1. L. Denise Edmonds, Ph.D. Cigna Onsite Health Coach Osteoporosis & Strength Training

2. Possible risk factors for Osteoporosis Have you had breast cancer? - Estrogen has protective effect on bones Chemotherapy may cause loss of ovarian function and reduce estrogen levels. Chemotherapy may have negative effect on bone Breast CA may stimulate osteoclasts (cells that break down bone)

3. Other risk factors: Ethnicity African American Women Yes your BMD is higher than that of other ethnic counterparts Osteoporosis is undiagnosed and undertreated in women Risk for hip fracture doubles every 7 years More likely to die from hip fracture Many are lactose intolerant and don’t consume proper amounts of milk Hispanic Women 10% women over 50 have osteoporosis & 49% of women have low BMD but not low enough to categorize it as osteoporosis Consume less calcium than needed Disease common to both groups increases risk of osteoporosis

4. Bone loss facts Bone mass decreases by about 0.5% per year or more after the age of 40, regardless of sex or ethnicity Muscle mass can decrease 3-5 % after 30 years old if you are inactive.

5. What is a girl to do? Pharmacological remedy – Rx from PCP Physical Activity Increase bone mass and strength FFM is a strong determinant of bone with aging Reduce risk of falling Balance training

6. Recommendations Exercise Rx Mode Weight bearing activity i.e. tennis, stair climbing, intermittent jogging during walking, volleyball, basketball, weight lifting Intensity Moderate to High Frequency Resistance Training 2-3 X / WK Weight bearing endurance activities Duration 30-60 m/day (difficult to quantify)

7. Thank You !!

8. Amy Fuller RD/LD Dietitian Specialist Lunch, Laugh & Learn February 27, 2014 Osteoporosis & Nutrition

9. Calcium RDA FEMALESMALES 19-301,000 mg/day19-301,000 mg/day 31-501,000 mg/day31-501,000 mg/day 51-701,200 mg/day51-701,200 mg/day >701,200 mg/day>701,200 mg/day

10. Calcium Sources 8 oz Yogurt = 300-450 mg 8 oz Milk = 300 mg 1 oz Cheese = 150-200 mg ½ cup Ice Cream = 100 mg

11. Calcium Sources Vegetables: ½ cup Broccoli = 47 mg ½ cup cooked Leafy Greens = 45-110 mg ½ cup Sweet Potato, baked = 32 mg Legumes: ½ cup Beans, canned = 34-61 mg ½ cup Lentils, boiled = 29 mg ½ cup Hummus = 62 mg Fruits: 1 medium Orange = 52 mg ½ medium fresh Papaya = 36 mg 1 cup fresh Raspberries = 27 mg 1 medium kiwi = 20 mg Nuts/Seeds: 1 Tbsp. Sesame Seeds = 88 mg ½ oz Almonds = 37 mg ½ oz Soybean Nuts = 20 mg

12. What Increases Calcium Absorption Vitamin D RDA Males & Females 19-70 = 600 IU/day Males & Females 71+ = 800 IU/day Dietary Sources: 1 oz Salmon (140 IU), 1 oz Canned Sardines (84 IU), 3 oz Chicken Liver ( 44 IU), 1 Egg Yolk (24 IU) Other Source: SUNLIGHT Acidic Conditions Spacing Calcium Intake

13. What Decreases Calcium Absorption Oxalic Acids (oxalates) Dietary Sources: Spinach, Swiss Chard, Dry Cocoa, Rhubarb, Bran Flakes, Wheat Germ Phytic Acid (phyates) Dietary Sources: Nuts, Seeds, Grains Dietary Fiber >30 g/day High Sodium Diets Tannins

14. Food Labels % Based on 1,000 mg 1 cup = 300 mg Serving Size = 8 ounces % Based on 400 IU 1 cup = 100 IU

15. Questions