendronate-Brand Name-Fosamax®Alendronate-Brand Name-Fosamax®Risedronate-Brand Name-Actonel®Risedronate-Brand Name-Actonel®

•Slows or Stops Bone Loss

•Increases Bone Density

•Reduces Risk for Fracture

Ibandronte Sodium-Brand Name-Boniva®

• Slows Bone Loss• Increases Bone Density• Reduces Risk for Fracture• Once a month treatment

BRAND NAME: MIACALCIN®

• Naturally occurring hormone involvedin calcium regulation

• Reduces bone loss, especially in the spine• Available as an injection or nasal spray

CALCITONIN

ESTROGEN THERAPY (ET)

• Approved for the prevention of osteoporosis in postmenopausal women

• Increases bone density and reduces the risk of fracture

ESTROGEN THERAPY (ET)HORMONE THERAPY (HT)

• Women who still have their uterus can protect the endometrial lining by taking a second hormone, progestin or progesterone in combination with estrogen (HT)

• ET/HT relieves menopausal symptoms and has a beneficial effect on bone health.

• Side effects may include vaginal bleeding, breast tenderness, mood disturbances and gall bladder disease.

WOMEN’S HEALTH INITIATIVE STUDY

• Study confirmed that one type of HT, Prempro®, reduced the risk of hip and other fractures

• Reduced colon cancer, BUT,• Increased a woman’s risk of breast cancer,

heart attacks and venous blood clots.

WOMEN’S HEALTH INITIATIVE STUDY

• Prescribe the lowest possible doses of ET/HT for the shortest period of time to manage symptoms of menopause

• Discuss alternative osteoporosis medications for women at risk for or diagnosed with osteoporosis

• Consult with her healthcare provider about the possible benefits and risks

PARATHYROID HORMONE OR PTH (1-34)

• Approved for the treatment of osteoporosis in postmenopausal women and men at increased risk for fracture

• Builds new bone and,• Significantly reduces the risk of spine and

other fractures• Self-administered as a daily injection

SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMs)

Raloxifene-Brand Name-Evista®• Prevents Bone Loss• Appears to reduce the risk of breast cancer• Possible side effects include hot flashes and

blood clots

MEN

• More than 2 million men have the disease and nearly 12 million more are at risk

• Alendronate and PTH are approved for treatment of osteoporosis in men

FALL PREVENTION

OsteoporosisFalls Break Bones

• You can prevent most falls– 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

Protect Your BonesWays to Make Your Home Safer

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Have handrails and plenty of light in all stairways.

Wear shoes that give good support and have non-slip soles.

Don’t use stepstools. Keep items you need within easy reach.

Maintain a clear path to the bathroom.

Make sure your walkways are wide enough.

Remove all small rugs. They can make you trip.

Move phone and electrical cords away from walkways and open areas.

Make sure that all areas are well lit. Use bright light bulbs.

Be aware that some medications, including over-the-counter medicines, can make you dizzy or sleepy.

Get your vision checked.

Remove things that you may trip over from stairs and places where you walk.

Protect Your Bones Ways to Make Your Home Safer

12

5 Remove all small rugs. They can make you trip.

Use non-slip mats in the bathtub or shower. Have grab bars put in next to your toilet and in the bathtub or shower.

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 disease.

Summary You 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 loss or build new bone

• 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

• Babies– Bone health begins before birth

SummaryYou are never too old or too young

to improve your bone health

Everyone has a Role to Play in Improving Bone Health

This report is a starting point for national action

How Can You Help?Educate Others

• Know your own risks

• Improve your bone health habits and those of your family

• Tell your family and friends about the importance of bone health

• And remember…you are never too young or too hold to improve your bone health.

How Can You Help?Educate Others

Let’s Work Together to Get KentuckyBone Healthy!

Acknowledgements

Thanks to:

Florida Department of Health

Osteoporosis Prevention & Education Program

(Slides adapted from Florida Department of Health’s Osteoporosis Prevention Curriculum for Adults)

Resources• 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 • American Dental Association

http://www.ada.org/public/media/releases/0210_release08.asp• American Dietetic Association:

http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/advocacy_1743_ENU_HTML.htm

• Center for Disease Control and Prevention: http://www.cdc.gov/brfss; http://www.cdc.gov/nhanes

• National Institute of Arthritis and Musculoskeletal and Skin Disease. Health Topics: Oral Health and Bone Disease. http://www.niams.nih.gov/bone/hi/oralhealth_bone.htm

Kentucky Department for Public Health

Osteoporosis Prevention and Education Program

502-564-7996 ext. 3777