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Office of the Surgeon General (US). Report of the Surgeon General's Workshop on Osteoporosis and Bone Health: December 12 – 13, 2002, Washington, DC. Rockville (MD): Office of the Surgeon General (US); 2003.

Cover of Report of the Surgeon General's Workshop on Osteoporosis and Bone Health

Report of the Surgeon General's Workshop on Osteoporosis and Bone Health: December 12 – 13, 2002, Washington, DC.

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Promising Public Health Prevention Strategies for Individuals and Families in Communities

The fourth panel, chaired by CAPT Allan S. Noonan, M.D., M.P.H., of the Office of the Surgeon General, focused on promising public health prevention strategies. In moderating the session, Dr. Noonan emphasized the diversity of the different programs featured, including individual, community, and state and Federal government approaches. Collectively these initiatives provide a roadmap for how people and organizations can participate in preventing bone disease from a variety of perspectives. He also emphasized that a public health approach to preventing bone disease can ultimately help to reduce costs. Yet today the U.S. spends only 1% of its health care dollar on preventive activities. Governments at all levels–Federal, state, and local–need to increase their commitment to prevention, thereby serving as catalysts for bringing together the community to prevent bone disease and its associated complications for individuals of all ages.

What Individuals Can Do to Assure Their Future Bone Health

Connie Weaver, Ph.D.

Purdue University

Dr. Weaver reviewed the importance of good diet to building bone and to keeping bones strong. She emphasized the importance of developing healthy behaviors early in life, both because early habits carry on into later life and because there is a narrow opportunity during youth to build bone. Figure 9 illustrates this latter point, showing that the rate of accumulation in both boys and girls rises rapidly until puberty, but then falls off dramatically. Total bone mass continues to grow until later in life. Boys tend to have a steeper accumulation curve than girls, and African Americans tend to accumulate bone at a faster rate than do Caucasians.

Figure 9. Maximal Bone Growth Precedes Peak Bone Mass.

Figure 9

Maximal Bone Growth Precedes Peak Bone Mass. Source: Martin AD; Bailey DA; McKay HA; Whiting S. Bone mineral and calcium accretion during puberty. Am J Clin Nutr 1997 Sep; 66(3):611–5.

Nutrients and dietary habits help to promote calcium retention and strong bones. By getting enough calcium, vitamin D (vitamin D promotes absorption of the calcium), and other nutrients including phosphates and magnesium, individuals are more likely to build strong bones. A diet that is low in salt and full of fruits and vegetables can help to minimize the amount of calcium loss from the bone via the urine. The net result should be a maximization of peak bone mass, minimal bone loss, and good body weight management. Unfortunately, however, most individuals are not getting adequate levels of calcium. In fact, after age 11, males, and to a greater extent females, fall below recommended levels, as exhibited in Figure 10.

Figure 10. Mean Calcium Intakes Fall Below Recommended Levels.

Figure 10

Mean Calcium Intakes Fall Below Recommended Levels. Source: Connie Weaver.

Christine M. Snow, Ph.D.

Oregon State University

Dr. Snow reviewed the unique role that exercise can play in building bone, preventing falls, and reducing fracture risk. She focused primarily upon exercise during youth and early adulthood (e.g., pre-menopause for women). Load-bearing exercises are central to bone development and maintenance. Bone-building exercises need to be site specific (i.e., they will help build bone in those areas that are the focus of the exercise) and involve “overloading” the bone through increased force and loading rates, which occurs in exercises such as jumping and aerobics. The bone-building benefits of exercise are particularly large in youth. Both impact and resistance exercises have been shown to increase bone mass by 3% to 5% and to alter bone geometry in boys and girls before adolescence. Exercise early in life appears to provide lasting benefits, as adults who engage in impact exercise during their youth have greater bone mass than those who do not.

Adults can benefit from exercise as well. Studies of premenopausal women show that spine loading exercise (e.g., rowing, upper-body lifting) increases bone density by 2% to 3%; use of a weighted vest combined with impact exercise increases hip BMD by 2% to 3% and also improves lower body strength, balance, and power; controlled impact exercises such as jumping increase hip BMD by 3%; and step aerobics and jumping increase spine and hip BMD by 1% to 2%. In some cases, these benefits can accrue with as little as 5 to 10 minutes of exercise, 5 days a week. That said, adults must continue exercising if they want to maintain these benefits. Studies show that adults lose 1% to 3% of bone mass within three to six months of ending an exercise regimen. As Dr. Snow noted, “if adults don’t use it (bone mass), they lose it.”

