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Module 4: Healthy Bones Learning Goals:

• To increase awareness of healthy bones. • To introduce osteoporosis and the risk factors for developing

osteoporosis • To increase awareness of ways to get adequate calcium and

vitamin D every day

Key Messages: 1. Osteoporosis is a disease that makes bones thin and weak. If you have

weak bones and fall, you can easily break (fracture) your wrist, shoulder or hip. Lifting or twisting can cause fractures in your back if you have osteoporosis (Osteoporosis Canada). To keep your bones healthy and strong tell your doctor if you:

• have not had a bone density test • had a wrist or other fracture after age 40 • have lost more than 2 inches in height (ask for annual

height measurement) • take steroids (e.g. prednisone), anti-seizure or thyroid

medications • have difficulty taking prescribed osteoporosis medication

like Fosomax, Didrocal • have conditions which affect bone loss such as epilepsy,

kidney disease, neuromuscular disorders such as Parkinson’s, Multiple Sclerosis, chronic malnutrition/malabsorption (Celiac Disease, Inflammatory bowel disease COPD)

Ask your doctor what you can do to lessen your risk for osteoporosis

2. You can keep bones healthy and strong by doing weight bearing exercises (walking, dancing, and bowling), eating a balanced diet, and getting enough calcium and vitamin D every day.

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3. Adequate amounts of elemental calcium and vitamin D are necessary for healthy bones. Osteoporosis Canada recommends that people age 50+ get: • 1200 mg Calcium daily, from food and supplements, AND 800 - 2000 IU Vitamin D daily, from supplements Food is the preferred choice for calcium rather than only supplements

4. November is Osteoporosis Month. March is Nutrition Month. Readings:

Quick Reference Guide 2010 Clinical Practice Guidelines and Management of Osteoporosis http://www.osteoporosis.ca/multimedia/pdf/Quick_Reference_Guide_October_2010.pdf Executive Summary 2010 Clinical Practice Guidelines for the Diagnosis and management of Osteoporosis in Canada http://www.osteoporosis.ca/multimedia/pdf/Executive_Summary_October_2010.pdf

.

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Let’s Talk About

Healthy Bones

Date: Time: Place:

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Let’s Talk About

Calcium & Vitamin D

Come & Taste a Smoothie!

Source: Microsoft Office Clipart Collection Date: Time: Place:

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Let’s Talk About

Colors of Good Nutrition

Date: Time: Place:

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Lesson Plan

Site: ____________________________________ Date: __________ Module Number: 4 Healthy Bones Preparation

Advertising arranged? i.e. posters printed, room booked

Time

Introduction

To inform about osteoporosis, how to have healthy bones, the need for daily calcium and vitamin D. Engage the group to share their understanding of this topic

5 min

Learning Goals Key Message Activity 30 min

To increase the awareness of osteoporosis

Osteoporosis means porous bones. If you have weak bones and fall, you can easily break (fracture) your wrist, shoulder or hip A bone density test shows how thick or thin the bones are in the hip and spine . Lifting or twisting can cause small fractures in your back. (Osteoporosis Canada

Define osteoporosis from web site information www.osteoporosis.ca Encourage participants to ask their doctor to do an annual height measurement. If many participants have osteoporosis:

• encourage them to talk to a pharmacist about osteoporosis medications

Encourage those on osteoporosis medications to take adequate calcium and Vitamin D

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To increase awareness of how to maintain bone health.

Do activities where your legs carry your weight (walking, climbing stairs, dancing, and bowling)

For information on Physical Activity refer to: http://www.osteoporosis.ca/index.php/ci_id/5523/la_id/1.htm

To increase awareness of how to get adequate daily calcium and vitamin D

Eat a balanced diet, Calcium helps to keep bones strong. Vitamin D is needed to absorb the calcium. If you are over age 50 you need: - 1200 mg calcium from food ( the preferred choice) and supplements - 800 - 2000 international units (IU) vitamin D

Calculate your Calcium Intake refer to: http://www.osteoporosis.ca/index.php/ci_id/5523/la_id/1.htm Refer to Osteoporosis Canada website nutrition tab Discuss food sources of calcium - and supplements. Demo: smoothies, or sardines with different sauces, variety of calcium fortified beverages . Greek yogurt (0-1% milk fat) has more protein and calcium than regular yogurt. Discuss vitamin D supplement types e.g. drops tablets

Learning Resources

Choose the resources that are appropriate for the literacy level of your group

Summary Repeat the Key Messages 5 min

Evaluation

Pick from list of Reflective Questions and record responses for evaluation purposes Record number who attended

5 min

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Module 4 Resources: 1. Pictures

