Bone Health & Osteoporosis

Transcription

1 Fleitz Continuing Education Jeana Fleitz, M.E.D., RT(R)(M) The X-Ray Lady 6511 Glenridge Park Place, Suite 6 Louisville, KY Telephone (502) Fax (502) Web address address xrayladyce@gmail.com Bone Health & Osteoporosis Approved for 12 Category A Continuing Education Credits American Society of Radiologic Technologists Course Approval Start Date 01/01/08 Course approval End Date 02/01/16 Florida Radiologic Technology Program Course Approval Start Date 08/10/09 Course Approval End Date 01/31/15 Provider # Please call our office before course approval end date for renewal status. A Continuing Education Course for Radiation Operators

2 Bone Health & Osteoporosis Homestudy Course Course Description The course Bone Health & Osteoporosis provides bone health and osteoporosis information from the United States Surgeon General s 2004 report to the nation. The report offers comprehensive information about the bone health status of Americans, disparities in bone health, symptoms of poor bone health and current treatment protocols. The report also provides information for health care providers on ways to improve bone health information to patients and the community at large. This homestudy course contains the reference, posttest, answer sheet and course evaluation. Objectives: Upon completion of this homestudy course, the participant will: 1. Recognize the importance of bone health and relate bone health status to overall health and wellbeing. 2. Recall structural composition of bone and identify important impacts that contribute to both poor bone health and optimal bone health. 3. Identify risk factors associated with osteopenia, osteoporosis, and overall poor bone health quality. 4. List conditions, medications, and diseases that contribute to loss of bone density and contribute to poor bone health. 5. Differentiate between facts and fiction related to bone health and screening for bone mineral density. 6. Correctly respond to questions concerning risk factors associated with low bone mass density. 7. State recommended dietary guidelines for various ages and conditions in order to maintain optimum bone health. 8. Explain how confounding influences of hereditary, diet, environment, personal beliefs, and general health status impact bone health. 9. Select correct responses to questions concerning systems-based activities that collectively encompass the overall goal of improving bone health status of Americans. 10. Select correct responses to questions concerning population-based health interventions; such as, public education programs, community projects, and media interventions.

3 Fleitz Continuing Education Jeana Fleitz, M.Ed., RT(R)(M) "The X-Ray Lady" 6511 Glenridge Park Place, Suite 6 Louisville, KY Telephone (502) Fax address xraylady@insightbb.com Web Address Homestudy Course Directions Directions To complete this course read the reference included with your homestudy course. We suggest that you read the reference prior to answering the post-test questions. Complete the post-test questions. If you have difficulty in answering any question, refer to the reference. Complete the Answer Sheet and Course Evaluation Complete the post-test and record your responses on the answer sheet and complete the course evaluation. You may mail your answer sheet to 6511 Glenridge Park Place, Suite 6, Louisville, KY If you mail your answer sheet and course evaluation, retain a copy before mailing. We request that you do not fax your answer sheet unless you are within two weeks of your expiration date. If you fax your answer sheet and course evaluation, obtain verification from the machine that the fax was delivered or call our office for verification. OR Use the Online Answer Sheet on our website homepage at After completing the ONLINE Answer sheet, just hit submit to send via . Remember to also complete the online course evaluation. Grading and Issuance of a Certificate Your answer sheet will be scored within 1-2 days of arrival in our office. To obtain continuing education credit, you must have a cumulative average score of at least 75%. Verification of awarded continuing education for this course will be submitted to the following states: KY, IA, FL. For ARRT and all other states, please self-report to the state radiation certification agency in your state and the ARRT and any other organizations. You will be awarded a certificate verifying satisfactory completion of this course, or notification if you do not. We are now ing certificates so be sure to include your address. Please let us know if you prefer to receive a copy in the mail and allow 4-5 days to receive your copy. Need Additional Information You may call our office (502) voice mail. Our office hours are 9 a.m. 6 p.m. Monday through Friday. The office operates on Eastern Standard Time and is closed on major holidays. You may also us at xraylady@insightbb.com. For information, about courses or to order online, visit our web site at The X-ray Lady Refund and Exchange Policy, Certificate Replacement Policy, and other related policies are included in each course.