Miriam E. Nelson, Ph.D.

Tufts University

Dr. Nelson expanded upon Dr. Snow’s comments by reviewing the benefits of physical activity in adults over the age of 50. She believes that adequate evidence exists to make the following recommendations to this population: get 30 minutes or more of moderate physical activity on most (preferably all) days of the week; and include a mix of exercises during this physical activity, such as weight-bearing exercises, strength training (two or three times a week), and balance training (to help prevent falls). These recommendations are outlined in Figure 11.

Figure 11. Global Recommendations: Physical Activity in Middle-Aged and Older Adults (50+ Years of Age).

Figure 11

Global Recommendations: Physical Activity in Middle-Aged and Older Adults (50+ Years of Age). Source: Miriam Nelson, Tufts University.

The benefits of these types of activities are significant. For example, weight-bearing exercises such as walking are associated with higher bone density. Walking more than a mile every day over long periods of time is associated with slower bone loss, and older women who walk for exercise are 30% less likely to fracture a hip. Other weight-bearing activities such as tennis and gardening are also associated with higher bone density. On a cautionary note, Dr. Nelson noted that most longitudinal studies of short-term walking–less than 12 months–show little slowing in bone loss; to maximize benefit, walking needs to be long-term and combined with other exercises.

For its part, strength training by older adults is associated with higher bone density and increased muscle strength. Studies indicate that engaging in moderate to strenuous strength-training exercises two or three times a week yields improvements in bone density of 1% to 2%. These exercises can be performed at home or in exercise facilities. Finally (and perhaps most importantly for elderly individuals), balance training helps to improve coordination and balance, and has been shown to reduce falls by 30% to 40%. These exercises can also be performed in the home.

In short, safe, culturally appropriate exercises can be fun and effective. A number of community programs for older women have been developed across the country (e.g., the Growing Stronger Program in Washington, D.C.). These programs–which can be developed wherever seniors congregate–can have a significant impact on bone health, balance, and muscle, which in turn should lead to a reduction in fractures.

Doug Kiel, M.D., M.P.H.

Research and Training Institute

Dr. Kiel reviewed the impact of smoking on bone density and fracture rates. Smoking early in life would not appear to have an effect on bone density in either men or women. After menopause, however, women who smoke lose bone mass at a greater rate than nonsmokers (see Figure 12). The evidence also suggests a causal relationship between smoking and bone density in older men. Smokers also have a greater risk of suffering a hip fracture, particularly as they get older (see Figure 13).

Figure 12. Differences in Bone Density Between Smokers and Non-smokers.

Figure 12

Differences in Bone Density Between Smokers and Non-smokers. Source: Law MR; Hackshaw AK. A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture. BMJ 1997; 315:841–846, with permission from the BMJ Publishing Group. (more...)

Figure 13. The Risk of Hip Fracture in Smokers Increases with Age.

Figure 13

The Risk of Hip Fracture in Smokers Increases with Age. Source: Law MR; Hackshaw AK. A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture. BMJ 1997; 315:841–846, with permission from the BMJ Publishing Group.

On a different but related note, Dr. Kiel also reviewed the rationale for use of hip protectors by older individuals at high risk of a hip fracture. Most hip fractures occur because of falls to the side. Energy absorption in soft tissue may account for 75% of the total energy transmitted during the fall. A hip protector system–like a car seat belt or bicycle helmet–can help to absorb much of this energy, effectively diverting it from the skeleton. A meta-analysis of six randomized controlled trials showed that hip protectors reduce the risk of hip fractures by as much as 63% to 76%. And unlike pharmacologic therapies that take one or two years before they are effective, hip protectors provide immediate benefits.

Federal Programs to Promote Bone Health for All Ages

Saralyn Mark, M.D.

National Bone Health Campaign, Office of Women’s Health, Department of Health and Human Services

Dr. Mark reviewed the National Bone Health Campaign, a national social marketing campaign to promote bone health in girls between the ages of 9 and 18 and thus reduce their risk of osteoporosis later in life. The initial focus of the effort is on girls 9 to 12 years of age, an age range that represents a “once-in-a-lifetime” opportunity to build skeletal mass. The campaign’s tailored messages make use of parents and other adults as spokespersons, since they may have influence over the behavior of young girls.

