1. Calcium, Bone Health & Osteoporosis - Introduction University of Georgia Cooperative Extension Service

2. What Is Osteoporosis? Porous bones Bones have lost calcium & other minerals Bones are fragile Spine, hip and wrist fractures are common

3. Life of Bones Functions Gives structure to body Protects internal organs Stores essential minerals Types Cortical bone Outer layer Trabecular bone Spongy inner layer

4. Life of Bones Living, active tissue Bone remodeling Osteoclasts Dissolve or break down bone tissue Stimulated by low calcium intake Osteoblasts Rebuild bone tissue Stimulated by exercise

5. Bone Architecture Normal Bone Osteoporotic bone National Osteoporosis Foundation, http://www.nof.org/osteoporosis/bonehealth.htm

6. Prevalence & Cost of Osteoporosis More than 44 million Americans affected 10 million have osteoporosis 34 million have low bone mass Called osteopenia More than 1.5 million fractures each year $17 billion in health costs in 2001

7. Osteoporosis in Georgia 1/3 people > age 50 affected by osteoporosis 75 fractures occur daily $323 million in health costs in 2000 $570 million in estimated health costs by 2025

8. Glimpse of Osteoporosis Fractures One out of two women > age 50 One out of eight men > age 50 Nearly 1/2 million hospitalized with fractures each year One out of five dies within 1 year Half never live independently again

9. Glimpse of Osteoporosis Men 80,000 hip fractures/ year Women of all ethnic backgrounds One in twenty African-American women One in ten Mexican-American women People of all ages Increasing number of women in 20s-30s

10. Risk Factors Female gender Increasing age Thin, small-boned - BMI < 19 Caucasian or Asian ethnicity Family history of fractures or osteoporosis

11. Risk Factors Abnormal menstrual history Late menarche Menstrual interruptions/irregularities Early menopause (< age 45) Past menopause Low testosterone levels (men) History of eating disorder/strict dieting

12. Risk Factors Medical conditions Bone fracture(s) after age 40 Rheumatoid arthritis Thyroid disorder Parathyroid disorder Poorly controlled Type 1 diabetes Lactose intolerance Digestion disorders

13. Risk Factors Medication use Long-term corticosteroid use High doses thyroid hormone Anti-seizure or epilepsy medications Certain diuretics Excessive aluminum-containing antacids Gonadotrophin-releasing hormone agonist

14. Lifestyle Risk Factors Inactive lifestyle Diet low in calcium Little sun exposure and diet low in vitamin D Consume few fruits and vegetables Drink excess alcohol (> 7 drinks/week) Current or former smoker Consume large amounts of caffeine

15. 5 Steps to Strong Bones Avoid harmful habits BMD testing & medications Active lifestyle Regular sunshine Healthy diet

16. Step 1: Eat a Healthy Diet for Bones Diet rich in calcium & vitamin D 2 – 4 servings milk/dairy foods Calcium-fortified foods Calcium/vitamin D supplements Foods rich in other bone healthy nutrients 5 or more servings vegetables & fruits Potassium, magnesium, zinc, copper Vitamin K & vitamin C

17. Building Bones Building bones = building a bank account Calcium is “deposited” During childhood, teen & young adult years When consume enough calcium & vitamin D Calcium is “withdrawn” During older adult years When do not consume enough calcium & vitamin D

18. Calcium & Vitamin D Matter at Any Age Children For bone growth Teens and young adults For bone growth Maximizing bone mass Adults Maximizing bone mass Minimizing bone loss

19. Calcium Recommendations 1997 National Academy of Sciences

20. Choose Calcium-rich Foods Milk, yogurt, buttermilk, ricotta cheese, hard cheeses Calcium-fortified foods Orange juice, soy drinks Breakfast cereals, cereal bars Tofu made w/ calcium sulfate Canned salmon w/bones

21. Include Foods = 1/2 Calcium- rich Source 2 servings = 1 calcium-rich food 1/2 cup pudding 1/2 cup frozen yogurt or ice cream 1/2 cup mustard or turnip greens 1/2 cup cooked rhubarb 1/3 cup almonds 1 piece cornbread

22. Include Foods = 1/4 Calcium- rich Source 4 servings = 1 calcium-rich food 1/2 cup cottage cheese 1/2 cup broccoli, kale, or okra 1 cup romaine lettuce 1/2 cup cooked beans 1 medium orange 2 dried figs 3 oz fresh fish or seafood 1/2 English muffin

23. Show Me the Calcium

25. Calcium Check Up How many servings do you eat? Calcium-rich foods Servings x 1 = 1/2 calcium-rich foods Servings ÷ 2 = 1/4 calcium-rich foods Servings ÷ 4 = Are you getting enough calcium? Is your total = 3 or 4?

26. Do You Need Calcium/vitamin D Supplements? Lactose intolerant or allergic to milk? Avoid milk/dairy foods? On a strict weight-loss diet? Over age 50, consume little milk and/or do not get sun exposure? On long-term steroid therapy?