4 Important Information Updated 2013 **WE DO NOT BUY BACK USED BOOKS** (If you ship your materials back to us once you have completed a course and received credit we will not ship the materials back to you. They will be discarded.) The following policies apply only if you do not want your course and have NO plans on completing it for credit. Refund Policy Applies to Hardcopy Courses Customers have 30 days from the date of the original purchase to receive a refund. After 30 days customers may receive a credit towards future purchases for any materials/book returned to us. All refunds and credits will be subject to a $5 restocking fee per course. There will be no refunds or credits for shipping & handling charges once a course has already shipped to you. Refunds will not be issued until the course material/book is received in our office and considered to be in excellent condition. Customers are responsible for the shipping costs when returning materials to our company for a refund. Credits expire after one year from the issuance date. Refund Policy Applies to Ebook Courses No refunds will be issued for Ebook courses once the materials have already been sent. Customers wishing to return an unwanted Ebook course will have 30 days from the original date of purchase to receive a credit towards a future purchase minus a $5 processing fee. Credits expire after one year from the issuance date. Exchange Policy An exchange of a course may be made up to 30 days after the date of purchase. Customers are responsible for the shipping costs when returning materials for an exchange. After materials have arrived at our office and are inspected and are in excellent condition the replacement materials will be shipped. Customers are responsible for payment of new shipping costs and any difference in price for the replacement course The following applies to both the Refund and Exchange Policies Refunds will be issued in the same manner as the original order (i.e., credit card/check). Refunds on materials purchased with a personal or company check will be refunded with a cashier s check after initial check payment has cleared the banking process. No refund/exchange will be made for courses that are within one month of the course approval expiration date. About Your Certificates and Faxing Your Answer Sheets Effective : All course certificates will be sent via unless we are otherwise notified. Be sure to add our to your address book so that your certificate is not sent to your junk/bulk mail. If you have a new or different please notify our office or make note of it on your answer sheet. Please DO NOT FAX your course answer sheet(s) and evaluation form(s) to us unless your certificate is going to expire within two weeks of the date you complete the course. Instead we request that you maintain a copy of your answer sheet for each course you complete, and mail these to us at the address listed above OR use our online generic answer sheet on our website at (the link is in the top right hand corner on the homepage). Certificate Replacement Charge A $5 replacement fee per certificate will be charged for any request that occurs 30 days after the issuance date on the original certificate. We can send a duplicate certificate via your address or U.S. mail service. If you request that your replacement certificate be faxed, there will be a $3 fee per page. Please retain your course certificates in case the ARRT or state licensing agency conducts an audit of your records. Because of the staff time required to research and prepare a replacement certificate, we assess a charge for this service. This will not affect the majority of customers.

5 Disclaimer Notice Jeana Fleitz, M.Ed., RT(R)(M) The X-Ray Lady 6511 Glenridge Park Place, Suite 6 Louisville, KY Telephone (502) Fax (502) Web address www. x-raylady.com address xraylady@insightbb.com The X-Ray Lady courses have been evaluated and approved for specific amounts of continuing education (CE) credit by the agencies listed on the front cover of this course. The X-Ray Lady (provider of x-ray CE courses) does not imply or guarantee that completion of a course automatically ensures renewal or initial issuance of any state, national, or federal x-ray certification or licensure requirements. It is the responsibility of the individual, completing a course, to understand and to comply with state, national, and federal x-ray certification and licensure regulations regarding initial and renewal requirements. Further, the provider claims no responsibility for determining if the topic or amount of continuing education credit is appropriate for any person. The field of medical imaging is ever changing. Those completing X-Ray Lady CE courses are advised to check the most current product information provided by equipment and supply manufacturers. The provider does not assume any liability for any injury and/or damage to persons or property arising from information contained in a course. The information contained in a course should not be used for personal medical diagnosis or treatment. Users of this information are encouraged to contact their physician or health care provider for any health related concerns. The X-Ray Lady, LLC is neither responsible nor liable for any claim, loss, or damage resulting from the use of courses.