• Vertebral fracture cascade • “Do you think you’ve lost height?” Show how the collapse of the vertebra

results in loss of height and reduces the straight strong spine over time • Bone crossword puzzle • Orange smoothie Recipe for demonstration

http://www.osteoporosis.ca/index.php/ci_id/5524/la_id/1.htm Osteoporosis Canada Information on Exercise

1. Health Canada Information

a. Eating Well with Canada’s Food Guide b. A Resource for Educators and Communicators for Eating Well with

Canada’s Food Guide c. http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/educ-

comm/resource-ressource-eng.php

Dieticians of Canada Information www.dietitiansofCanada.ca Samples • Empty containers of foods and drinks high in calcium • Empty supplement bottles for calcium - tablets, liquid, effervescent,

chewable tablets, soft chews • Empty supplement bottles for vitamin D – tablets and drops • Food models of dairy servings and foods that are alternate sources of

calcium • Supplies for making orange juice smoothies • Containers of calcium rich food products for taste testing e.g. sardines

with various sauces, salmon with bones, fortified orange juice, rice and soy beverages

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8. Demonstration themes for osteoporosis education Suggestion 1: To demonstrate bone mineral density Use a heavy mug to show that high bone density makes stronger bones. Get a bone china tea cup to describe the weakness of the bone density when osteoporosis is present. Discuss fracture risks if each one falls Show the Vertebral cascade to show the results of collapsing vertebra in the spine Suggestion 2 Demonstrate importance of Daily Calcium intake need for Vitamin D supplements Place a pile of the empty sources of calcium on one chair as you talk with participants about food sources of calcium and types of supplements. Have another chair on the opposite side of speaker. Explain that the calcium needs to get to the bone sites and Vitamin D is necessary to help the body absorb all the high calcium foods and supplements. Talk about Vitamin D being the train that hauls the calcium to the bone construction sites

Evaluation Reflective Questions: At the end of each presentation, pick one of these questions. Ask the whole group the question or go around the room to each participant. Preface: Let's take a few minutes to think about what we've heard and how we'll use it in our lives. Questions:

• What's one thing you will start doing after this talk?

• What's one thing you will stop doing after this talk?

• What's one thing you will change after this talk?

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• What's one thing you'll do today or this week because of what you have just learned?

Picture provided by the Osteoporosis Society of Alberta

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Did You Know?

Source: Singapore General Hospital – Osteoporosis Patient Resource. URL: www.sgh.com.sg/.../Osteoporosis.htm

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Orange Breakfast Smoothie

Yields 3 servings of 250 ml. each Keeps covered in the fridge for 3 days For demonstration, you will need:

Disinfectant cloths Hand blender Whisk Spatula Measuring cups Pitcher Plastic container with lid Package of skim milk powder Disposable Dixie cups (taste test only not the full serving is provided) Sample bottle of Vitamin D supplement

Need to purchase:

6 oz. orange juice 1 cup low fat (1% milk fat) plain yogurt ½ tsp vanilla extract

Method

1. Wash your hands 2. Mix together

6 oz. orange juice 1 cup low fat (1% milk fat) plain yogurt 1/3 cup skim milk powder ½ tsp vanilla extract 1 cup water or ice

3. Mix until smooth

Let participant demonstrate making a second batch

Nutrition Facts for Orange Breakfast Smoothie

Serving Size 8 oz (220 g)

Amount Per Serving

Calories 139 Calories from Fat 14

% Daily Value

Total Fat 1.6g 0%

Saturated Fat 0g 0%

Cholesterol 5mg 1%

Sodium 105mg 4%

Total Carbohydrate 20.5g 11%

Dietary Fiber 0.1g 0%

Sugar 14g

Calcium 453mg

Protein 10g

Vitamin A 8% Vitamin C 43%

Calcium 45% Iron 2%

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Suggested Inventory List for Module 4 Kit

Module 4: Bone Health

Quantity Item (s) Comments 1 Folder with Module 4

Pictures for Group Discussion • Vertebral fracture cascade • Did you know?

Handouts • Eating Well with Canada’s Food

Guide Osteoporosis Canada (see list)

Choose 1 or 2 handouts that are appropriate for your group (consider literacy level)

1 bag Empty containers of food and supplements high in Calcium • Orange juice with Calcium • Fortified RICE beverages • Fortified SOY beverages • Plain Greek Yogurt – low fat • Cottage Cheese • Pudding mix to make with skim

milk • Can of salmon with bones • Papers from cans of sardines

• Empty bag of whole unsalted almonds

• Instant oatmeal with calcium added

• Calcium carbonate and citrate – tablets, liquid, chewable,

effervescent Vitamin D – tablets, drops

Smoothies kit

• Disinfecting wipes /bag J-cloths • 1 blue lid pitcher • 1 fitted lid container • 1 set metal measuring cups • 1 spatula • 1 metal whisk • 1 hand blender • 1 bag skim milk powder

1 package small paper cups

Purchase: Orange juice

Yogurt