Download Build Your Bones! Osteoporosis – Its Prevention

Build Your Bones!
Osteoporosis – Its Prevention and Treatment
Slide 1
Welcome to the course, Build Your Bones: Osteoporosis – Its Prevention and Treatment, which is a
Texas A&M AgriLife Extension Service Professional Development Training Program. This course covers
basic, relevant nutrition information about the disease osteoporosis and its diagnosis, prevention, and
treatment methods. This module is approximately 1.5 hours in length.
This course will be presented in a voice-narrated format that allows you to follow along with a
PowerPoint slide presentation. A high-speed Internet connection is required to complete the course.
Content for this module is divided into multiple sections (see menu bar on the left for course outline),
enabling you to complete and/or review content at your own pace. Printable handouts, if applicable,
will be presented prior to the section in which they are referenced.
In the next section, you will be directed to complete a brief, multiple-choice pre-learning assessment.
Once you have completed the pre-learning assessment, you will be free to advance to the course
content by clicking on the “Next Section” button at the bottom of the page. At the conclusion of this
module, you will be directed to complete a post-learning assessment that will determine if you
successfully pass the course.
If at any time you wish to take a break from the module, simply log out and return to the course when
you are ready to continue. When you sign back in to the module, you will be taken directly to the
section where you left off. To review a section you have already completed, click on the desired section
on the left menu bar.
Slide 2
The learning objectives for Build Your Bones: Osteoporosis – Its Prevention and Treatment are as listed
below. At the conclusion of this module, participants will be able to:

Discuss osteoporosis, including its incidence, symptoms, diagnosis, and prevalence;

Describe bone health and why calcium and vitamin D are needed daily for all ages;

Explain the types of prevention of osteoporosis;

Name risk factors for having osteoporosis;

Describe the treatment of osteoporosis;

Be aware of how to utilize the ingredients listing and Nutrition Facts labels on all
manufacturers’ food labels and other identifiers to make comparisons of not only the energy
nutrients, but of the calcium and vitamin D as relative to the Percent Daily Values;

Identify foods high in calcium;

Identify major sources of vitamin D;

List six weight-bearing exercises; and
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
Identify reliable, research-based osteoporosis resources to help discern fact from fiction about
this devastating disease.
The Disease Osteoporosis
Slide 3
Keeping your bones healthy should be at the top of your health concerns list. Osteoporosis occurs
when bones become weak and can easily break. It’s a major health threat for an estimated 44 million
people who are 50 years old and older.
10 million people are estimated to have osteoporosis, and 34 million have low bone mass, which places
them at risk for osteoporosis. Unfortunately, 1 in 2 women and 1 in 4 men over age 50 will have an
osteoporosis-related fracture.
In 2005, it cost $19 billion to treat this disease, and the costs are expected to rise to $25.3 billion by the
year 2025.
Slide 4
Dubbed as the “silent disease,” osteoporosis is a debilitating disease that causes bones to become so
fragile that they break.
Bone loss can occur without even one symptom! You may not be aware that you have it until you get a
fracture due to the weakened bones. You don’t even need to fall to cause the break.
Also, a sudden strain in your back or other part of your body or hitting a big bump can cause a bone to
break if you have osteoporosis.
Slide 5
As Macie, our example in this slide, can attest, getting shorter may just be the beginning of problems.
Macie noticed that her clothes didn’t fit the same because she had lost a couple of inches in height.
Then she began having trouble moving around and had an increased feeling of pain. She had
developed a deformed, curved back known as a “dowager’s hump,” and it was prominent.
So, what should Macie do? She needs to go to her family physician, who will most certainly diagnose
her with the condition known as “osteoporosis.”
As you can see in this picture, the bone on the left is normal, and the one on the right shows that
osteoporosis is present. Osteoporosis makes bones thin and weak, and it’s invisible until a bone breaks
or fractures. Fractures can occur from just coughing, rolling over in your sleep, or lifting a bag of
groceries. Unfortunately, one in two women and one in eight men over age 50 are predicted to have
an osteoporosis-related fracture in their lifetime. But the good news is that osteoporosis is a disease
that is mostly preventable and treatable.
Slide 6
The most common breaks in weak bones are in the wrist, spine, and hip.
Slide 7
You’re never too young or old to improve bone health!
Slide 8
After your mid-30s, you begin to slowly lose bone mass. Women lose bone mass faster after
menopause, but bone loss happens to men, too.
Bones can weaken early in life without a healthy diet and the right kinds of physical activity.
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Lifestyle Factors and Risk Assessment
Slide 9
Lifestyle-related osteoporosis risk factors, which are also known as “bone health robbers,” are often a
surprise to people who develop the disease.
Bone health robbers accelerate bone loss. Calcium and vitamin D deficiencies, along with the lack of
weight-bearing exercise, family history, and being female are just some of those bone health robbers.
Others include smoking, drinking alcohol, caffeine, being underweight, and aging.
Slide 10
Are you at risk of developing osteoporosis? Do you:

eat or drink less than 2 milk product servings daily?

smoke cigarettes or drink alcoholic beverages?

exercise less than 30 minutes daily?

have a family history of the disease?

starve as “thin is in”?
Other risk factors for developing osteoporosis include being female, small boned, aging, and drinking
more than one or two caffeine-containing drinks daily.
Slide 11
There’s no reason to worry about frail bones, or is there? Gladys once thought that women didn’t have
to worry about frail bones until they got older. Was she ever wrong! She found out too late that
women of all ages need to take steps to keep their bones strong.
Unfortunately, millions of women already have or are at risk for osteoporosis. Some days, Gladys has a
hard time doing the things she wants to do without help. But she still tries to keep her bones as strong
as she can. Gladys makes sure to get enough calcium and vitamin D, and she walks with her neighbor in
the mornings. Gladys also talked with her doctor about taking medicine to help.
Slide 12
Online Activity 1: Now that you’re aware of some of the risk factors for developing osteoporosis, it’s
time to take the online quiz, Check up on Your Bones, to access your risk of developing osteoporosis. It
will take approximately 5 minutes to complete the quiz, and you’ll receive immediate feedback from
the website. Go to: www.niams.nih.gov/Health_Info/Bone/Optool/index.asp.
So, how did you do on online osteoporosis risk quiz, according to the immediate feedback you were
given from your quiz results? If for any reason your assessment indicated that you are at risk, please
check with your physician in the near future to find out more about your own health status and what
you need to do to either treat or further prevent osteoporosis.
Osteoporosis Detection and Fall Prevention
Slide 13
Health care providers can confirm a diagnosis of osteoporosis by conducting a bone mineral density, or
BMD, test. It’s one of the most accurate ways to assess bone health.

Central machines measure bone density in the hip, spine, and total body.

Peripheral machines measure bone density in the finger, wrist, kneecap, shin bone, and heel.
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When the BMD test is repeated over time, it can be used to track the rate of bone loss. Also, if a
patient is being treated for osteoporosis, the BMD test can monitor his or her response to treatment.
BMD testing is painless and noninvasive. The most common methods of BMD testing use low-dose xrays, which are typically taken of your lower spine and hip. Results of this test are usually reported as
two scores, a T-score and a Z-score.

The T-score compares the patient’s BMD to that of a 30-year old.

The Z-score compares the patient’s BMD to that of other people of the patient’s age, gender,
and race.
A negative value for either score means that your bones are thinner than the standard. The risk of
fracture almost doubles for each standard deviation decrease in bone mineral density. Doctors will
review the scores with their patients to help them better understand the test results.
Slide 14
The good news is that risk factors for osteoporosis can be reduced by most people! It’s important to
start building healthy bones while you’re young. Additionally, healthy food choices and lifestyle are
important for BOTH men and women.
Slide 15
Fall prevention is very important, and here are some methods to use in your home to help prevent
falls.

Wear supportive, low-heeled shoes.

Avoid using area rugs.

Keep the floors uncluttered.

Keep hallways and stairs well-lighted.

In the shower or tub, have grab bars and a rubber mat for safety.

If you live alone, a 24-hour monitoring system might be a wise choice.

Keep a portable phone and flashlight at your bedside, and carry it with you.

A cane or walker will provide stability, if needed.