6 Bone Health and Osteoporosis Posttest X-Ray Lady 6511 Glenridge Park Pl., Ste. 6 Louisville, KY Telephone xrayladyce@gmail.com Web Address Use our 24/7 Online webpage Answer Sheet & course evaluation and automatically your answer sheet to our office 1. Healthy bones: a. allow for mobility b. serve as a storehouse for minerals c. protect against injury 2. Research has led to an understanding that certain medications such as are a significant contributor to osteoporosis. a. antibiotics b. vasodilators c. glucocorticoids d. hormones 3. It is estimated that in the year 2020 one in two Americans over the age of 50 will have, or be at high risk of developing osteoporosis. 4. The risk of mortality is 2.8 to times greater among hip fracture patients during the first 3 months after a fracture. a. 3 b. 4 c. 5 d The World Health Organization (WHO) estimates that million Americans over age 50 have low bone mass or osteopenia of the hip. a. 15 b. 25 c. 34 d Approximately % of individuals age years old report that they engage in no exercise at all. a. 15 b. 25 c. 45 d. 60

7 7. According to the text, the most important barriers towards bringing improvements in bone health relate to all of the following, except: a. men b. racial minorities c. ethnic minorities d. adolescents 8. In the Healthy People 2010 Osteoporosis and Bone Health Report, objective number 2.9 has as its target to reduce cases of osteoporosis by %. a. 2 b. 6 c. 8 d The skeleton is a storehouse for calcium and phosphorus. 10. Hydroxyapatite contains calcium and magnesium. 11. Trabecular bone makes up % of the total skeletal mass. a. 15 b. 25 c. 50 d During childhood bones grow because occurs inside the bone. a. restriction b. reduction c. resorption d. reversal 13. Peak bone mass is typically achieved by the early: a. teens b. 20s c. 30s d. 40s 14. Most of the adult skeleton is replaced about every years. a. 2 b. 5 c. 10 d. 18

8 15. Inhibition of bone formation is the dominant mechanism for weakening of the skeleton in: a. primary osteoporosis b. Paget s disease c. glucocorticoid-induced osteoporosis d. osteogenesis imperfecta 16. The final phase of bone formation lasts up to to months. a. 1 2 b. 3 4 c. 5 6 d Bone health is influenced by all of the following, except: a. genetic inheritance b. environment and diet c. physical activity d. socioeconomic status 18. Calcium regulating hormones include all of the following, except: a. cortisol b. parathyroid hormone c. calcitriol d. calcitonin 19. The hormone derived from vitamin D is: a. cortisol b. calcitonin c. calcitriol d. testosterone 20. Rickets in children and osteomalacia in adults is caused by a deficiency in vitamin: a. B b. C c. D d. K 21. Insulin-like growth factor-1 (IGF-1) is produced in large amounts in the: a. spleen b. liver c. bone marrow d. small intestines

9 22. The most common fractures in osteoporosis occur at all of the following locations, except: a. spine b. wrist c. hip d. skull 23. For practical purposes, the WHO has defined osteoporosis as a bone mineral density (BMD) value more than standard deviations below the mean for normal young white women. a. 1.0 b. 1.5 c. 2.0 d Juvenile osteoporosis affects previously healthy children between the ages of: a. 1 2 b. 4 5 c d Between 30% - % of elderly men are deficient in biologically active sex steroids. a. 40 b. 50 c. 60 d All of the following are genetic disorders that contribute to secondary osteoporosis, except: a. cystic fibrosis b. Ehlers-Danlos c. osteogenesis imperfecta d. ankylosing spondylitis 27. A study found that % of women with systemic lupus erythematosus reported at least one fracture since the onset of the disease. a. 5 b. 12 c. 18 d One factor that may cause bone loss in severely depressed individuals is increased production of: a. glucose b. insulin c. cortisol d. calcitonin

10 29. When more than 7.5 mg of prednisone or equivalent per day is administered, the fracture rate increases by at least fold by 6 months. a. 4 b. 10 c. 15 d An inherited condition, X-linked hypophosphatemic rickets, affects the kidneys ability to retain: a. water b. calcium c. phosphate d. protein 31. Adynamic bone disease is associated with: a. Cushing s syndrome b. renal osteodystrophy c. Paget s disease d. cystic fibrosis 32. In very rare cases less than % of patients with Paget s disease developed osteosarcoma. a. 1 b. 5 c. 12 d The most severe form of osteogenesis imperfecta is type: a. I b. II c. III d. IV 34. The most common benign bone tumor is: a. Ewing s sarcoma b. osteosarcoma c. myeloma d. osteochondroma 35. White women at age 50 years have a % lifetime risk of hip fracture. a b c d. 7.2

