Mature Adults Osteoporosis Presentation

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Mature Adults Osteoporosis Presentation

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1. Please see note below: Points to be covered in PPT or any educational opportunity with age 60+ audience-If you are addressing various ages please refer to document with Osteoporosis Education Over the Life Span-Key Points on the CD. Mature Adults 60+ Nutrition- Calcium/Vit D Physical Activity- weight bearing/balance training importance Alcohol/Smoking Fall Prevention & Home Safety Oral Health-- Vision exam Risk Factors Women - BMD/DEXA all women > 65 years ? Physician decides! Talk to him/her Men - BMD/DXA ? NOF recommends all men over age 70 years Physician decides! Talk to him/herPlease see note below: Points to be covered in PPT or any educational opportunity with age 60+ audience-If you are addressing various ages please refer to document with Osteoporosis Education Over the Life Span-Key Points on the CD. Mature Adults 60+ Nutrition- Calcium/Vit D Physical Activity- weight bearing/balance training importance Alcohol/Smoking Fall Prevention & Home Safety Oral Health-- Vision exam Risk Factors Women - BMD/DEXA all women > 65 years ? Physician decides! Talk to him/her Men - BMD/DXA ? NOF recommends all men over age 70 years Physician decides! Talk to him/her

2. No Bones About It FYI do not have to announce to group- 1st picture ? 50 year old postmenopausal with hot flashes 2-3 picture postmenopausal- 55+ At greater risk for vertebral fractures than any other type of fracture. Last picture: 75 year old + with kyphosis: at risk for hip and vertebral fractures FYI do not have to announce to group- 1st picture ? 50 year old postmenopausal with hot flashes 2-3 picture postmenopausal- 55+ At greater risk for vertebral fractures than any other type of fracture. Last picture: 75 year old + with kyphosis: at risk for hip and vertebral fractures

3. ?I?ve lost six inches in height and none of my clothes fit me anymore.?

4. Comments

5. ?What will I do if I have to give up driving??

6. ?Medications are expensive. But I can?t afford to let my condition get worse and this medicine will help stop or slow down the bone loss.?

7. ?If somebody had told me sooner what I know now about osteoporosis, none of this might be happening to me!?

8. With Osteoporosis your body?s frame (bones) becomes like the frame of a house damaged by termites Weak bones break easily May never walk again Can even be fatal With Osteoporosis your body?s frame (bones) becomes like the frame of a house damaged by termites Weak bones break easily May never walk again Can even be fatal

9. Osteoporosis The Most Common Bone Disease Characterized by low bone mass and deterioration of bone structure Not a natural part of aging Increased risk for women, post-menopausal, over age 65 All races, sexes, and ages are susceptible Preventable and treatable!

10. The ?silent disease? Often called the ?silent disease? Bone loss occurs without symptoms First sign may be a fracture due to weakened bones A sudden strain or bump can break a bone Fragile bones are not painful at first Fragile bones are not painful at first

11. The problem in America Major health threat for an estimated 44 million (55%) of people 50 years and older 10 million estimated to have osteoporosis 34 million have low bone mass placing them at risk 1 in 2 women and 1 in 4 men over 50 will have an osteoporosis-related fracture Never too old to improve your bone health Important to follow the steps known to strengthen and protect bones weight bearing exercise such as walking or stair climbing ? at least 30 minutes per day Weight lifting diet adequate in calcium and vitamin D Caring for bone fractures from osteoporosis cost American $18 billion each year A stack of dollar bills 1,119 miles high ? farther than the distance from New York to St. Louis The cost of caring for these patients and the work that is lost adds billions more Broken bones in your spine are painful Heal slowly Weak bones in spine Gradually lose height Posture becomes hunched over Difficult to walk or sit up Risk of osteoporosis is greatest for women also high for Whites and Asians than other groups Risk for older men and women of all backgroundsNever too old to improve your bone health Important to follow the steps known to strengthen and protect bones weight bearing exercise such as walking or stair climbing ? at least 30 minutes per day Weight lifting diet adequate in calcium and vitamin D Caring for bone fractures from osteoporosis cost American $18 billion each year A stack of dollar bills 1,119 miles high ? farther than the distance from New York to St. Louis The cost of caring for these patients and the work that is lost adds billions more Broken bones in your spine are painful Heal slowly Weak bones in spine Gradually lose height Posture becomes hunched over Difficult to walk or sit up Risk of osteoporosis is greatest for women also high for Whites and Asians than other groups Risk for older men and women of all backgrounds