The initiative was based on lessons learned from a series of focus groups designed to understand current knowledge levels and motivating forces among girls and their parents. The focus groups with girls found that they had little knowledge of the health benefits from calcium and physical activity, or of the amount of each they needed to promote bone health. But these girls could be motivated by messages that invoke “power” and “strength”–especially if the spokesperson is a strong, bold, confident, active female who is part of a group. Based on this research, the “Powerful Bones, Powerful Girls” campaign name was developed. For their part, parents had little knowledge of the calcium requirements or physical activity requirements for adolescent girls, although they perceived calcium to be good for overall health. (The parents’ primary concern was having their daughters eat a diet that was good for their overall health.) Barriers to achieving a healthy diet rich in calcium were as follows: a perceived need for a large quantity of food to meet the calcium requirements; a lack of time to prepare healthy, calcium-rich meals; inadequate financial resources to buy groceries and other necessities; and a lack of perceived influence over their daughter’s behavior.

The campaign was launched in September 2001. It consists of a web site for girls (www.cdc.gov/powerfulbones), advertising and promotion to girls and parents, and collateral material for girls (e.g., calendars with stickers, water bottles, and pens). Many organizations, including the Girls Scouts, Girls, Inc., and the National Association of School Nurses, are collaborating on the campaign. A web site and collateral materials for parents are currently under development, while a journal for girls will be available during the winter of 2002–2003.

The campaign appears to be reaching many individuals. During the first year, 24 million print media impressions and 986,000 broadcast impressions had been distributed, along with 1.3 million items related to the campaign. The campaign’s award-winning web site was accessed 579,000 times during the year.

John McGrath, Ph.D.

Milk Matters Program, National Institute of Child Health and Human Development

Milk Matters is a public health education campaign to increase awareness about the importance of calcium in the diets of children and adolescents. It was launched in response to growing evidence on the importance of calcium to health and the failure of children and adolescents to get adequate levels in their diets. The campaign targets health professionals and parents (as gatekeepers that influence children) as well as children and teenagers who consume calcium. The goals of the program are threefold: to create awareness of the importance of calcium in building strong bones and a healthy body, and of milk as an excellent source of calcium; to increase knowledge about the importance of beginning osteoporosis prevention in childhood; and to change attitudes about the role of milk and other dairy foods in the diet as a source of calcium. The campaign does not make behavior change an explicit goal; the campaign’s leaders felt that it was unrealistic to expect an educational campaign to have a significant influence on consumption, since its budget is small and the dairy industry funds major efforts to promote consumption of dairy products.

The primary strategy for reaching these goals is involvement and fun. For parents and health professionals, the campaign has used credible sources to develop informational products to help influence children (and in the case of health professionals, their parents). For children and teens, the campaign includes a variety of fun activities (e.g., a coloring book, a web site geared to young people) as well as educational messages that speak to children in their language through channels that they value.

Bess Dawson-Hughes, M.D.

National Institutes for Health Osteoporosis and Related Bone Diseases-National Resource Center

Founded in 1994, the NIH Osteoporosis and Related Bone Diseases National Resource Center is funded by NIAMS and six other NIH institutes and offices and is operated by NOF in partnership with the Paget and Osteogenesis Imperfecta Foundations. Headquartered in Washington, D.C. in the NOF offices, the center’s mission is to increase knowledge about osteoporosis and related bone diseases, including knowledge of primary and secondary prevention strategies, diagnostic tools, and treatment options. Within the past year, the center has received 32,000 requests for information, one-third of which were from doctors.

The center is constantly focused on identifying and addressing gaps in knowledge about osteoporosis. One of the recent challenges has been to understand and reach a new audience–girls and their parents. To that end, the center has been developing culturally appropriate programs and materials targeting Hispanic girls, older Hispanic women, and older Asian women. The center is currently focused on addressing another large gap–the failure to test for (and when appropriate treat) osteoporosis in individuals with osteoporotic fractures. At present only 5% of such individuals receive testing or treatment. Through partnerships with the American Academy of Orthopedic Surgeons and other organizations, the center is distributing educational materials to physicians, patients, and family members. The materials are free of charge and are formatted to allow for easy reproduction (e.g., they can be downloaded from the center’s web site).

Dr. Dawson-Hughes expressed her hope that the center could use the upcoming Surgeon General’s Report as a new, fresh catalyst for the development and dissemination of effective messages about osteoporosis, including educational materials and model programs. Dr. Noonan endorsed this strategy, noting that the Surgeon General’s Report should not be viewed as an end in and of itself, but rather as a foundation on which to build a wide variety of programs to promote bone health.