Clean any spills that cause a surface to be slippery.
Nutrition - Osteoporosis Prevention/Treatment
Slide 16
Being aware of prevention and treatment options will help to keep your bones healthy and less likely
to develop osteoporosis.
While new information on good foods and bad foods seems to surface regularly, some basic guidelines
to help us know what Americans should eat to stay healthy have been designed by a committee of
experts in the field of foods and nutrition. This committee was appointed by the USDA and U.S.
Department of Health and Human Services to draft a document on selecting food choices that promote
health and prevent disease. What parts of a healthy diet have special importance for women? Let’s
take a look at the 2010 Dietary Guidelines for Americans’ major messages.

Select a variety of nutrient-dense foods.
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
Maintain a healthy weight, and balance calories with exercise.

Wisely select:
o less fat and cholesterol, such as fat-free, ½%, and 1% milk products for calcium;
o more fiber from whole grains, fruits, and vegetables; and
o less sugar and salt, or sodium.

If you drink alcoholic beverages, do so in moderation.
Slide 17
MyPlate is the practical application of the USDA’s 2010 Dietary Guidelines for Americans
recommendations.
Let’s start with nutrition since you’ll consume your daily recommended nutrients through wise
selections from the website, ChooseMyPlate.gov. The food groups are now Grains, Protein, Vegetables,
Fruits, and Dairy. Remember, no one food group is more important than another, They’re all are
needed for good health.
Most people should eat the number of servings from each of the five major food groups daily. When
choosing what to put on your plate, choose to eat less fats, oils, sweet beverages, and desserts since
most foods in this category supply calories but few other nutrients. Go to ChooseMyPlate.gov, and
review the range of servings given for each group because individual needs vary with age, sex, and
activity level.
With ChooseMyPlate.gov, use a small, or 9 inch, plate, and mentally divide the plate in half.

On the right side of the plate, ¼ of the plate is made up of Grains, which are bread, cereal, rice,
and pasta foods.

The other quarter of that side of the plate is made up of Protein, which includes meat, poultry,
fish, dry beans, eggs, and nuts.

On the left half of the plate, you see that ⅔ of the plate is made up of Vegetables – the higher
fiber, non-starchy type.

The other third of that side of the plate is made up of Fruits.

Finally, a serving of Dairy is shown, which includes milk, yogurt, cheese, and dairy-like foods.
Slide 18
Bones are living organs, with calcium continually being deposited and withdrawn from them each day.
You reach your peak bone mass at about age 30.
You need to ensure that you have plenty of calcium, Vitamin D, and other nutrients while you are
young, and continue making deposits of these nutrients as you age.
Slide 19
As we’ve seen, dairy products are the major calcium dietary source.
Also important in bone health is Vitamin D, which is sometimes called the sunshine vitamin. Vitamin D
increases intestinal absorption of calcium; however, adequate Vitamin D intake in older women is
questionable.
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Ensure that you consume the recommended number of servings for the dairy group from
ChooseMyPlate.gov.
Slide 20
Both women and men need enough calcium to build maximum bone mass during their early years. Low
calcium intake appears to be one important factor in the development of osteoporosis.
The most important time to get enough calcium is while bone is in its growth stage during adolescence
and early adulthood. Getting enough calcium during this stage may delay fractures later in life.
Women attain peak bone mass by age 30. About 85 to 90 percent of adult bone mass is acquired by
the age of 18 in girls and age 20 in boys.
Adequate nutrition and regular participation in physical activity are important factors in achieving and
maintaining optimal bone mass.
Slide 21
The Institute of Medicine of the National Academy of Sciences recommends specific amounts of
dietary calcium for various stages of life. The chart shown on this slide is for ages 19 and over. You see
the milligrams per day needed and the upper limits that are the safe boundaries. Too much calcium
can put you at risk for health problems, such as kidney stones, just as much as too little calcium.
Men who are 19-70 years old require only 1,000 milligrams of calcium each day, but those who are 71
years and older need 1,200 milligrams.
Women who are 19-50 years old require 1,000 milligrams of calcium each day; however, by age 51 and
older, they need 1,200 milligrams.
Look at this chart and determine how many milligrams of calcium you need based on your age and sex.
Remember that your body doesn't produce calcium, so you must get it through other sources.
Slide 22
It’s just never too late to make necessary lifestyle changes, such as increasing your dietary calcium
intake through healthful food choices. Calcium can be found in a variety of foods, including:

low-fat dairy products, such as cheese, milk, yogurt, and dairy-like foods;

canned fish with soft bones you can eat, such as sardines and canned salmon;

dark green leafy vegetables, such as bok choy, collard and turnip greens, broccoli, Brussels
sprouts, and kale; and

calcium-fortified foods and beverages, such as soy products, cereal, and fruit juices.
One serving of each of these calcium-rich foods provides about 300 to 400 milligrams of calcium, or
about one-third of the recommended amount of calcium needed daily.
If you have trouble getting enough calcium in your meals, you may need to ask your doctor if you
should take a calcium supplement, such as calcium carbonate, calcium phosphate, or calcium citrate.
Slide 23
Along with its recommendation for calcium intake, the Institute of Medicine of the National Academy
of Sciences recommends specific amounts vitamin D for various stages of life. Vitamin D is important
for bone health and helps your body absorb calcium. Some calcium supplements contain vitamin D. A
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few foods naturally contain small amounts of vitamin D, such as canned salmon with bones and egg
yolks. You can also get vitamin D through fortified foods and even sun exposure.
You can readily see that your vitamin D needs also increase with age. The new recommendations
increase the RDA for vitamin D to what you see on the slide:

Those who are 19-70 years old need 600 IU of vitamin D each day.

Those over 70 years need up to 800 IU of vitamin D each day.

The upper level intakes of vitamin D for those who are 19 years and older is 4000 IU per day.
Higher levels may increase the risk for acute adverse effects.
Slide 24
The main dietary sources of vitamin D are:

fortified milk;

some fortified grains and cereals;

cold saltwater fish, such as salmon, halibut, herring, tuna, oysters, and shrimp; and

some calcium and vitamin/mineral supplements.
Slide 25
Vitamin D is manufactured in your skin following direct exposure to the sun. However, the amount
varies with time of day, season, latitude, and your skin pigmentation. Getting 10–15 minutes of
exposure to your hands, arms, and face two to three times per week may be sufficient, but it depends
on your skin’s sensitivity. Clothing, sunscreen, window glass, and pollution reduce the amount of
Vitamin D produced.
Slide 26
Reading the Nutrition Facts on food labels helps us to make wise selections for our calcium and vitamin
D sources. We can also watch out for the extra calories by looking at the calories and carbohydrate,
protein, and fat content of foods we select.
Nonfat milk is lower in saturated fat and cholesterol than whole milk.
Looking at this slide, compare the amounts of calcium from the whole and nonfat milk labels. Both
provide 30% of the total daily value of calcium plus 25% of vitamin D. Nonfat milk provides no
saturated fat, whereas whole milk provides 5 grams, or 25%, of the saturated fat allowed for a day.
If you haven’t already done so, it’s time to print out Activity 2, How to Calculate the Amount of Calcium
per Serving on the Nutrition Facts Label. Follow the directions provided.
Exercise – Osteoporosis Prevention/Treatment
Slide 27
Regularly engage in weight-bearing exercises. Even simple activities, such as stair climbing, walking,
and dancing, can strengthen bones.
Slide 28
Prevent bone loss by making daily activity and exercise a part of your lifestyle. In particular, weightbearing exercises are recommended to help prevent osteoporosis; however, many people aren’t
exactly sure of what constitutes a weight-bearing physical activity. Simply put, it’s any activity in which
your body works against gravity. Some examples of weight-bearing activities are walking, jogging,
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dancing, running, hiking, climbing stairs, gardening, performing yoga or tai chi, playing tennis, or lifting
weights. It all helps to prevent bone loss!
Slide 29
By incorporating activities and exercises into your daily lifestyle, you decrease your chances of
fracturing your bones. As we mentioned in the previous slide, weight-bearing exercises cause muscles
to work against gravity, which helps to maintain bone strength. Walking, tennis, gardening, swimming,
and bicycling are beneficial to strengthen muscles, improve flexibility, and improve your balance. All of
these exercises are good aerobic exercises; however, bicycling is the least effective weight-bearing
exercise of the group.
When exercising, wear comfortable, low-heeled walking shoes, keep the floor uncluttered, and install
hand rails or grab bars to prevent falls.
Staying active keeps your bones younger for a lifetime, and it helps to preserve your independence for
as long as possible.
Medication/Other – Osteoporosis Prevention/Treatment
Slide 30
The National Institutes of Health Osteoporosis and Related Bone Diseases – National Resource Center’s
website has an overview of current therapeutic medications
(http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/overview.asp).
Medications to prevent and/or treat osteoporosis include:

bisphosphonates, such as Alendronate® sodium;

estrogen agonists/antagonists, which are also called selective estrogen receptor modulators or
SERMS, such as Tamoxifen and Raloxifene hydrochloride;

calcitonin, which is a peptide hormone given by injection and now available as a nasal spray;

parathyroid hormone;

estrogen therapy, which is used less due to its connection with certain cancers;

hormone therapy; and

a recently approved RANK ligand, or RANKL, inhibitor. RANKL is an essential cytokine for the
formation and activation of osteoclasts and promotes bone resorption. RANKL blockade may
emerge as a novel therapeutic option for human bone diseases.
Slide 31
Do you smoke or chew tobacco? Tobacco products are bone health robbers. For years, you’ve heard
that smoking may be hazardous to your health, and most people think about heart disease and lung
cancer when this is mentioned. However, tobacco users are also at a greater risk of developing
osteoporosis. Smoking can be toxic to your bone cells, and it also reduces your body’s absorption of
calcium.
Slide 32
Consuming too much alcohol can increase your risk of developing osteoporosis. ChooseMyPlate.gov
recommends no more than one alcoholic drink per day for women and two alcoholic drinks for men.
One drink would be 12 ounces of beer or 1.5 ounce of alcohol in a mixed drink, or 5 ounces of wine.
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
Consuming too many caffeine-containing drinks can also increase your risk of osteoporosis. If
you’re drinking 600 or more milligrams of caffeine-containing drinks per day, you need to cut
back on your consumption to avoid increasing your risk for osteoporosis and other healthrelated conditions. Consider the amount of caffeine found in a serving of these drinks:
o Coffee ranges from 27 to 200 milligrams.
o Tea ranges from 40 to 120 milligrams.
o Soft drinks have up to 47 milligrams.
o Sports or energy drinks have up to 280 milligrams.
Slide 33
Society’s emphasis on a lean body appearance has led many people – and especially young girls and
women – to adopt unhealthy calorie-restricted diets. Many of these diets are low in calcium and may
increase the person’s risk for osteoporosis now or in their later years of life.
The American public needs to understand why consuming foods containing calcium and vitamin D are
the foremost and best way to meet calcium needs, and to learn how to increase their calcium intake
from these sources.
The best way to counteract the effects of aging on bone health is by following the recommendations
for nutrition and weight-bearing exercises.
Summary
Slide 34
In summary, remember that osteoporosis is a serious disease, affecting 10 million people in the United
States in 2011. Women are most often affected by this disease. It can debilitate you and rob you of
your independence. But the good news is that the risk for osteoporosis may be reduced!
Americans need to prevent and/or treat it through early detection, awareness of fall prevention, and
understanding the importance of eating foods that contain calcium and vitamin D.
The best way to increase dietary calcium intake is to eat and drink more dairy products, such as milk,
yogurt, and dairy-like foods that are fortified with calcium and vitamin D; canned sardines or salmon
with bones; and dark, leafy greens.
It’s never too late to make the necessary lifestyle changes to prevent osteoporosis.
Be sure to download our handout, Reliable Osteoporosis and Bone Health Resources. It will be a helpful
tool for learning how to live a healthy life and possibly prevent and/or treat osteoporosis.
Author
This module was developed by:
Mary Claire Kinney Bielamowicz
PhD,MS,RD,LD,CFCS
Regents Fellow
Professor and Nutrition Specialist
Texas A&M AgriLife Extension Service
Texas A&M University System
Department of Nutrition and Food Science
Educational programs of the Texas A&M AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin.
The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating
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