12. A woman?s hip fracture risk equals her combined risk of breast, uterine and ovarian cancer.

13. Hip fractures account for 300,000 hospitalizations annually.

14. 1 in 5 people with a hip fracture end up in a nursing home within a year.

15. The most common breaks in weak bones are in the wrist, spine and hip. If you break a bone after the age of 50, talk to your health care professional about measuring your bone density If you break a bone after the age of 50, talk to your health care professional about measuring your bone density

16. Why Are Healthy Bones Important? Strong bones support us and allow us to move Bones are a storehouse for vital minerals Strong bones protect our heart, lungs, brain and other organs

17. After mid-30?s, you begin to slowly lose bone mass. Women lose bone mass faster after menopause. Men lose bone mass too.

19. Risk factors If you have any of these ?red flags,? you could be at high risk for weak bones. Talk to your health care professional.

20. 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

21. 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 I sometimes fall I'm not active

22. I have one of these medical conditions: Hyperthyroidism Chronic lung disease Cancer Inflammatory bowel disease Chronic liver or kidney disease Hyperparathyroidism Vitamin D deficiency Cushing's disease Multiple sclerosis Rheumatoid arthritis

23. I take one of these medicines: Oral glucocorticoids (steroids) Cancer treatments (radiation, chemotherapy) Thyroid medicine Antiepileptic medications Gonadal hormone suppression Immunosuppressive agents

24. The good news: Osteoporosis is preventable for most people! Healthy diet and lifestyle are important for BOTH men and women. If you have osteoporosis, your doctor can detect and treat it

25. Simple Prevention Steps

26. Step 1 Get your daily recommended amounts of calcium and vitamin D. Over 50 ? need 1200 mg of calcium per day or 120% of the ?Nutrition Fact? food label on packaged foods Between 51 and 70 ? need 400 International Units (IU) of vitamin D Over 70 ? need 600 IU of Vitamin D Vitamin D helps your body absorb calcium Calcium is critically important to bone healthOver 50 ? need 1200 mg of calcium per day or 120% of the ?Nutrition Fact? food label on packaged foods Between 51 and 70 ? need 400 International Units (IU) of vitamin D Over 70 ? need 600 IU of Vitamin D Vitamin D helps your body absorb calcium Calcium is critically important to bone health

27. Step 2 Be physically active everyday Improve strength and balance Strength training, including light weights, 2 ? 3 times per week At least 30 minutes of physical activity per day Any activity that puts stress on bones keeps them strong walking, gardening, dancing, running Balance training at least once per week Examples: Yoga Pilates Tai Chi One-leg balances Toe walking Forward-backward leg swings with knee flexed The physical activity will also strengthen your body ? leads to fall reduction Benefits of exercise only last as long as the exercise is part of a regular routineStrength training, including light weights, 2 ? 3 times per week At least 30 minutes of physical activity per day Any activity that puts stress on bones keeps them strong walking, gardening, dancing, running Balance training at least once per week Examples: Yoga Pilates Tai Chi One-leg balances Toe walking Forward-backward leg swings with knee flexed The physical activity will also strengthen your body ? leads to fall reduction Benefits of exercise only last as long as the exercise is part of a regular routine

28. Step 3 Avoid smoking and excessive alcohol.

29. Step 4 Talk to your doctor about bone health. Be sure to discuss Your risk factors Your medication Calcium & vitamin D intake Do you need a bone density scanBe sure to discuss Your risk factors Your medication Calcium & vitamin D intake Do you need a bone density scan