11 36. One-fourth of the spine fractures that come to clinical attention are caused by: a. car accidents b. falls c. pathology d. stretching and bending 37. Fracture incidence in the United States is usually highest for: a. Asians b. Blacks c. Whites d. American-Indians 38. Between the ages of 20 and 80, White women lose of their hip bone mineral density. a. one-fourth b. one-third c. one half d. two-thirds 39. Mexican-American women in the United States have an estimated prevalence of hip osteoporosis of %. a. 6 b. 9 c. 14 d The dialysis rate for Blacks is times greater than that of Whites. a. 5 b. 10 c. 15 d Despite the large numbers affected very few people die as a direct result of bone disease. 42. A prospective study of women over 65 showed that each standard deviation of bone loss at the hip was associated with a % increase in total mortality. a. 55 b. 42 c. 30 d. 25

12 43. The least debilitating fractures from osteoporosis occurs in the: a. hip b. spine c. pelvis d. wrist 44. The typical hip fracture patient is about years old. a. 90 b. 80 c. 70 d Only 40% - % of patients regain their previous ambulatory function a year after the hip fracture. a. 45 b. 56 c. 79 d In addition to functional impairments, fractures from bone disease can have a negative impact on: a. self-esteem and body image b. psychological mood c. feelings of isolation and helplessness 47. All of the following are clinical signs and consequences of spine fractures, except: a. weight loss b. kyphosis c. reduced lung function d. increase in height 48. Relatively healthy survivors of a hip fracture report a % reduction in quality of life in the first 12 months. a. 68 b. 52 c. 45 d A variety of studies indicate that genetic factors are responsible for determining 50% to % of bone mass and other qualitative aspects of bone. a. 55 b. 75 c. 80 d. 90

13 50. Between the age of 40-50, age-related bone loss may equal a total of % of bone. a. 15 b. 25 c. 35 d The Institute of Medicine (IOM) recommends that those ages 9-18 should have mg of calcium per day. a. 210 b c d Sunlight is the main source for vitamin: a. D b. A c. K d. C 53. Excess vitamin D can be toxic, leading to all the following, except: a. hypercalcemia b. hypertension c. kidney failure d. calcification of soft tissue 54. After reviewing available trial studies, investigators concluded that calcium supplements reduced bone loss by approximately % after 2 or more years of use. a. 12 b. 8 c. 4 d About % of the body s magnesium is found in the skeleton. a. 80 b. 70 c. 60 d Recent studies in adult women suggest that each additional gram of sodium eaten per day increase bone loss by % per year. a. 1 b. 2 c. 5 d. 7

14 57. The Surgeon General s Report recommends a minimum of physical activity of moderate intensity in most, if not all days of the week. a. 15 minutes b. 30 minutes c. 1 hour d. 2 hours 58. All of the following are true regarding the effects of physical activity on bone mass, except: a. the effects vary by age b. lifting weights helps improve bone density of the hips c. when activity level is stopped or reduced the effect diminishes accordingly d. bone gains will be greater in a sedentary person who becomes physically active than in an active person who increase his/her level of physical activity 59. Jumping from a height of roughly inches is a safe, effective simple method of improving bone mass and size in children. a. 5 b. 10 c. 15 d Sarcopenia refers to: a. overgrowth of bone matrix b. malabsorption of calcium c. involuntary loss of skeletal muscle mass d. overloading of cortical bone 61. All of the following are consistent predictors of bone mass in adolescents, except: a. body weight and height b. calcium levels c. pubertal development d. family income 62. Older women who experience weight loss in later years have been found to have a fold greater risk of subsequent hip fracture. a. 2 b. 4 c. 6 d About % to % of falls in the elderly result in fracture. a. 3 5 b c d

15 64. All of the following are true regarding reproductive factors and bone health, except: a. amenorrhea is linked to low bone mass b. bilateral oophorectomy does not result in decrease bone mass c. the effect of oral contraceptives on bone health has not been established d. pregnancy and lactation generally do not decrease bone mass of healthy adult women 65. Anti-seizure medications that cause bone loss include: a. Phenobarbital and sodium valproate b. Carbamazepine c. Sodium valproate 66. All of the following statements concerning threats to bone health are true, except: a. the nicotine and cadmium found in cigarettes can have a direct toxic effect on bone health b. alcoholism has not been demonstrated to have negative effects on bone c. lead is among the most significant environmental threats to bone health d. extreme low body weight has a negative impact on bone health 67. The Dietary Guideline for Americans recommends that individuals eat the following each day: a servings of grain foods and 3 5 servings of vegetables b. 2-4 servings of fruit c. 2-3 servings each of dairy or other calcium rich foods and meat or beans 68. The food source containing 306 mg calcium is: a. cheddar cheese, 1½ oz. shredded b. cream cheese, regular, 1 tbsp. c. sardines, canned in oil with bones, 3 oz. d. 8 oz. of soy beverage that is calcium fortified 69. Vegetables containing calcium that is well absorbed includes: a. carrots and turnips b. broccoli and kale c. spinach and beets d. asparagus and squash 70. One cup of fortified milk contains IUs of vitamin D. a. 25 b. 50 c. 75 d. 100

