OsteoporosisA Community Health Promotion

Projectby

Keressa Clark, Karen Melton, Revonda Watts, and Kayla Williams

Why Osteoporosis is a Problem

• Osteoporosis affects over 10 million people in the United States

• Affects over 200 million people worldwide• Cause of over 1.3 million fractures a year in the

United States• 18 million at risk in the United States• Usually no symptoms until a fracture occurs• Fractures cause increase hospitalizations and long

recovery

How We Addressed The Problem• Education provided to a group of adults 55

years or older on Osteoporosis• This project took place at the Slater Senior

Center in Bristol• The group consisted of 45 females and 2

males• Covered material included the definition,

causes, risk factors, symptoms, diagnosis, treatment, and prevention of osteoporosis

• A section devoted to exercises• Project boards were set up• Hand outs and calculators were provided for

each participant• Each presenter asked and answered multiple

questions throughout the presentation• Effectiveness of this project was evaluated

using a Likert scale questionnaire that was given at the end of the presentation

• Ice cream sundaes were provided to allow for interactive nutritional education

Karen educated the group on the following topics:

What is Osteoporosis• A disease that causes weak, thin, and brittle

bones which may result in bones breaking with little to no injury

Causes• Bone loss due to normal aging• Less than ideal bone growth in childhood or

adolescence• Reduced estrogen in women and reduced sex

hormones in men• Other disease processes that inhibit bone

growth or vitamin absorption• Hereditary factors• Certain medications

Risk factors you can not change• Age • Genetic/ethical background• Personal history of previous fractures

Risk factors you can change• Low body mass and weight• Smoking• Alcohol consumption• Caffeine consumption• Inactivity• Hormone deficiencies• Diet low in calcium and vitamin D • Long term use of medications that can contribute to

osteoporosis

Symptoms• Back pain• Loss of height• Stooped posture• Usually no symptoms until a fracture occurs

Diagnosis• Your doctor will take a medical history to

determine your risk • Blood test may be ordered to determine any

underlying cause of bone loss• A bone density scan (DEXA) will be done to

determine your bone mass and any loss of bone mass

Revonda educated the group on the following:

Treatment of OsteoporosisNon-pharmacological treatments Include:• Exercise• Prevent falls• Vitamin D• Calcium • Gain weight• Stop Smoking

Pharmacologic approachesBisphosphonates• Commonly used to treat osteoporosis• A class of drugs that prevent the loss of bone

mass due to osteoporosis.• Fosamax 70 mg oral weekly• Boniva 150 mg oral monthly• Actonel 35 mg oral weekly• Reclast 5 mg intravenous for three doses

annually

How do bisphosphonates work?• After binding to the mineralized bone surface,

they are taken up by osteoclasts during bone resorption.

Precautions/side effects:• Take with plenty of water at least 8ozs• Take in the am 30 min before your first meal,

drink, or other medication.• Do not lay down, recline or bend over for 30

minutes after taking this medication • Call if difficulty swallowing, rash, shortness of

breath, acid reflux , abdominal pain, or musculoskeletal pain occur.

• This medication may cause constipation and nausea

Other Pharmacologic Treatment Options:• Estrogen Replacement therapy• Evista 60 mg oral daily• Calcitonin (Miacalcin) 200 IU nasal daily• Forteo 20 mcg subcutaneous daily up to two

years (Parathyroid hormone)Natural Remedies:• Fosteum (FDA approved)• Herbal Supplements• Naturopathic Approaches

Keressa educated on the following:

Prevention of Osteoporosis• Calcium supplements• Vitamin D • Stop smoking• Know your risk factors• Don’t drink alcohol• Don’t be sedentary• Limit caffeine intake

Prevention of Osteoporosis Continued• Keep weight above 126 lbs or body mass

above 18• Do weight bearing exercises• Get a bone density scan• Know your T-score and what it means• Consider hormone replacement• Talk to your doctor about your medications

that may increase your risk• Increase dietary intake of calcium

Foods High in Calcium

• Produce Serving Size Calcium• Collard greens 8 oz 360 mg• Broccoli rabe 8 oz 200 mg• Kale, frozen 8 oz 180 mg• Soy Beans, green 8 oz 175 mg• Bok Choy 8 oz 160 mg• Figs, dried 2 figs 65 mg• Broccoli 8 oz 60 mg• Oranges 1 whole 55 mg