30. Step 5 Have a bone density test and take medication when appropriate. Discuss significant risks with a health care professional Medications Family history Recent falls or broken bones All Women - BMD/DXA > 65 years. Physicians decision! Men - BMD/DXA ?. Guidelines for DXA only address postmenopausal women. NOF recommends all men over age 70 years have a bone density scan. Physician decision! Discuss significant risks with a health care professional Medications Family history Recent falls or broken bones All Women - BMD/DXA > 65 years. Physicians decision! Men - BMD/DXA ?. Guidelines for DXA only address postmenopausal women. NOF recommends all men over age 70 years have a bone density scan. Physician decision!

31. Food and supplement labels

32. Calcium Requirements for 50+ Years

33. Nutrition labels & calcium FDA uses ?Percent Daily Value? (% DV) to describe amount of calcium needed by general U.S. population daily 120% DV for calcium = 1,200 mg Look for this label: ?Nutrition Facts? on foods ?Supplement Facts? on vitamin/mineral supplements

34. You need more vitamin D as you age

35. Calcium & vitamin D recommendations 51 - 70 years 1,200 mg calcium (120% DV) 400 IU vitamin D (100% DV) 70 and older 1,200 mg calcium (120% DV) 600 IU vitamin D (150% DV) Senior adults over age 70 have the greatest need for vitamin D and are less able to make vitamin D from sunlight. Seniors need to be sure to consume enough vitamin D. It is difficult for many seniors to get enough vitamin D from foods and therefore a supplement may be needed. There is some evidence that the intake of 800 IU/day of vitamin D (or more)?along with adequate calcium may reduce the risk for falls (by increasing muscle strength) and reduce the risk for fracture in postmenopausal women and seniors. All at-risk individuals should follow the advice of their medical professional to get enough vitamin D through either food and/or supplements. Senior adults over age 70 have the greatest need for vitamin D and are less able to make vitamin D from sunlight. Seniors need to be sure to consume enough vitamin D. It is difficult for many seniors to get enough vitamin D from foods and therefore a supplement may be needed. There is some evidence that the intake of 800 IU/day of vitamin D (or more)?along with adequate calcium may reduce the risk for falls (by increasing muscle strength) and reduce the risk for fracture in postmenopausal women and seniors. All at-risk individuals should follow the advice of their medical professional to get enough vitamin D through either food and/or supplements.

36. Percent Daily Value (DV) of calcium in common foods

37. % DV calcium: Milk group Yogurt 1 cup (8 oz.) = 30% DV Milk 1 cup = 30% DV Cheese 1 ? oz. natural/2 oz. processed = 30% DV Milk pudding 1/2 cup = 15% DV Frozen yogurt, vanilla, soft serve ? cup = 10% DV Ice cream, vanilla ? cup = 8% DV Soy or rice milk, calcium-fortified 1 cup = varies?check label

38. % DV calcium: Grain products group Cereal, calcium- fortified Serving size and amount of calcium varies?check label

39. % DV calcium: Vegetable group Broccoli, raw 1 cup = 9% DV Collards 1/2 cup = 20% DV Turnip greens, boiled 1/2 cup = 10% DV

40. % DV calcium: Fruit group Orange juice and other calcium-fortified beverages 6 oz. = 20 to 30% DV, varies?check label

41. % DV calcium: Meat & Beans Group Baked beans 1 cup = 14% DV Salmon, canned, with edible bones 3 oz. = 18% DV Sardines, canned, in oil, with edible bones 3 oz. = 32% DV Soybeans, cooked 1 cup = 26% Tofu, firm, with calcium ? cup = 20% DV; check label

42. What about Vitamin D? Main dietary sources of vitamin D are: Fortified milk (400 IU per quart) Some fortified cereals Cold saltwater fish (Example: salmon, halibut, herring, tuna, oysters and shrimp) Some calcium and vitamin/mineral supplements

43. Vitamin D from sunlight exposure Vitamin D is manufactured in your skin following direct exposure to sun. Amount varies with time of day, season, latitude and skin pigmentation. 10?15 minutes exposure of hands, arms and face 2?3 times/week may be sufficient (depending on skin sensitivity). Clothing, sunscreen, window glass and pollution reduce amount produced.