16 71. The nutrient that helps certain enzymes and local regulators function properly is: a. boron b. copper c. fluoride d. isoflavones 72. All of the following are examples of weight-bearing exercise for adults, except: a. lap swimming b. stair-climbing c. jumping rope d. jogging 73. Red Flags that warrant further assessment for osteoporosis or other bone disease include: a. history of fractures b. unusual cessation of menstrual periods c. high levels of serum calcium or alkaline phosphatase 74. A finding of a high serum alkaline phosphatase level is an indicator of: a. osteopenia b. osteomalacia c. Paget s disease d. osteopetrosis 75. The gold standard of tests for identifying osteoporosis and fracture risk is: a. radiography b. computed tomography (CT) c. magnetic resonance imaging (MRI) d. bone mineral density testing 76. The Osteoporosis Risk Assessment Instrument (ORIA) has % specificity. a. 93 b. 85 c. 70 d Among elderly white women those who currently use anticonvulsant drugs are considered to be at % increased risk for hip fracture. a. 100 b. 80 c. 70 d. 60

17 78. The U.S. Preventive Services Task Force (USPSTF) recommends bone density screening for all women age and older. a. 30 b. 45 c. 55 d The most widely accepted method for measuring BMD is: a. dual x-ray absorptiometry (DXA) b. peripheral DXA (PDXA) c. quantitative computed tomography (QCT) d. quantitative ultrasound (QUS) 80. The International Society of Clinical Densitometry (ISCD) recommends using the mean score for the L 1 to L vertebrae to calculate spine BMD. a. 3 b. 4 c. 5 d It is recommended that patients receiving high-dose long-term glucocorticoid therapy has BMD monitored every until BMD is shown to be stable or improved. a. 3 months b. 6 months c. year d. 18 months 82. All of the following are formation markers, except: a. osteocalcin b. N-telopeptide of type I collagen c. bone specific alkaline phosphatase d. carboxyterminal propeptide of type I collagen 83. Researchers found that on average, a drug that reduced bone resorption by 70% would decrease the risk of non-spine fractures by %. a. 20 b. 40 c. 60 d The most important use for bone markers today is in monitoring: a. severity of fractures b. compliance with proper diet c. effectiveness of ongoing therapy d. effects of an exercise program

18 85. The term that refers to actions that block or slow the progression of a disability to a state of dependency is: a. primary b. secondary c. tertiary d. remnant 86. All of the following are antiresorptive therapies, except: a. bisphosphonates b. estrogen c. teriparatide d. receptor modulators (SERMs) 87. Alendronate administration is not advised in patients with: a. hypertension b. gallstones c. renal failure d. abnormalities of the esophagus 88. Over a 3-year period, ibandronate has been shown to decrease the incidence of new spine fractures by %: a. 82 b. 75 c. 64 d The FDA approved estrogen in for the relief of menopausal symptoms. a b c d Investigators have found that there was a decreased incidence of breast cancer in women who took raloxifene for year(s). a. 10 b. 5 c. 3 d Calcitonin is a hormone secreted by cells found within the: a. thyroid gland b. liver c. pancreas d. gallbladder

19 92. Zoledronic acid was recently approved for treatment of all the following, except: a. hypercalcemia b. hypotension c. myeloma d. metastatic breast cancer 93. Approximately % of advanced prostate cancer patients develops clinically significant bone metastasis. a. 90 b. 80 c. 70 d Health care professionals that bear much of the responsibility of promoting awareness, diagnosis, prevention, and treatment of osteoporosis falls on: a. pediatricians b. geriatricians c. internists and primary care physicians 95. All of the following are true regarding infants who are born prematurely, except: a. it can take up to 15 years for their bone mass to catch up with that of fullterm newborns b. breast feeding may not provide for all of their nutrient needs c. those that are breastfed need added nutrients, particularly calcium, vitamin D, phosphorus, and protein d. those that are not breastfed should be given infant formulas that are designed to provide calcium and phosphorus 96. The efficiency of calcium absorption is greatest when calcium is taken in a dose of milligram (mg) or less. a b c d Sodium chloride intake increases: a. hormones released by the pituitary gland b. insulin secreted by the pancreas c. urine calcium excretion d. urine protein excretion 98. All of the following are true for older adults, except: a. calcium and vitamin D absorption increases with aging b. limited mobility causes the aged to be outdoors less and receive less sunlight c. recommended calcium intake is 1200 mg per day after age 50 d. protein supplementation has been shown to speed healing of hip fractures

