1. Healthy Bones for Life™ Welcome and Introductions

2. Community talks Bone health hotline Bone health fairs Bone-safe workshops All About Bones BONESENSE eNewsletter Fracture risk screening awareness outreach and education advocacy www.americanbonehealth.org

3. The terrible statistics Why you should care 1 of every 2 women over age 50 will have a fracture due to osteoporosis 1 of every 4 men over age 50 will have a fracture due to osteoporosis 25% of hip fracture patients die within a year There are 2 million preventable fractures every year Falls are the leading cause of hospitalization for Americans over age 60 Only 35% of Americans meet their daily calcium requirements Osteoporosis costs $20 billion annually

4. So…is osteoporosis a problem? 70% …of people with osteoporosis have never been screened and don’t know they have osteoporosis. Curtis, J. Osteoporosis International 2009

5. Today’s presentation Learn why bone health should matter to you NOW Understand the disease called osteoporosis Learn about Prevention Diagnosis Treatment  Osteoporosis or Fractures

6. Annual incidences National Osteoporosis Foundation, 2005 American Heart Association, 2011 Stroke Center, 2011 American Cancer Society 2011

7. Osteoporosis is disease characterized by loss of bone mass leading to fragile bones that break easily. What is osteoporosis? Images reproduced with permission from The Osteoporosis Book ©Trelle Enterprises

8. Bones remodel every 7-10 years Osteoblasts – Build bone Osteoclasts – Breakdown bone Bone remodeling means you have the opportunity to have new bones every 7-10 years! Images reproduced with permission from The Osteoporosis Book ©Trelle Enterprises

10. Progression of spine fractures Results:  height  breathing  appetite  elimination Images reproduced with permission from The Osteoporosis Book ©Trelle Enterprises

11. Risk factors for osteoporosis Things you can’t change Gender Heredity Age Medical conditions Medications

12. Risk factors for osteoporosis Things you can change Calcium consumption Vitamin D intake Quit smoking Moderate alcohol Physical activity Posture Some medications

13. Secondary osteoporosis Medical Conditions Anorexia Nervosa Alcoholism Cancers Celiac Disease Crohn’s Disease Cushing’s Disease Hypogonadism Hyperthyroidism Liver Disease Malabsorption Rheumatoid Arthritis

14. Secondary osteoporosis Medications Adrenocoricotropic hormone Anticoagulants (Heparin ® ) Anticonvulsants (Dilantin ® ) Chemotherapy drugs Cyclosporine Gonadotropin releasing hormone antagonists or agonists Lithium Methotrexate Steroids Thyroxine - high doses (Synthroid ® )

15. Genetics You wouldn’t expect these women to have bone health issues! Medications Athletic and Performance Energy Deficit

16. Screening Fractures Height loss Wrist and heel screening FORE Fracture Risk Calculator™ (FRC) Diagnostic Bone Mineral Density test (DXA) Women >65 Men >70 Anyone younger with a risk factor Images reproduced with permission from The Osteoporosis Book ©Trelle Enterprises

17. T-scores Osteoporosis Porous bone that can lead to fractures 0 +1-2-3 -2.5 Low Bone Density Normal As compared to an average 30 year old -4 (osteopenia) +2 +3 +4

18. Calcium Vitamin D Weight bearing activity Preventing bone loss

19. The dynamic duo for bone health CalciumVitamin D EVERY DAY! 1000 - 1200 mg* /day (diet + supplements) Body can only absorb 500 mg at a time You can take too much (no more than 1500 /day) EVERY DAY! 800 - 2,000 IU* /day (supplements) Sunshine alone is not a reliable source Research shows vitamin D can reduce falls up to 20% *Amounts (RDAs) change with age!

20. How to get your calcium

21. How much calcium did you get yesterday?

22. Good non-dairy options To get 300 mg of calcium you need: 3.5 oz. tin salmon with bones 2½ cups cooked broccoli 2 cups cooked garbanzo beans 1 cup black beans 5-6 medium oranges 15 medium dried figs 6 tbsp. sesame seed butter 150 almonds ¾ cup of tofu 3 oz. tin of sardines with bones

23. Calcium supplements Calcium citrate – Citracal, etc easier on stomach, can take with or without food Calcium carbonate – Caltrate, Viactiv, Tums, etc. less expensive, take with food The best calcium is the one you will take every day for the rest of your life!

24. How to read a label Simply add a 0 to the calcium percentage to get the exact milligram amount 30% + 0 = 300 mg

25. How to get your vitamin D It’s very hard to get enough vitamin D through diet!

26. Exercise for strong bones* Begin with 30 minutes, 3 times/week Weight bearing helps prevent bone loss Walking Weight lifting Jump rope Dancing Tennis Jogging Pilates (modified) Yoga (modified) *Get a complete medical exam before starting an exercise program.

27. Exercise to prevent falls and fractures Get up from a chair without using arms Modified squats Y-exercise Balance on one leg Do It Right! And Prevent Fractures! Maintain leg strength, balance and posture

28. Good strength and balance can help prevent falls and fractures Stop multi-tasking Remove trip hazards Get your eyes checked Keep a night light on Get your medications checked 2 million people land in the emergency room each year from a fall. 500,000 falls result in hospital stays. Images reproduced with permission from The Osteoporosis Book ©Trelle Enterprises

29. Nobody likes taking drugs, but when thinking about taking a bone drug ask yourself... What is my risk of having a life changing fracture? Treatments for osteoporosis Osteoporosis treatments reduce fracture risk by at least 35%

30. Before starting drug treatment know your fracture risk Fracture risk results consider: Family history Age Gender Personal or family history of fractures Medications / medical conditions T-score

31. Advocate for yourself! 83% of patients will not tell their doctors everything Many doctors forget to ask If doctors don’t ask, the patients won’t tell BONESENSE can help Prepare Ask Make another appointment if needed

32. Important things to remember Bring your previous bone density scan report with you each time you have a bone density scan (DXA) Always ask your doctor for your T-score Always ask your doctor for a copy of your most recent bone density scan report so you can compare it to your last report

33. Assess your bone health Use the FORE Fracture Risk Calculator and take it to your doctor Slow bone loss With calcium, vitamin D and weight-bearing exercise Prevent falls and fractures Use good posture and practice balance exercises Treat your osteoporosis Learn the facts about the medication side effects and rare events What’s next? Understand the consequences of no action Don’t be a victim to osteoporosis. Support your bones!

34. How you can help! DONATE! Become a presenter - Contact Emely at American Bone Health - 888-266-3015 x 11 Follow us on Twitter and Facebook Subscribe to BONESENSE eNewsletter at www.americanbonehealth.org

35. We have covered a lot! If you don’t remember it all: Call our hotline 888-266-3015 Check the website www.americanbonehealth.org Contact me! You can reach me at: Last updated 10/21/12