Suzanne Feetham, Ph.D., R.N., F.A.A.N.

Bureau of Primary Health Care

Dr. Feetham described the role of the Health Resources and Services Administration (HRSA) in addressing two critical, related issues for the future of bone health–increasing access to care and reducing health disparities across ethnic and racial groups. HRSA, also known as the “Access Agency,” seeks to improve the nation’s health by assuring equal access to comprehensive, culturally competent, quality health care for all. As a safety net for U.S. health care, HRSA also assures the availability of quality health care that meets the unique needs of low-income, uninsured, isolated, vulnerable, and special-needs populations. To accomplish its goals, HRSA’s Bureau of Primary Health Care operates 750 consolidated health centers or CHCs that collectively serve 10.3 million individuals through more than 3,300 service delivery sites. These centers serve individuals of all ages, roughly two-thirds of whom are racial and/or ethnic minorities and 85% of whom have incomes that are below 200% of the Federal poverty line. President Bush has committed the Federal government to dramatically expanding the CHC program as a means of enhancing access and reducing disparities for the poor. To that end, his five-year plan calls for there to be 1,200 centers serving 16 million individuals by 2006. The challenge facing HRSA is to manage this growth while strengthening existing centers and maintaining quality.

In addition to operating CHCs, HRSA engages in a variety of collaborative initiatives in partnership with other Federal agencies that are designed to reduce health disparities and improve health outcomes by increasing leadership capacity and generating new information. Disease management collaboratives have been developed in the areas of diabetes, cancer, cardiac care, asthma, and depression. Collaboratives oriented at prevention have been launched in diabetes, healthy weight management, tobacco use, blood pressure, immunizations, lead screening, and oral health. Surgeon General Reports and Healthy People 2010 objectives have served as a catalyst for a number of these initiatives. Roughly 70% of CHCs have participated in one or more collaboratives. HRSA has embarked on several osteoporosis prevention and outreach initiatives. For example, HRSA is supporting the North Carolina Primary Care Association in forming a statewide partnership in women’s health that includes osteoporosis workshops, exhibits, support groups, and train-the-trainer programs. HRSA has also worked in collaboration with other Federal agencies to support the “Powerful Girls, Powerful Bones” program in collaboration with Northeast Ohio Neighborhood Health Services. Looking ahead, Dr. Feetham sees the prevention collaboratives as a potential prototype for further work in the area of osteoporosis.

State and Community Programs to Promote Bone Health for All Ages

Denise Cyzman

Michigan Public Health Institute

Ms. Cyzman described the Michigan Osteoporosis Project (MOP), which was launched in August 1999 on the basis of an earlier strategic plan developed by the state. The project is overseen by a statewide advisory committee in collaboration with the state public health department, and is funded through a variety of sources (although the bulk of funds comes from the state and CDC, which recently funded a fall prevention program). The MOP engages in a wide variety of activities, including community interventions such as participating in statewide screening and education (including referrals and follow-up), conducting health coaching for risk reduction and school-based programs, and developing brochures for pediatricians. The MOP also offers education and tools for providers, including the development of voluntary quality assurance standards, continuing medical education, journal articles, and fall prevention programs in emergency departments and clinics. An integral part of MOP is a commitment to evaluate the outcomes from all its activities. For example, the MOP conducted an osteoporosis/arthritis behavioral risk factor survey in 2000–2001, and hopes to repeat the survey in 2003. In addition, MOP requires all subcontractors to evaluate the outcomes of individual projects. To date, MOP has been able to document increases in knowledge about osteoporosis, as well as some increase in physical activity in the schools.

Ms. Cyzman raised a concern about the fragility of state funding, which resonated with other state representatives in attendance. The Michigan state government recently terminated all funding for the MOP in response to a state budget crisis caused by the poor economy. Given that the state has historically provided $400,000 in annual funding (out of a total budget in FY2003 of just over $700,000), MOP’s leadership will have to scramble to find other sources of funding if it is to continue to provide the same level of services. (Following Ms. Cyzman’s presentation, several audience members from other states, including Georgia, Texas, Connecticut, and South Carolina, noted that their legislatures had also reduced funding levels for programs related to bone health.)

Betty Wiser, Ed.D.