44. Help for the lactose-intolerant Start with small portions of foods such as milk and gradually increase serving size. Eat dairy foods in combination with a meal or solid foods. Try dairy foods other than milk: Many hard cheeses (cheddar, Swiss, Parmesan) have less lactose than milk Yogurt made with live, active bacteria It may be easier to digest lactose that is pre-digested Try Lactose-hydrolyzed milk and dairy products Commercial lactase preparations Start with small portions of foods such as milk and gradually increase serving size. Eat dairy foods in combination with a meal or solid foods. Try dairy foods other than milk: Many hard cheeses (cheddar, Swiss, Parmesan) have less lactose than milk Yogurt made with live, active bacteria It may be easier to digest lactose that is pre-digested Try Lactose-hydrolyzed milk and dairy products Commercial lactase preparations

45. When you don?t like to ?drink? milk Make oatmeal and cream-type soups with milk instead of water Add powdered milk to food (1 tablespoon = 50 mg calcium) Add milk to coffee Serve milk-based desserts (puddings, tapioca, frozen yogurt, custard, ice cream). Limit fat and sugar. Try chocolate milk. 8-oz. has only 2 - 7 mg caffeine. Average glass provides only 60 more calories than unflavored milk. Make instant hot cocoa with milk, not water. Top baked potatoes with plain yogurt; sprinkle with chives Enjoy plain or flavored low fat yogurt straight from the carton or combined Used flavored yogurt as a fruit salad dressing; experiment with substituting plain yogurt for some or all of the sour cream in vegetable salad dressings Make oatmeal and cream-type soups with milk instead of water Add powdered milk to food(1 tablespoon = 50 mg calcium) Add milk to coffee Serve milk-based desserts (puddings, tapioca, frozen yogurt, custard, ice cream). Limit fat and sugar. Try chocolate milk. 8-oz. has only 2 - 7 mg caffeine. Average glass provides only 60 more calories than unflavored milk. Make instant hot cocoa with milk, not water. Top baked potatoes with plain yogurt; sprinkle with chives Enjoy plain or flavored low fat yogurt straight from the carton or combined Used flavored yogurt as a fruit salad dressing; experiment with substituting plain yogurt for some or all of the sour cream in vegetable salad dressings

46. Calcium supplement considerations

47. 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 Calcium citrate Doesn?t require stomach acid for absorption May be taken anytime?check with your healthcare provider May cost more

48. Vitamin D necessary for calcium absorption Choose a supplement with vitamin D unless obtaining vitamin D from other sources. Follow age group recommendation. Avoid going over a daily combined total of 2,000 IU or 50 mcg from food and supplements. It?s not necessary to consume calcium and vitamin D at the same time to get the benefit of enhanced calcium absorption.

49. Limit calcium to 500 mg at a time Our bodies can best handle about 500 mg calcium at one time from food and/or supplements. Spread your calcium sources throughout the day.

50. Increase amount slowly Start supplements with 500 mg calcium daily for about a week, gradually adding more. Gas and constipation can be side effects: Increase fluids and high fiber foods if diet is low in whole grains and fruits and vegetables. Try a different type of supplement if side effects continue.

