Bone Fractures Worksheet - PowerPoint by tfe14389

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									INTRODUCTION
GOALS & OBJECTIVES
Goal: is to increase awareness of
osteoporosis, the risk factors, steps
to prevent, treatment options, and
suggestions to reduce fractures
Objective: is to provide a broad-
based community education
program to educate the public
about prevention, diagnosis, and
treatment options
   -PEGGY, AGE 46

―I was absolutely blown
away to discover I had
osteoporosis. And there
are thousands of women
out there in the condition
I was in!‖
   -DIANNE, AGE 61

―I was devastated! I was always
very physically active in school
with hockey and track. I
couldn’t believe it—I was in
shock! My doctor told me not to
pick up my grandchildren, a bag
of groceries, or vacuum. I felt
like I was in a bubble.‖
    -LINDA, AGE 53

―When the doctor revealed the
DXA results, I was stunned. I’d
been drinking lots of milk all my
life, yet I had a full blown case
of osteoporosis. If your doctor
doesn’t suggest it, be assertive.
You’ll be the one to pay the
price if you’re not.‖
FACTS
 AND
FIGURES
   NATIONAL STATISTICS
Osteoporosis affects more than 28
million Americans; 80% of them
are women and 20% men
1 in 2 women and 1 in 8 men over
the age of 50 will develop
osteoporosis
Thin bones are the cause of 1.5
million fractures a year
    FLORIDA STATISTICS

Over 2.1 million individuals have
osteoporosis or low bone mass
1998 - 22,630 residents had hip
fractures
1998 - Hospital charges for hip
fractures were $477.8 million with
80% discharged to nursing homes
  VERTEBRAL FRACTURES
Can lead to chronic back pain, loss of
height, protruding stomach, stooped
posture - back pain is the most common
complaint
At age 50, a woman has a 50% chance of
an osteoporosis-related fracture during
her life
Loss of ability to do daily living activities
(cooking, cleaning, getting dressed, etc.)
        HIP FRACTURES
A woman’s hip fracture risk equals
her combined risk of breast, uterine
and ovarian cancer
15-20% need long-term care
facilities
There is a 20% increased risk of
death during the first year following
a hip fracture
       MYTHS OR FACTS
Men do not get osteoporosis
Diet can provide all of the calcium a
body needs
If your grandmother had
osteoporosis, you will get it too
Dairy products are the only source
of calcium
     Activity – Myths or Facts About Osteoporosis
       MYTHS OR FACTS

If you have osteoporosis, you can
do nothing about it
Our bones stop growing when we
reach full height (about age 20)
Susceptibility to fractures can
indicate osteoporosis
       MYTHS OR FACTS
Low calcium intake during
adolescence can cause osteoporosis
later
Exercise is dangerous for older
people
   MEN & OSTEOPOROSIS
Lifetime risk of getting
osteoporosis is the same as a
man’s lifetime risk for prostate
cancer
Nationally, one in eight men over
50 will get osteoporosis
By age 75, one in three men will
get osteoporosis
 ALL
ABOUT
BONES
OSTEOPOROSIS: ―The Silent Disease‖

          ―Osteo‖ is Latin for ―bone‖
          ―Porosis‖ means ―porous or full
           of holes‖
          ―Osteoporosis‖ means ―bones
           that are full of holes‖
Osteoporosis can develop without
symptoms
You may not know you have the disease
until a bone fractures
       TYPES OF BONE
(1) Cortical – is hard, compact,
  dense bone (example: mid-
  section of larger, long-bones of
  arms and legs)
(2) Trabecular – is spongy, porous
  and flexible bone (example: end
  of the wrist, hip and the spine)

        Activity - Understanding Our Bones
HEALTHY BONE

      Bone is living
      tissue, which is
      constantly being
      broken down and
      rebuilt, a process
      called remodeling
      Bone is renewed
      like skin, hair and
      nails
      OSTEOPOROTIC BONE

                              The loss of
                              living bone
                              tissue makes
                              bones fragile
                              and more
                              likely to
                              fracture
Note: arrow points to micro - fracture
 BONE ―REMODELING‖

Resorption-
removes old
bone
Formation-
replaces old bone
with new bone
OSTEOCLASTS-PHASE 1




Cells called osteoclasts (think
―C‖ for chiseler) seek out old
bone or damaged bone tissue
and destroy it, leaving small
spaces (resorption)
OSTEOBLASTS – PHASE 2




