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© 2004 Wolf Rinke Associates, Inc. All rights reserved for this self-directed, accredited learning program. Reproduction in whole or part without written permission from the publisher is prohibited.
Customer Comments
Mary Lisa Underwood: "I have taken four Wolf Rinke study courses so far. All the materials have been enjoyable to read. They have been packed with information that will be professionally usefull."
Agapita Beninati: "Completing this course vividly enriched my knowledge and understanding of the disease!"
Shirley Dunn: "Well written, it will help me do an in-service."
Lori Adler-Stern: "Facts about osteoporosis that I could relate to myself."
Kathryn Curtis: "The topic was specific enough to be direct and interesting."
Gael M Germain: "Your program was written in a very consumer friendly way and was well organized."
Overview and Instructions
Osteoporosis awareness is becoming increasingly widespread. Nutrition professionals
must be aware of the etiology of osteoporosis, as well as prevention and treatment.
There are more women and older adults than ever participating in community and
outreach health programs, and seeking independent nutritionists for consultation
about their bone health. To meet the nutritional needs of those who are concerned
about their bone health, nutrition professionals must understand the rationale
for specific nutrient and health recommendations in both preventive health and
therapeutic nutrition.
This self-directed, accredited learning program begins with an explanation of
the bone architecture and prevention strategies. This chapter also includes
an explanation of bone densitometry tests and biochemical markers. In chapter
2, the treatment of osteoporosis is discussed, including diet, exercise and
pharmacologic agents.
Chapter 3 reviews the screening, diagnostic, and monitoring guidelines. Although
one universal set of guidelines has not been published, the nutrition professional
will be knowledgeable concerning guidelines of several professional organizations.
Chapter 4 summarizes secondary causes of osteoporosis. Two case studies provide
practice and application.
This is a category I Continuing Professional Education (CPE) learning program
approved for 9 Continuing Professional Education Units (CPEUs). That means that
the learner has little or no prior knowledge of the geriatric nutrition literature.
The focus is to increase knowledge and application by the learner.
We suggest you follow these learning guidelines:
Wolf Rinke Associates, Inc.
P.O. Box 350
Clarksville, MD 21029
fax: 410-531-9282
Upon receipt of your successfully completed CPE REPORTING FORM, 9 CPEUs will
be reported to the accrediting agency which you specify.
STUDY WELL AND ENJOY THE LEARNING PROCESS!
Karen Chapman-Novakofski, PhD, RD, LD
Goals and Objectives
Goals
To provide you with comprehensive nutrition information that will enable you
to counsel clients concerning their bone health and improve the quality of their
life.
Objectives
As a result of studying and applying the information presented in this accredited,
self-directed learning program, you will be better able to:
Table of Contents
Chapter 1. Preventing Osteoporosis 1
Bone architecture 2
Defining osteoporosis 5
Medical definition 5
Diagnosis 5
Considerations in densitometry 9
Risk factors for osteoporosis 10
Non-modifiable risk factors 11
Genetics and family history 11
Ethnicity 13
Gender 16
Age 16
Being frail or in poor health 17
Modifiable risk factors 18
Estrogen deficiency 18
Poor diet 19
Calcium 19
Vitamin D 23
Physical inactivity 25
Alcoholism 26
Smoking 27
Related nutrients 28
Fluoride 28
Magnesium 29
Phosphorus 31
Vitamin A 31
Vitamin K 32
Biochemical measures of bone metabolism 33
Urinary calcium 34
Markers of bone formation 36
Total alkaline phosphatase 36
Bone-specific alkaline phosphatase 36
Osteocalcin 36
Propeptides of type 1 collagen 37
Markers of bone resorption 37
Urinary hydroxyproline 37
Pyridium crosslink and
crosslinked telopeptides 37
Bone sialoprotein 38
Tartrate-resistant acid phosphatase 38
Sources of variability 38
Clinical applications 39
Fractures 40
Chapter 2. Treating Osteoporosis 43
Nutrition 43
Calcium 43
Vitamin D 46
Soy isoflavones 48
Physical activity 48
Pharmacologic agents 49
Hormone replacement therapy (HRT) 49
Biphosphonates 50
Calcitonin 51
Selective estrogen receptor modulators (SERMS) 51
Parathyroid hormone 52
Other medications 52
Chapter 3. Screening, Diagnosis, and Monitoring Guidelines 55
Chapter 4. Secondary Osteoporosis 59
Osteoporosis due to other disease states 59
Osteoporosis due to medications 60
Case Studies: Case Study 1 63
Case Study 2 66
References 71
List of Abbreviations 91
Glossary 93
Self-Assessment Questions 95
Answer Key 105
Explanations to Self-Assessment Questions 107
About the Author 113
About Wolf Rinke Associates, Inc. 114
About the Author
Karen Chapman-Novakofski, PhD, RD, LD, is a registered and licensed dietitian with more than ten years of experience working in the area of bone health. With eleven years experience as a clinical dietitian, Karen is also an Associate Professor of Nutrition in the Department of Food Science and Human Nutrition, the Division of Nutritional Sciences, and the Department of Internal Medicine at the University of Illinois. Dr. Chapman-Novakofski has published more than sixty journal articles and abstracts, and teaches nutrition and bone health in both a community setting and at the graduate level of professional development. She recently was awarded the Award of Excellence from the Nutrition Education for the Public Dietetic Practice Group of the American Dietetic Association for her "Happy Bones" Osteoporosis Prevention Program. Karen is a member of many professional organizations including the American Dietetic Association, the Society for Nutrition Education, and the American Society for Nutritional Sciences.