20 99. A T-score less than 2.5 indicates: a. excessive bone mass b. normal bone mass c. osteopenia d. osteoporosis 100. The Z-score in older individuals compares the patient s bone density to that expected for their age, rather than to peak bone mass The physical therapist s role in bone health includes: a. evaluate patient balance b. evaluate the patient s risk of falling c. teach specific exercises and techniques to minimize risk of falling 102. The Clowes et al (2004) study suggests that the key to maximizing adherence to any therapy be: a. insurance reimbursement b. social acceptance of the therapy c. follow up by health care professionals d. family intervention and oversight 103. The health care system in the United States is a collection of independent enterprises, some small and some large, that provides or pays for various aspects of health care There is one overriding principle that governs systems-based approaches to osteoporosis and bone health that is, to focus on: a. hospital providers b. private practitioners c. populations d. Congressional support 105. The two aspects to the knowledge stage are the need for consumers to be aware of the importance of the bone health and for clinician to be aware of the evidence related to best practices for improving bone health.

21 106. The Assessing Care of Vulnerable Elder (ACOVE) project is aimed at changing behaviors related to: a. falls b. cognitive impairment c. urinary incontinence 107. A common strategy for using professional education to disseminate guidelines and evolving research includes presentations at meetings and other common continuing medical education activities has been overwhelmingly successful A systems-based approach to osteoporosis requires just treating the immediate problems or symptoms Public health agencies may want to consider supplementing their awareness activities with broad-based and/or targeted screening programs that include: a. vaccinations for influenza b. local screening for hypertension c. local screening for hypercholesterolemia 110. Several populations deserve special attention by all components of the health care system including the uninsured and underinsured, the poor, men, nursing home residents, frail elderly persons, and rural and other remote populations Minority populations that are more prone to lactose intolerance than are other groups include: a. Caucasians and Hispanics b. Pacific Islanders and African Americans c. Asians and African Americans d. American Indians and Asians 112. Men account for roughly % of all hip fractures. a. 5 b. 10 c. 15 d. 20

22 113. Regular physical activity is associated with improved health and reduced risk of overall mortality and has many bone health benefits, including reduced risk of osteoporosis and fractures The similarities in expression of the 2 risk factors, osteoporosis and elevated cholesterol, that suggest a program comparable to the National Cholesterol Education Program (NCEP) has the potential to be effective in improving bone health to include all of the following, except: a. the first symptom of each usually goes unnoticed b. osteoporosis is now and cholesterol was under detected and underdiagnosed c. both require a 2-prong approach, e.g., lifestyle change and early detection and control d. by knowing one s number, the condition can be assessed and treated as needed 115. To address lactose intolerance among Asian Americans, the Living Healthy kit suggests that Asian-American women can include dietary alternatives such as: a. tofu and soybeans b. bok choy c. seaweed 116. In 1997, Missouri State survey data showed that % of the state s population did not engage in adequate levels of physical activity. a. 95 b. 80 c. 65 d New Jersey s Project Healthy Bones was based on: a. public awareness of the need for calcium and vitamin D supplements b. the use of strength training exercises to improve bone density in older adults c. physician education about osteoporosis d. nutrition information to new mothers 118. Professional associations play a critical role in promoting bone health Fractures, especially in the elderly need to be thought of by both the public and practitioners as a sentinel event that probably signals: a. the presence of a frail skeleton b. increased risk of future fracture c. an opportunity to intervene to prevent future fractures

23 120. All health care professionals have a critical role to play in promoting the bone health of their patients by: a. paying close attention to bone health issues when conducting wellness visits and treating people with other illnesses b. emphasizing the basics of good bone health c. recognizing red flags and risk factors that might signal the potential for osteoporosis and other bone diseases