 Cells called osteoblasts (think
 ―B‖ for builder) use minerals
 like calcium, phosphorus, and
 vitamin D to fill in the spaces
 with new bone (formation)
BUILD YOUR BONE BANK
You build bone until about age 30
Steps to building healthy bones
            include:
        Calcium & vitamin D
        Limit Caffeine & Alcohol
              Exercise
            Don’t Smoke
    BONE BANK DEPOSITS
From birth through adolescence, new
bone is built faster than old bone is
removed
In mid-life, depending on lifestyle and
other factors, bone removal can achieve
a balance with bone formation
After menopause, bone removal may
accelerate due to a decrease in
estrogen
    BONE LOSS & AGING
The first 5-15 years after
menopause a woman can lose
approximately 25 - 30 % of
trabecular bone & approximately
10 – 15 % of cortical bone
Bone loss often occurs
without symptoms or
warning signs
CHANGES IN BONE MASS




    After menopause, bone removal
accelerates due to a decrease in estrogen
  EARLY WARNING SIGNS
History of broken bones as an
adult
Unexplained back pain –
subsides after a couple of weeks
Loss of more than an inch in
height
Posture has become stooped
  OSTEOPOROSIS




Normal Posture   Dowager’s Hump
      CLARIFICATIONS

There is no relationship between
osteoporosis and arthritis
Osteoporosis is a generalized
bone disease that causes porous
bones, usually not causing
symptoms until a fracture occurs
      CLARIFICATIONS

Arthritis refers to a group of
diseases and conditions that
affect the joints and are usually
painful
Osteoarthritis is a degenerative
type of arthritis affecting the hip,
knees and tips of the fingers—no
relationship to osteoporosis
        CLARIFICATIONS

Steroids are sometimes used to treat
arthritis, and using steroids may put a
person at risk for osteoporosis
There is no clear relationship between
dental cavities and osteoporosis
Someone with osteoporosis may have
weakened jawbones and be prone to
losing teeth
 RISK
FACTORS
RISK FACTORS - CAN’T CONTROL

  Gender: Females are usually
  diagnosed with osteoporosis at four
  times the rate of males. Bone mass in
  males is approximately 15-20% higher
  than females
  Small Boned & Thin: may result in
  smaller bones with a lower bone
  density
         Activity - Risk Factor Worksheet
RISK FACTORS - CAN’T CONTROL

 Race/Ethnicity: Women, especially
 Caucasian and Asian women with thin
 frames are at greater risk
 African American women have a higher
 peak bone mass (10%) than Caucasian
 women, but other factors such as
 nutrition, exercise, certain diseases,
 and medications may increase their
 risk of osteoporosis
RISK FACTORS - CAN’T CONTROL

 Heredity: your family history may put
 you genetically at risk or may be a result
 of family members sharing the same
 environment, exercise, and nutritional
 habits
 Menopause or several months without
 periods: bone loss begins to exceed
 bone formation, due to a decrease of
 estrogen
RISK FACTORS - CAN’T CONTROL

 Age: In your 40’s you start to
 lose bone faster than you
 build new bone. The
 accumulated loss of
 bone puts an older
 person at higher risk
RISK FACTORS – CAN CONTROL

Calcium Rich Diet:
 milk, cheese, yogurt
Weight Bearing Exercise:
 walk, bike, run
Vitamin D:
 sunshine, multivitamin, fortified food
RISK FACTORS – CAN CONTROL

Caffeine: Recommendation-
No more than 2-3 cups of
caffeine beverages per day

Cola, coffee and
chocolate all
contain caffeine
RISK FACTORS – CAN CONTROL
 Alcohol: consuming more than
 one alcoholic drink per day is
 associated with risk of low bone
 mass
 Eating Disorders:
 anorexia nervosa or
 bulimia can lead to
 malnutrition and
 bone loss
RISK FACTORS – CAN CONTROL

             Smoking: causes
             lower bone density

 Immobility: extreme
 lack of exercise can
 lead to bone loss
    OTHER RISK FACTORS
Steroids - cause increased bone
breakdown and decreased bone
replacement
Prolonged hyperthyroidism – can
cause increased risk of bone loss
Thyroid hormone - (in excess) – acts
on bone cells to increase resorption
     OTHER RISK FACTORS
Diuretics – some types of diuretics may
increase excretion of calcium in the urine
Kidney failure – affects the metabolism of
calcium, phosphorous and vitamin D
Chronic hepatitis – chronic liver disease
may cause bone loss in several different
ways
Intestinal disease – some can affect the
absorption of vitamin D & calcium
DRUGS-MAY CAUSE BONE LOSS

 Cortisone                      Isoniazid
 Seizure drugs                  Lithium
 Cyclosporine                   Heparin
 Methotrexate
 Some Hormones                  Lupron®
                                Zoledex®
 Ask your healthcare provider
PREVENTION
    CALCIUM’S FUNCTION