51. Medications Bisphosphonates (Fosamax?) - Alendronate & Alendronate with Calcium (Boniva?) - Ibandronate (Updated 2006) (Actonel?) - Risedronate & Risedronate with Calcium (Miacalcin?) Calcitonin Estrogen Therapy/Hormone Therapy Parathyroid Hormone (PTH 1-34) Selective Estrogen Receptor Modulator (SERM) (Evista?) Raloxifene PRESENTER NOTES: This is a list of available medications for the prevention and treatment for osteoporosis. There are medications available that have been approved for men. Explain: you will not cover this information but you did want them to know that medication is available and that would be a decision between you and your doctor. Like with any medication.there are side effects and everyone has a different history and set of possible diseases. Add that this slide is just to let them know there are medications available for some people depending on their health and circumstances. Alendronate= (Fosamax?) Risedronate = (Actonel?) Calcitonin= (Miacalcin?) Raloxifene (Evista?) (Boniva?) - Ibandronate FDA has approved the following medications for the prevention and/or treatment of osteoporosis: bisphosphonates (alendronate, ibandronate and risedronate) Bisphosphonates are a class of drugs that can slow bone loss, increase BMD of the spine and hip, and reduce fracture risk. These drugs must be taken as directed. Calcitonin is a hormone your body produces (by thyroid gland) that controls your blood calcium levels and acts on your bone cells that control bone turnover. The drug can slow bone loss, increase spine BMD, reduce risk of fractures and it can help relieve the pain associated with spinal fractures in some people. It is available as a nasal spray or injection. Parathyroid hormone (PTH) is also a hormone your body produces (by parathyroid gland) that helps control blood levels of calcium and phosphate. It also act on bone cells. PTH is approved an injection that can help rebuild bone. You should talk to your doctor about medications that treat/help prevent osteoporosis if you have any risk factors. Hormone replacement therapy can help prevent and treat osteoporosis. It can help reduce bone loss, increase spine and hip BMD and reduce risk of spine and hip fractures in postmenopausal women. Women who consider hormone therapy need to discuss the risks/benefits with their doctors and determine which therapy is appropriate for them (ERT v. HRT). Basically, postmenopausal women who still have their uterus need estrogen + progesterone (HRT) to reduce risk of uterine cancer. Selective estrogen receptor modulators (SERMs) and are approved for both prevention and treatment of osteoporosis. It can help prevent bone loss and increase BMD. It can be an option for some women who do not want to/cannot use ERT/HRT. It does not provide all the other protective benefits of ERT/HRT and will not help with menopause symptoms (e.g., hot flashes). PRESENTER NOTES: This is a list of available medications for the prevention and treatment for osteoporosis. There are medications available that have been approved for men. Explain: you will not cover this information but you did want them to know that medication is available and that would be a decision between you and your doctor. Like with any medication.there are side effects and everyone has a different history and set of possible diseases. Add that this slide is just to let them know there are medications available for some people depending on their health and circumstances. Alendronate= (Fosamax?) Risedronate = (Actonel?) Calcitonin= (Miacalcin?) Raloxifene (Evista?) (Boniva?) - Ibandronate FDA has approved the following medications for the prevention and/or treatment of osteoporosis: bisphosphonates (alendronate, ibandronate and risedronate) Bisphosphonates are a class of drugs that can slow bone loss, increase BMD of the spine and hip, and reduce fracture risk. These drugs must be taken as directed. Calcitonin is a hormone your body produces (by thyroid gland) that controls your blood calcium levels and acts on your bone cells that control bone turnover. The drug can slow bone loss, increase spine BMD, reduce risk of fractures and it can help relieve the pain associated with spinal fractures in some people. It is available as a nasal spray or injection. Parathyroid hormone (PTH) is also a hormone your body produces (by parathyroid gland) that helps control blood levels of calcium and phosphate. It also act on bone cells. PTH is approved an injection that can help rebuild bone. You should talk to your doctor about medications that treat/help prevent osteoporosis if you have any risk factors. Hormone replacement therapy can help prevent and treat osteoporosis. It can help reduce bone loss, increase spine and hip BMD and reduce risk of spine and hip fractures in postmenopausal women. Women who consider hormone therapy need to discuss the risks/benefits with their doctors and determine which therapy is appropriate for them (ERT v. HRT). Basically, postmenopausal women who still have their uterus need estrogen + progesterone (HRT) to reduce risk of uterine cancer. Selective estrogen receptor modulators (SERMs) and are approved for both prevention and treatment of osteoporosis. It can help prevent bone loss and increase BMD. It can be an option for some women who do not want to/cannot use ERT/HRT. It does not provide all the other protective benefits of ERT/HRT and will not help with menopause symptoms (e.g., hot flashes).