North Carolina Department of Health and Human Services

Dr. Wiser reviewed North Carolina’s state osteoporosis program, which began in 1994 with an exhibit at a health and aging conference. In 1995, the first statewide osteoporosis workshop was held, with support from the private sector. This workshop proved to be a catalyst that led to a “snowballing” level of interest in osteoporosis. In 1996, the Osteoporosis Coalition of North Carolina was launched; that same year the state legislature began funding for osteoporosis programs, a commitment that continues to this day. In 1997, the legislature allocated $200,000 for the creation of the Osteoporosis Task Force, and in 1999 expanded coverage of bone density testing for those under the age of 65.

In each of these activities, the state has relied on a coalition consisting of a variety of organizations, including cross-agency collaboration as well as partnerships with women’s organizations, civic and faith groups, universities and research centers, and NOF. Over the years, the state osteoporosis program has made a variety of recommendations and has developed strategic plans, fact sheets, and reports related to osteoporosis. More than 50 workshops, 400 statewide and local exhibits, and 17 support groups have been sponsored. The most innovative of these workshops focus on “training-the-trainers”–in other words, they strive to teach community leaders how to educate the public about osteoporosis and how to mobilize support for osteoporosis education in the community. Each year the state holds an Osteoporosis Legislative Day during which free bone density screenings are offered as well as a Best Bones Night sponsored in conjunction with the Girls Scouts. The state has developed a handbook to assist support group leaders and has sponsored an hour-long call-in television program on osteoporosis.

Looking ahead, the state hopes to improve education and awareness for all North Carolinians, focusing in particular on service providers, individuals over the age of 50, and youth. As in Michigan and other states, securing and maintaining funding is an annual challenge, a task that is made easier if the program can be made more accountable for documenting the impact of its activities.

Peggy Lassanske

Elder Floridians Foundation

The Elder Floridians Foundation began its work on osteoporosis in 1997, following the passage the previous year by the state legislature of an unfunded mandate for a state education program on osteoporosis. The state’s mandate was a response to evidence suggesting that the public was poorly informed about the disease, in part because physicians were not doing a good job in discussing or treating it. More than three million women in Florida are at risk for osteoporosis. Both the state and the Elder Floridians Foundation felt that greater awareness could lead to increases in screening and treatment rates, which ultimately would save the state money.

Thus, in 1997 the foundation launched Project Osteoporosis: Be Smart, Be Dense, Know the Difference. This community-based education and prevention program was designed to create grassroots support and a more knowledgeable public, and to encourage discussions between physicians and patients about osteoporosis. The program included a risk assessment questionnaire, a slide presentation, a free peripheral bone density test (at the wrist), and a follow-up survey. (The density test was considered to be more of an educational tool than a definitive means of diagnosis.) Through outreach and advocacy efforts, the foundation formed partnerships with industry and community groups and secured funding from the state government ($150,000 in 1998 and $500,000 in 1999). Since its founding, Project Osteoporosis has sponsored 436 programs, educated more than 50,000 individuals, and provided free peripheral screenings to more than 20,000 individuals.

Data from the baseline questionnaire and follow-up survey suggest that the program is making a difference. Between 1998 and 2002, the percentage of surveyed individuals who have discussed osteoporosis with their doctor has increased modestly (from 33% to 37%), the percent who have changed their behavior has increased significantly (from 56% to 77%), the percent who have received a diagnostic test has doubled (from 19% to 38%), and the percent who have discussed results with their doctor has increased slightly (from 53% to 55%).

Jeannie Suarez-Reyes, M.P.H.

Hispanic Girls: Theater Approach to Healthy Bones, National Alliance on Hispanic Health

The National Alliance for Hispanic Health is the oldest and largest national health and human services program oriented at improving the health and well-being of Hispanics. The organization represents all Hispanic groups, and emphasizes the use of theater as a tool for prevention. Hispanic Girls: Theater Approach to Healthy Bones is a pilot project funded by the NIH Osteoporosis and Related Bone Diseases National Resource Center (described earlier by Dr. Dawson-Hughes) that is intended to promote bone health among Hispanic girls between the ages of 9 and 19 through theater. The goal is to reach 1,000 girls through the community implementation site (Concilio Latino de Salud in Phoenix, AZ). Theater within the Hispanic community has historically been an effective communications vehicle that appeals to a variety of audiences (girls, parents, grandparents, and siblings) through multiple physical senses (e.g., visual, oral). More important, perhaps, theater empowers participants by transforming youths into the deliverers of messages. A small group of girls develops the script for the program, a script that emphasizes nutrition, exercise, and other healthy lifestyle behaviors. The vehicle of theater allows for the development of a more dramatic and compelling message, while still being flexible enough to adapt to the unique needs and cultures of a local group.