Blood clotting (control bleeding)
Regulates heart beat
Muscle function
Nerve transmission
Bone formation
DAILY CALCIUM REQUIREMENTS

 Age                     Milligrams (mg)
 1-3 years                      500
 4-8 years                      800
 9-18 years                    1,300
 19-50 years                   1,000
 over 50 years            1,200- 1,500
 National Academy of Science
       CALCIUM NEEDS
Adolescents-may lack calcium due to
high fat snacks with empty calories,
soda and dieting
Eating Disorders-anorexic or bulimic
teens lack calcium and may develop
osteoporosis at an early age
Older Adults-may have increased
calcium need due to poor absorption
             SERVING SIZE
1 ½ cup (12 oz) of liquid is the size of soda-
pop can
1 cup (8 oz) of food is the size of large handful
½ cup (4 oz) of food is about half a large
handful
3 (oz) of cooked meat, fish, poultry is about
the size of a deck of cards
A serving size is the amount of the food after it
is cooked
SERVINGS-INCLUDE CALCIUM
                              Food            Serving

                              Fat:          Sparingly
                              Dairy:            2-3
                              Protein           2-3
                              Vegetable:        3-5
                              Fruit:            2-4
                              Grains:           6-11
  Activity - Calcium Worksheet or Calcium Card Game
           CALCIUM IN FOODS
1 oz cream cheese:           20 mg
1 hard boiled egg:           30 mg
½ cup cooked broccoli:       40 mg
½ cup cottage cheese:        80 mg
1 oz cheddar cheese:         205 mg
6 oz calcium-fortified OJ:   250 mg
1 cup milk:                  300 mg
1 cup fruit yogurt:          345 mg
3 oz sardines with bones:    370 mg
8 oz vegetable lasagna:      450 mg   Activity - Results to
                                      Calcium Card Game
FOOD LABELS
     Serving size & number
     of servings

     Calories, Total &
     Saturated fat in grams,
     Cholesterol & Sodium,
     Fiber, Sugars, & Protein
     in grams

     % Daily Value (DV)



     Daily Amount
   READING FOOD LABELS
Calcium content may vary greatly
between different brands of food
The percentage of calcium in a food is
based on 1000 milligrams. A food
containing 20% calcium = 200 mg
A food containing 10-19% of calcium
is a good source; 20% of calcium or
higher is a very good source
           Activity – Nutrition Facts
% DAILY VALUE OF CALCIUM
FOOD                                          %DV
Fruit yogurt                                  35%
Oatmeal                                       10%
Turnip Greens                                 20%
                                Total % DV = 65%
Add % DV by reading food labels to ensure
you get the recommended daily calcium
               Activity - Foods and Calcium
    LACTOSE-INTOLERANCE
Individuals who have difficulty
digesting the sugar found in
milk, called lactose
Start with small portions of
food such as milk--gradually
Increase portions
Eat dairy foods in combination with other foods
Many hard cheeses have less lactose than milk
Commercial lactase preparations aid digestion
  CALCIUM SUPPLEMENTS
Read Labels--several different
types of calcium supplements
available
Avoid -―natural‖ calcium such as
bone meal or dolomite-some
contain toxic lead or mercury
―Elemental calcium‖ - is the type of
calcium the body absorbs
     ELEMENTAL CALCIUM
Kinds of Calcium           % Elemental Calcium
Calcium carbonate                           40%
Calcium phosphate (tribasic)                39%
Calcium phosphate (dibasic)                 30%
Calcium citrate                             21%
Calcium lactate                             13%
Calcium gluconate                            9%
Example, a 500 mg calcium tablet may only contain
         45-200 mg of elemental calcium
         CALCIUM TIPS
Do not take more than 500 mg
of calcium at a time or 2000 mg
total per day
Your body can absorb only
about 500 to 600 mg at a time
Example: take one tablet at
breakfast and another at
dinner
CARBONATE            CITRATE
Needs acid to     Doesn’t require
dissolve and for   stomach acid for
absorption         absorption
Less stomach      May be taken
acid as we age     between meals
Take ―at‖ or      May cost more
―after‖ meals when
more stomach acid
TEST YOUR CALCIUM TABLET
Put a calcium tablet in a
cup of half water and
half vinegar. Stir
every 5 minutes.
If it doesn’t dissolve
in 30 minutes, it probably
won’t dissolve in your
stomach
VITAMIN D
     •Vitamin D is
     necessary for
     calcium to be
     absorbed
     •Multivitamin or
     calcium tablets may
     contain 400 IU daily
     (don’t exceed 800)
     •Vitamin D is in milk
     (100 IU in 1 cup)
             EXERCISE!
Walking
Dancing
Gardening
Tennis
Jump Rope
Volleyball
                 Activity – Exercise Guide
Skating
ENVIRONMENTAL SAFETY