27. Upper Limits Calcium: 2500 mg/day Vitamin D: 2000 IU/day 1997 National Academy of Sciences

28. Vitamin D Two sources Diet Fluid milk (100 IU/8 ounces) Fatty seafood, fish oils, eggs Other fortified foods, supplements Regular sunlight exposure Skin produces own vitamin D

29. Step 2: Get Regular Sun Exposure Helps you meet vitamin D needs Expose arms and/or legs for 10 - 15 minutes daily, without sunscreen Apply sunscreen after this time

30. Vitamin D Recommendations 1997 National Academy of Sciences

31. Step 3: Maintain an Active Lifestyle Regular weight-bearing exercises Strength-training exercises Balance & stretching exercises

32. Weight-bearing Exercises 30 minutes daily, > 3 times weekly Walking, running or jogging Stair climbing, jumping rope, skating Aerobics, tennis Basketball, soccer, volleyball

33. Strength Training Exercises 2 times weekly Lifting weights Dumbbells (free weights), weight machines Resistance exercises Push ups, leg lifts Stomach curls/crunches Standing calf & toe raises Squats, lunges

34. Balance & Stretching Exercises 3 times weekly (or every day) Improve balance & flexibility Help reduce risk of falling Do stretches after other exercises

35. Step 4: Get a Bone Mineral Density (BMD) Test... All women age 65 and older All postmenopausal women < age 65 with risk factors or current fracture(s) Men/women with history of fracture(s), loss of height, and/or chronic back pain Men/women with significant risk factors

36. BMD Testing Women considering medication therapy for BMD Women with long-term use of HRT/ERT Men/women being treated for osteoporosis

37. ... & Talk to Doctor Your About Medications Calcium/vitamin D supplements Hormone replacement therapy Estrogen only (ERT) Estrogen + progesterone (HRT) Birth control pills Selective estrogen receptor modulators (SERMs) Raloxifene (Evista ® )

38. Medications Bisphosphonates Alendronate (Fosamax ® ) Risedronate (Actonel ® ) Calcitonin (Miacalcin ® ) Parathyroid hormone (PTH) Testosterone

39. Step 5: Avoid Harmful Habits Smoking Strict dieting Heavy drinking (alcohol) High caffeine consumption Diet low in calcium and vitamin D Inactive lifestyle

40. Extra Advice for Older Adults Fall prevention Reduce household hazards Keep floors safe Improve lighting Install handrails Reorganize furniture Remove clutter Improve balance & strength Exercises Review medicines

41. It’s Up To You Now! What are you going to do to have strong bones that last a lifetime?

42. Thank You. Prepared by Marilyn O. Wright, MS, RD, LD Family Nutrition Program Specialist University of Georgia College of Family & Consumer Sciences Cooperative Extension Service

43. References Nelson, M.E. (2000) Strong Women, Strong Bones. Berkley Publishing Group (Perigee), New York. http://www.strongwomen.comhttp://www.strongwomen.com Nelson, M.E. (1997) Strong Women Stay Young. Bantam, New York. National Academy of Science Institute of Medicine (1999) Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D & Fluoride. National Academy Press, Washington, D.C. http://www.nap.edu/catalog/5776.htmlhttp://www.nap.edu/catalog/5776.html National Osteoporosis Foundation, http://www.nof.org/http://www.nof.org/ NIH Osteoporosis & Related Bone Disease National Resource Center, http://www.osteo.org/ http://www.osteo.org/ Duyff, R.L. (1996) The American Dietetic Association’s Complete Food & Nutrition Guide. Chronimed, Minneapolis. USDA Nutrient Data Laboratory, http://www.nal.usda.gov/fnic/foodcomp/http://www.nal.usda.gov/fnic/foodcomp/ Picado, C. & Luengo, M. (1996) Corticosteroid-induced bone loss. Prevention & management. Drug Saf, 15(5): 347-59.

44. Resources National Osteoporosis Foundation www.nof.org Bonebuilders (Arizona) http://www.bonebuilders.org/ National Institutes of Health http://www.osteo.org/ American Society for Bone Mineral Research http://www.asbmr.org/

45. Resources Strong Women Stay Young http://www.strongwomen.com/ Powerful Bones http://www.cdc.gov/powerfulbones/ NOAHNet http://www.arches.uga.edu/~noahnet/ NICHD (NIH) – Milk Matters http://www.nichd.nih.gov/milk/milk.cfm Georgia Osteoporosis Initiative http://www.gabones.net/

46. Resources Pharmaceutical http://www.merck.com/ http://www.oscal.com/ http://www.tums.com/ http://www.citracal.com/ http://www.caltrate.com/ http://www.calciuminfo.com/index.htm

47. Resources National Dairy Council (800) 426-8271 http://www.nationaldairycouncil.org/ Other dairy councils/industry http://www.dcwnet.org/index_flash.html http://www.southeastdairy.org/ http://www.oregondairycouncil.org/ http://www.dairycouncilofca.org/ http://www.whymilk.com/ http://www.eatsmart.org/

48. Resources Yogurt http://www.stonyfield.com/ http://www.dannon.com/ Cheese http://www.ilovecheese.com/ Soy http://www.whitewave.com/ http://www.soyfoods.com/ http://www.genisoy.com/ Milk-replacement beverages http://www.Vitamite100.com/