2. Prevent Osteoporosis… GET HEALTHY KENTUCKY

3. SPONSORED BY: Kentucky Department for Public Health Osteoporosis Prevention and Education Program

4. PRESENTED BY:

6. 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?

7. WHAT IS OSTEOPOROSIS ? Osteo = bone Porosis = full of holes Osteoporosis = means bones that are full of holes

8. Normal Bone

9. Osteoporosis

10. NORMAL HEALTHY BONE OSTEOBLASTS OSTEOCLASTS

11. OSTEOPOROTIC BONE The loss of living bone tissue makes bones fragile and more likely to fracture.

13. 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

14. WHAT HAPPENS WHEN BONES BREAK

15. Osteoporosis When 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

16. Osteoporotic Spine Fracture Normal Compressed bone Fractured

18. Osteoporosis When 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

19. 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

20. 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.

21. 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.

22. HOW COMMON IS OSTEOPOROSIS?

25. 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

26. RISK FACTORS

27. 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

28. 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: Hyperthyroidism Chronic lung disease Cancer Inflammatory bowel disease Chronic hepatic or renal disease Vitamin D deficiency Cushing’s disease Multiple sclerosis Rheumatoid arthritis Activity – Risk Factor Worksheet

29. 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

30. Osteoporosis & Persons with Disabilities Low intake of dietary calcium Medications Weak or unused muscles Lack of accessibility to exercise facilities

31. Osteoporosis Affects Women & Men of All Ethnicities

32. RISK FACTOR REVIEW Discuss significant risks with a health care professional –Gender –Nutrition/Calcium Intake –Age –Medications –Family history –Recent falls or broken bones

33. STEPS TO PREVENTION

34. Live 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

35. STEPS TO PREVENTION Don’t smoke Limit alcohol intake Limit caffeine

36. A cup = 8 ounces.

37. Activity – Calcium Card (Optional)

38. 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

39. 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

40. 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

41. 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

43. 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

44. Activity – Exercise Guide (optional)

46. BONE DENSITY TESTING

47. 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

48. Dual-Energy X-Ray Absorptiometry “Gold Standard” test to determine a diagnosis Measures hip & spine Painless, safe and requires no injections Takes 5-10 minutes Determines risk for fracture

49. UNDERSTANDING YOUR T-SCORE

50. Medicare Criteria for Bone Mineral Density Testing Women who are estrogen deficient Individuals with vertebral abnormalities Individuals with hyperparathyroidism Individuals receiving steroid therapy Monitoring drug therapy

51. TREATMENT OPTIONS

52. 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

53. BISPHOSPHONATES Alendronate-Brand Name-Fosamax® Risedronate-Brand Name-Actonel® Slows or Stops Bone Loss Increases Bone Density Reduces Risk for Fracture

54. Ibandronte Sodium-Brand Name-Boniva® Slows Bone Loss Increases Bone Density Reduces Risk for Fracture Once a month treatment

55. BRAND NAME: MIACALCIN® Naturally occurring hormone involved in calcium regulation Reduces bone loss, especially in the spine Available as an injection or nasal spray CALCITONIN

56. ESTROGEN THERAPY (ET) Approved for the prevention of osteoporosis in postmenopausal women Increases bone density and reduces the risk of fracture

57. 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.

58. 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.

59. 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

60. 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

61. 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

62. 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

63. FALL PREVENTION

64. Osteoporosis Falls 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

65. Protect Your Bones Ways to Make Your Home Safer 1 2 3 4 5 6 7 8 9 10 11 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.

66. 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.

67. 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.

68. 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

69. 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 Summary You are never too old or too young to improve your bone health

71. Everyone has a Role to Play in Improving Bone Health This report is a starting point for national action

72. 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.

73. How Can You Help? Educate Others

74. Let’s Work Together to Get Kentucky Bone Healthy!

75. Acknowledgements Thanks to: Florida Department of Health Osteoporosis Prevention & Education Program (Slides adapted from Florida Department of Health’s Osteoporosis Prevention Curriculum for Adults)

76. Resources The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You http://www.surgeongeneral.gov/library/bonehealth http://www.surgeongeneral.gov/library/bonehealth National Osteoporosis Foundation http://www.nof.orghttp://www.nof.org American Dental Association http://www.ada.org/public/media/releases/0210_release08.asp 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 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 http://www.cdc.gov/brfsshttp://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 http://www.niams.nih.gov/bone/hi/oralhealth_bone.htm

78. Kentucky Department for Public Health Osteoporosis Prevention and Education Program 502-564-7996 ext. 3777