• Seafood Serving Size Calcium• Sardines 3 oz 325 mg• Salmon 3 oz 180 mg• Shrimp, canned 3 oz 125 mg• Dairy• Ricotta 4 oz 335 mg• Yogurt, plain 6 oz 310 mg• Milk 8 oz 300 mg• Yogurt with fruit 6 oz 260 mg• Mozzarella 1 oz 210 mg• Cheddar 1 oz 205 mg• Yogurt, Greek 6 oz 200 mg

• Fortified Food Serving Size Calcium• Almond , rice, soy milk 8 oz 300 mg• Orange, fruit juices 8 oz 300 mg• Tofu w/calcium 4 oz 205 mg• Waffle, frozen 2 pieces 200 mg• Other• Mac & cheese, frozen 1 package 325 mg• Pizza, cheese, frozen 1 serving 115 mg• Pudding 4 oz 160 mg• Beans, baked, canned 4 oz 160 mg

Kayla educated and demonstrated the following:

Exercises• Exercise is key to building and maintaining

strong bones and muscle.• Weight bearing/strength exercises, balance,

and flexibility• Get permission from your doctor before

starting a new exercise or exercising for the first time, especially if previous surgery, fracture, health conditions etc

Safety First!• Drink plenty of water/stay hydrated • Wear comfortable clothes and sturdy shoes• Be aware of your surroundings: no scatter rugs,

animals running around etc.• Breathe regularly during strength exercise• Use smooth steady movement when lifting weights• Keep arm and leg joints slightly bent• Make slow steady movements• Always bend from the hips, not the waist• Stop if you feel pain

Warm Up• Spend about 5 minutes at the beginning of your routine

to warm up to help prevent injury• Walking, jogging• Ride a bike• Dancing• Walk up and down the stairs a few timesStrength Exercises• Hand grip• Wall push-up• Overhead arm raise• Back leg raise• Side leg raise• Toe stand

Balance Exercises• Stand on One Foot• Heel-to-Toe Walk• Balance WalkCool Down/Flexibility• Ankles• Back• Thigh• Shoulder/upper arm

Evaluation Results• Do you or someone you know have osteoporosis?• YES: 87% NO: 13%• Prior to today’s presentation, did you know about risk factors

and ways to prevent or treat osteoporosis?• YES: 25% NO: 5% SOME: 1% • Do you feel today’s presentation helped you gain better

knowledge in these areas:• YES: 100% • Did we properly address any areas of concern you may have?• YES: 90% NO: 7% SOME: 3% • Would you be willing to attend another presentation from

King University’s FNP students?• YES: 84% NO: 16%

ANY ADDITIONAL COMMENTS:• “Everyone involved seemed to be truly into the program.”• “Meds and side effects are very important to “old” people-you might

include our decreased levels of metabolism more, also,-we are all concerned with costs of meds-as well as MD training in this area today!”

• Multiple “Good Job” comments• “Very good presentation”• “Everyone did a very good job”• “Good Job!! Thanks. Please do another presentation” with little hearts

drawn out from comments!!• “Great job! Let’s have more”• “Could have included comments on osteopenia”• “Excellent presentation-ladies were so knowledgeable and

communicated properly”• “The ladies were very knowledgeable. Very helpful. Great dispositions.”• “Well done.”

Ice Cream Social

Project Boards and Handouts

References• American Academy of Orthopaedic Surgeons.(n.d.).Osteoporosis/Bone

Health in Adults as a National Public Health Priority. Retrieved May 13, 2015 from http://www.aaos.org/about/papers/position/1113.asp

• Arcangelo,V.P. (Eds.). (2013). Osteoporosis. In V.P. Arcangelo & A.M. Peterson Pharmacotherapeutics for advanced practice. A practical approach (3th ed., pp. 896-903). Ambler, PA: Lippincott Williams &Wilkins.

• National Institute on Aging at the National Institute of Health. (2015, March 17). Workout to go. Retrieved from https://www.nia.nih.gov/sites/default/files/workout_to_go_1.pdf

• National Osteoporosis Foundation.(2015). Exercise for strong bones. Retrieved May 17, 2015 from http://nof.org/exercise

• National Osteoporosis Foundation. (n.d.). Making a Diagnosis. Retrieved from http://nof.org/articles/8

• National Osteoporosis Foundation. (n.d.). A Guide to Calcium-Rich Foods. Retrieved from http://nof.org/articles/886

• Physioworks. (n.d.). Osteoporosis. Retrieved from http://physioworks.com.au/injuries-conditions-1/osteoporosis

• Uphold, C.R. & Graham, M.V. (Eds.). (2013).Clinical guidelines in family practice (5th ed., pp. 849-860). Gainesville, FL: Barmarrae Books.