52. 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 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

53. Protect Your Bones Ways to Make Your Home Safer 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 Remove all small rugs. They can make you trip. Make sure your walkways are wide enough. Remove things that you may trip over from stairs and places where you walk. 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 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 Remove all small rugs. They can make you trip. Make sure your walkways are wide enough. Remove things that you may trip over from stairs and places where you walk. 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

54. Protect Your Bones Ways to Make Your Home Safer Remove small rugs Have grab bars put next to toilet, in bathtub or shower Use non-slip mats in the bathrub and shower Use brighter lights Wear shoes and slippers that give good support and have non-slip solesRemove small rugs Have grab bars put next to toilet, in bathtub or shower Use non-slip mats in the bathrub and shower Use brighter lights Wear shoes and slippers that give good support and have non-slip soles

55. Protect Your Bones Falls Prevention Annual medication review Have an annual medication review conducted by a healthcare provider or pharmacist Insure this review includes an adequate focus on falls and fall-related injury prevention goal of reducing or eliminating medications that increase falls risk. Changes in cognitive and physical function, dizziness or lightheadedness, balance difficulties, confusion and sedation refer for a comprehensive assessment. Medication use can cause these changes interventions aimed at medication modification to help reduce the risk of falls modifications might include dosage reduction elimination of a particular medication an alternative medication. ?2005 NCOA Falls Free: Promoting a National Falls Preventions Action Plan Have an annual medication review conducted by a healthcare provider or pharmacist Insure this review includes an adequate focus on falls and fall-related injury prevention goal of reducing or eliminating medications that increase falls risk. Changes in cognitive and physical function, dizziness or lightheadedness, balance difficulties, confusion and sedation refer for a comprehensive assessment. Medication use can cause these changes interventions aimed at medication modification to help reduce the risk of falls modifications might include dosage reduction elimination of a particular medication an alternative medication. ?2005 NCOA Falls Free: Promoting a National Falls Preventions Action Plan

56. Hip Fracture Prevention: Falling How do Younger Adults Fall?

57. Hip Fracture Prevention: Falling How do Older Adults Fall? This is one of the ways patients fall. Backward and lateral falls also occur and put the patient at risk for fractures. Osteoporotic fractures commonly affect the hip because the elderly tend to fall sideways or backwards, landing on this joint. Younger, more agile persons tend to fall forward, landing on the outstretched wrist, thus fracturing the distal radius This is one of the ways patients fall. Backward and lateral falls also occur and put the patient at risk for fractures. Osteoporotic fractures commonly affect the hip because the elderly tend to fall sideways or backwards, landing on this joint. Younger, more agile persons tend to fall forward, landing on the outstretched wrist, thus fracturing the distal radius

58. Hip Fracture Prevention: Hip Protectors

59. Bone Health Building Blocks

60. 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. Your dentist will take your medical history, discuss oral health risk factors and review clinical & x-ray examinations at your dental visits.Your dentist will take your medical history, discuss oral health risk factors and review clinical & x-ray examinations at your dental visits.

61. ORAL HEALTH Continued The National Institute of Arthritis and Musculoskeletal and Skin Disease Steps for Healthy Bones Eat a well-balanced diet rich in calcium and vitamin D. Live a healthy lifestyle. Don?t smoke, and if you choose to drink alcohol, do so in moderation. Engage in regular physical activity or exercise. Weight-bearing activities, such as walking, jogging, dancing, and lifting weights, are the best for strong bones. Report any problems with loose teeth, detached or receding gums, and loose or ill-fitting dentures to your dentist and doctor. Healthy Bones help with Healthy Teeth!Healthy Bones help with Healthy Teeth!

62. For more information The 2004 Surgeon General?s Report on Bone Health and Osteoporosis: What It Means to You http://www.surgeongeneral.gov/library/bonehealth National Osteoporosis Foundation http://www.nof.org


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