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Osteoporosis. “No Bones About It”. No Bones About It. Typical comments from people with osteoporosis. “I’ve lost six inches in height and none of my clothes fit me anymore.”. Comments. “It’s hard to get clothes that look nice when my back is so hunched over.”. Comments.

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Osteoporosis

“No Bones About It”

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Typical comments from people with osteoporosis

“I’ve lost six inches in height and none of my clothes fit me anymore.”

comments
Comments

“It’s hard to get clothes that look nice when my back is so hunched over.”

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Comments

“What will I do if I have to give up driving?”

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Comments

“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.”

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Comments

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

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Overview

Osteoporosis causes weak bones. In this common disease, bones lose minerals like calcium. They become fragile and break easily.

Normal

Bone

Bone with

Osteoporosis

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

osteoporosis the most common bone disease
OsteoporosisThe 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!
the silent disease
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
the problem in america
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

Source: National Osteoporosis Foundation Web site; retrieved July 2005 at http://www.nof.org

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

Source: National Osteoporosis Foundation Web site; retrieved July 2005 at http://www.nof.org

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Hip fractures account for 300,000 hospitalizations annually.

People who break a hipmight not recover formonths or even years.

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

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

Some people never walk again.

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

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The most common breaks in weak bones are in the wrist, spine and hip.

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

why are healthy bones important
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
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After mid-30’s, you begin to slowly lose bone mass.
  • Women lose bone mass faster after menopause.
  • Men lose bone mass too.

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

risk factors
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.

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

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1
  • 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
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2
  • 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
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3

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
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4

I take one of these medicines:

  • Oral glucocorticoids (steroids)
  • Cancer treatments (radiation, chemotherapy)
  • Thyroid medicine
  • Antiepileptic medications
  • Gonadal hormone suppression
  • Immunosuppressive agents
the good news osteoporosis is preventable for most people
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
simple prevention steps
Simple Prevention Steps

The Surgeon General recommends five simple steps to bone health and osteoporosis prevention …

step 1
Step 1

Get your daily recommended amounts of calcium and vitamin D.

Use MyPyramid.gov to help plan an overall healthy diet

step 2
Step 2

Be physically active everyday

Improve strength and balance

Even simple activities such as walking, stair climbing and dancing can strengthen bones.

step 3
12 oz.

5 oz.

1.5 oz.

Step 3

Avoid smoking and excessive alcohol.

MyPyramid.gov recommends no more than 1 drink per day for women and 2 for men.

step 4
Step 4

Talk to your doctor about bone health.

step 5
Step 5

Have a bone density test

and take medication

when appropriate.

Source of photo: USDA ARS Photo Unit Photo by Peggy Greb

Testing is a simple, painless procedure.

food and supplement labels
Food and supplement labels

Assess calcium and vitamin D intake by using food and supplement labels.

calcium requirements for 50 years
Calcium Requirements for 50+ Years

Goal

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

nutrition labels calcium
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
you need more vitamin d as you age
You need more vitamin D as you age

Daily vitamin D needs in International Units (IU)

Age

calcium vitamin d recommendations
Calcium & vitamin D recommendations
  • 51 - 70 years1,200 mg calcium (120% DV)400 IU vitamin D (100% DV)
  • 70 and older1,200 mg calcium (120% DV)600 IU vitamin D (150% DV)
percent daily value dv of calcium in common foods
Percent Daily Value (DV) of calcium in common foods

Approximate % DV for foods based in part on The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

dv calcium milk group
% DV calcium: Milk group
  • Yogurt1 cup (8 oz.) = 30% DV
  • Milk1 cup = 30% DV
  • Cheese1 ½ oz. natural/2 oz. processed = 30% DV
  • Milk pudding1/2 cup = 15% DV
  • Frozen yogurt, vanilla, soft serve½ cup = 10% DV
  • Ice cream, vanilla½cup = 8% DV
  • Soy or rice milk, calcium-fortified1 cup = varies—check label

Choose fat-free or low fat most often

dv calcium grain products group
% DV calcium: Grain products group
  • Cereal, calcium- fortifiedServing size and amount of calcium varies—check label

Calcium-fortified

dv calcium vegetable group
% DV calcium: Vegetable group
  • Broccoli, raw1 cup = 9% DV
  • Collards1/2 cup = 20% DV
  • Turnip greens, boiled1/2 cup = 10% DV
dv calcium fruit group
% DV calcium: Fruit group
  • Orange juice and other calcium-fortified beverages6 oz. = 20 to 30% DV, varies—check label

Look for 100% juice

dv calcium meat beans group
% DV calcium: Meat & Beans Group
  • Baked beans1 cup= 14% DV
  • Salmon, canned, with edible bones3 oz. = 18% DV
  • Sardines, canned, in oil, with edible bones3 oz. = 32% DV
  • Soybeans, cooked1 cup = 26%
  • Tofu, firm, with calcium ½ cup = 20% DV; check label
what about vitamin d
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
vitamin d from sunlight exposure
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.

Source: National Osteoporosis Foundation Web site; retrieved July 2005 at http://www.nof.org

help for the lactose intolerant
Help for the lactose-intolerant

Some people lack the enzyme lactase needed to digest lactose (milk sugar).

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

Calcium carbonate vs. citrate
vitamin d necessary for calcium absorption
Vitamin D necessary for calcium absorption
  • Choose a supplement with vitamin D unless obtaining vitamin D from other sources.
  • Follow age group recommendation. Avoid goingover a daily combined total of 2,000 IU or 50 mcg from foodand supplements.
  • It’s not necessary to consume calcium and vitamin D at the same time to get the benefit of enhanced calcium absorption.

Vitamin D is like a key that unlocks the door and lets calcium into the body.

limit calcium to 500 mg at a time
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.

increase amount slowly
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.
medications
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

Source:

Physician’s Guide to Prevention and Treatment of Osteoporosis. 2nd ed. Washington, DC: National Osteoporosis Foundation; 2003.

osteoporosis falls break bones
OsteoporosisFalls Break Bones

You can prevent most falls

protect your bones falls prevention
Protect Your BonesFalls Prevention

Annual medication

review

bone health oral health
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.
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.

ORAL HEALTH Continued
for more information
For more information
  • The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to Youhttp://www.surgeongeneral.gov/library/bonehealth
  • National Osteoporosis Foundation http://www.nof.org

Thanks to University of Nebraska–Lincoln Extension educational programs

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