An independent evaluator of the project has found that it has increased knowledge about bone health among all ages, but especially among youth. Motivation levels for changing behavior are moderate to high, although participants are less sure about altering their diets to include foods high in calcium. More information about this approach, including a discussion guide and questionnaire, is available through the National Alliance for Hispanic Health.

Karen Lim

Living Healthy: The Asian American Women’s Osteoporosis Education Initiative, National Asian Women’s Health Organization

Founded in 1993, the National Asian Women’s Health Organization (NAWHO) is a nonprofit, community-based advocacy organization that has a membership of 200 organizations and 4,000 individuals in 24 states and Washington, D.C. Along with osteoporosis, programs cover a variety of issues affecting women, including violence prevention, breast and cervical cancers, diabetes, immunization, mental health, and reproductive health. Key activities include research and education, professional and public education, social marketing, leadership development, and collaboration building. The overall goal is to achieve health equity for the 30 to 50 distinct ethnic groups that make up the Asian-American community.

Postmenopausal Asian-American women are at high risk for osteoporosis due to diets low in calcium (many Asians are lactose intolerant), low weight, and small bones. One in five Asian women over the age of 50 has osteoporosis. While they vary by culture, common barriers to preventive care include language problems (the word osteoporosis does not translate into most Asian languages), low literacy rates, a lack of orientation to preventive care (talking about a disease is viewed as “asking for it” in many Asian cultures), lack of familiarity with western medicine and health care systems, and financial constraints. In addition, most Asian-American women play the role of caregiver in their families; their own health and well-being often take a back seat.

To address these barriers, NAWHO developed Living Healthy: The Asian-American Women’s Osteoporosis Education Initiative. With support from the NIH Osteoporosis and Related Bone Diseases National Resource Center, this initiative involves in-language community education through the development of a culturally competent guide/curriculum for development of localized osteoporosis education seminars for post-menopausal Asian-American women. Because NAWHO cannot independently develop the 30 to 50 different programs that would be needed to reach the various Asian ethnic groups, the group decided to develop a framework that can be tailored to the unique needs of individual communities. The goals of the program are to raise awareness of risk factors and diagnostic and treatment tools for osteoporosis, and to describe the consequences of the disease. The program also encourages prevention through the adoption of positive lifestyle behaviors, including appropriate levels of diet and exercise and periodic consultation with health care providers.

To reach these goals, the Living Healthy Implementation Kit provides a step-by-step guide to planning, implementing, and evaluating an effective, culturally competent education seminar on osteoporosis. The kit is divided into three components: messages about osteoporosis (provided in print, orally, and visually); steps for planning, coordinating, and evaluating the seminar; and resources to assist. The kit allows local advocates to customize the seminar using a mix of topics, exercises, languages, speakers, and discussion opportunities that best meet the audience’s unique needs.

To date, the kit has been implemented in three ethnically and geographically diverse California communities through local Asian-American community-based organizations. Highlights from these experiences are as follows: less than half of the participants had heard of osteoporosis before the seminar; those that had heard of the disease thought it was a natural part of aging that could not be prevented; and community forums appear to be highly effective in increasing knowledge and changing attitudes.

Personal Perspectives

The panel included the perspectives of two individuals on the importance of education and awareness campaigns.

Katherine Moy Chin

Ms. Chin, a retired dietician and member of the Maryland Governor’s Commission on Asian Pacific American Affairs, expanded upon Ms. Lim’s remarks by emphasizing the concerns of the Asian-American population, especially for elderly and immigrant women. She reiterated the need for general education on osteoporosis, focusing on such basic questions as: What is it? Why should I care? What should I do about it? She highlighted the language barriers faced by Asian Americans, and called for bilingual educators in the schools and in organizations catering to the elderly. She called on these educators to stress the importance of diet and nutrition, but to keep in mind that many Asian Americans are lactose intolerant. And like Ms. Lim, she highlighted the need for tailored approaches that cater to the unique needs of the many different ethnic groups that comprise the Asian-American population.

Julie Gonzalez

Ms. Gonzalez is a 10-year-old, fifth-grade student who has participated in the Strong Girls, Strong Bones program through her Girls Scouts troop. Through innovative and engaging activities, this program taught her and her fellow scouts about the make-up of bones and about bone disease, including what osteoporosis is, how it affects people, and how it can be prevented. Noting that she learned a great deal and had lots of fun doing so, she called for more of these types of programs aimed at building awareness among youth.

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