             PREVENT
              PAINFUL
                FALLS

                   Activity –
             Environmental Safety
                   Cartoon
 BONE
DENSITY
TESTING
     WHO NEEDS TESTING?
If you have major risk factors for
osteoporosis
If you have a family history of osteoporosis
If you have a personal history of fractures
after age 45
If you are on prolonged use of steroids
If you are postmenopausal, and not on
estrogen replacement therapy
     Consult your healthcare provider
     SCREENING TESTS

Portable scanners:
SXA - (Single Energy X-ray
Absorptiometry), measures wrist
or heel
pDXA - (Peripheral Dual Energy
X-ray), measures wrist or heel
      SCREENING TESTS

RA - (Radiographic Absorptiometry),
x-ray of hand that is compared to a
small metal wedge
QCT - (Quantitative Computed
Tomography), measures the spine
Ultrasound - sound waves to
measure the heel, shin, and kneecap
DXA-BONE DENSITY TESTING
        WHAT IS A DXA?
DXA (Dual Energy X-ray
Absorptiometry) is the ―gold
standard‖
Measures bone density in the hip,
spine, and forearm
Painless, non-invasive, requires no
injections
Takes 10 - 20 minutes
      WHAT IS A T-SCORE?
  World Health Organization T-score is
 comparing the average bone density to
that of healthy young Caucasian women
T-Score                  Diagnosis
 0 to –1                 ―Normal‖
-1 to –2.5               ―Osteopenic‖-
                         low bone mass
-2.5 or lower            ―Osteoporotic‖
INSURANCE
         INSURANCE

Most insurance
policies cover bone
density testing for
diagnostic
purposes only, not
as a screening test
         MEDICAID

Medicaid will usually cover
―medically necessary‖
osteoporosis testing for
―high risk‖ individuals
Consult with your healthcare
provider
         MEDICARE
Women over age 65
Men and women with previous
spinal fractures
Men and women on prednisone
or other steroid-type
medications or who are
planning to begin such
medications
           MEDICARE
Men and women with primary
hyperparathyroidism
Men and women being treated with
drugs for osteoporosis to see if the
therapy is working
Deductibles & co-pays may apply
Covered every 2 years, if ordered by
healthcare professional
MEDICATION
    MEDICATIONS

  Estrogen - ―ERT‖
Fosamax® - Alendronate
 Actonel® - Risedronate
Evista® - Raloxifene
 Miacalcin® - Calcitonin
        ESTROGEN

Most cost-effective prevention
for osteoporosis
Slows bone loss and may
slightly increase bone mass
Estimated to reduce hip
fracture by 30-50%
      EVISTA (Raloxifene)

SERMS-Selective Estrogen Receptor
Modulators-designer drugs
SERMS act like estrogen but doesn’t
stimulate breast or uterine tissue
Evista is the first and only SERM
approved for the prevention and
treatment of osteoporosis
      BISPHOSPHONATES
Fosamax and Actonel
Specifically designed to affect the
skeleton, increase bone density &
reduce number of fractures
Must be taken correctly - on an empty
stomach, first thing in the morning
with glass of plain water, fasting, &
remain upright for 30 minutes
   FOSAMAX ® (Alendronate)
Approved for prevention and treatment
Approved for treatment of steroid-
induced osteoporosis in men and
women
Prevention – 5 mg daily
Treatment – 10 mg daily or
70 mg once weekly
(for men and postmenopausal women)
  ACTONEL ® (Risedronate)
Weekly 35 mg is approved for prevention
and treatment of osteoporosis in
postmenopausal women, and for women
who have osteopenia, but are not yet
postmenopausal
Daily 5 mg dose is approved for prevention
and treatment of glucocorticoid-induced
osteoporosis in women
Actonel may be given to males at the
discretion of the Health Care Provider
 MIACALCIN (Calcitonin)

Is a naturally occurring
hormone involved in calcium
regulation and bone
metabolism
Available by injection or nasal
spray
PUTTING
 IT ALL
TOGETHER
   SUMMARY


      Calcium Rich Diet
              Vitamin D
          Prevent Falls
Weight-Bearing Exercise
      SUMMARY


     Don’t Smoke
 Minimize Caffeine &
      Alcohol
Testing & Medication if
        Needed
 HEALTHCARE PROVIDERS

Healthcare
providers are the
best source of
information about
osteoporosis and
medical options
Activity – Affirming a Positive Change

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