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honeywell touchscreen thermostat installation manualPlease try again.Please try again.Please try again. This four color publication contains many illustrations and graphics. It is also available in Spanish. Then you can start reading Kindle books on your smartphone, tablet, or computer - no Kindle device required. Full content visible, double tap to read brief content. Videos Help others learn more about this product by uploading a video. Upload video To calculate the overall star rating and percentage breakdown by star, we don’t use a simple average. Instead, our system considers things like how recent a review is and if the reviewer bought the item on Amazon. It also analyzes reviews to verify trustworthiness. Please try again later. Gayle L. Reed 5.0 out of 5 stars Also some really great exercises. They don't require any special equipment except a place to sit down or lean on. A chair works great for both.Explanations are in plain English. I had a much better understanding of osteoporosis after reading this guide.All the very best!This is a must for all people who have osteoporosis, but it is also very useful for people who are at risk for osteoporosis or who are caring for a relative with osteoporosis. The National Osteoporosis Foundation is a respected and recognized leader in this field and the information can be trusted. As a nurse practitioner, I recommend it to my patients who need this information to be better informed on this subject.I found this to be an excellent resource for myself and my family members. It is easy to read and provides excellent information on risk factors, diet, exercise, screenings, preventing falls and so much more. I highly recommend this publication to everyone!Page 1 of 1 Start over Page 1 of 1 Previous page Next page. Please try again.Please try again.Please try again. Then you can start reading Kindle books on your smartphone, tablet, or computer - no Kindle device required. Full content visible, double tap to read brief content. I highly recommend this publication to everyone!http://heritagecam.com/userfiles/ford-ranger-manual-pdf.xml

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They are not intended to replace the services of trained and qualified health professionals or to be a substitute for medical advice of physicians. For more information, see our complete Medical Disclaimer. It also includes important information about living with osteoporosis, safe movement and exercise for daily living. It will help you understand what osteoporosis is doing to your body, understand treatments, build your confidence in treating this disease and identify sources of support throughout the course of treatment. Topics include: Medications Vertebral Fractures Patient Resources Guide These presentations cover a variety of topics, including basics about osteoporosis, prevalence of the disease, risk factors, bone density testing, nutrition, advocating as a patient and more. Your Guide to a Bone Healthy Diet includes the daily calcium and vitamin D intake recommended for men and women and shows you how to estimate your dietary calcium intake and determine how much you need to supplement to make up any shortfall. It contains helpful information on anti-fracture medicine, safe movement recommendations, and fall prevention. The book is in both English and Spanish. But, it is also important to avoid unintentional injuries, especially those of the spine, which may occur with everyday activities. The following video series shows how simple changes can be made to help keep you healthy and active. Donate today. Exercise caution Try these tips Most people think of osteoporosis as a women-only health problem, but older men also need protection from this bone-weakening disease. About one in four men older than 50 will break a bone because of osteoporosis during his lifetime, according to the National Osteoporosis Foundation. And research has found that compared with women, older men are more likely to die following a fracture related to osteoporosis. No content on this site, regardless of date.http://www.marenconsulting.es/admin/fck/ford-ranger-manual-repair.xml Exercise caution Try these tips This Special Health Report, Osteoporosis: A guide to prevention and treatment, can help you keep your bones strong and healthy, and avoid fractures. It describes how you can prevent and treat osteoporosis through diet, exercise, and medications. You'll also find advice on the right amount of calcium and vitamin D, tips on fall-proofing your home, and help with putting together a personalized plan to preserve or boost your bone strength. The prospect that a simple fall could break your hip or wrist can make you watch every step you take. Fear can replace the freedom to do all the things you love. In the years after menopause, women can lose up to one-fifth of their bone mass. But men aren't immune to the disease. Two million American men have osteoporosis and one in four over age 50 will suffer an osteoporosis-related fracture. You'll be warned about medications that hasten bone loss. And you’ll find out if you should have your bone density checked — and which tests are the best. You’ll learn about other bone-protective strategies, too, including specific exercise routines, and discover some surprising foods that help weaken bones. The good news is there’s a lot you can do to shield your bones from this disease. And the sooner you act, the better off you — and your bones — will be. Your skin cells use sunlight to produce a precursor chemical that the liver and kidneys then convert into active vitamin D. Some people make all the vitamin D they need by going outside for a few minutes a day with bare arms and legs. (Don’t wear sunscreen during this short time, except on your face to avoid the photoaging effects of the sun.) Keep your exposure time short—just 10 minutes or so a day— to guard against skin cancer. And if you’re out longer than that, do cover up or apply sunscreen. People with dark skin produce less vitamin D than those with fair skin.https://ayurvedia.ch/du1055xtss2-manual And no matter who you are, as you age, your skin can’t produce vitamin D as readily, your intestines have more difficulty absorbing this vitamin from food or supplements, and your kidneys convert less vitamin D to the active form that your body uses. Learn More. Received 2014 Jun 12; Accepted 2014 Jun 24.This article has been corrected. See Osteoporos Int. 2015 May 19; 26(7): 2045. This article has been cited by other articles in PMC. Abstract The Clinician’s Guide to Prevention and Treatment of Osteoporosis was developed by an expert committee of the National Osteoporosis Foundation (NOF) in collaboration with a multispecialty council of medical experts in the field of bone health convened by NOF. Readers are urged to consult current prescribing information on any drug, device, or procedure discussed in this publication. Keywords: Diagnosis, Guide, Osteoporosis, Prevention, Treatment Executive summary Osteoporosis is a silent disease until it is complicated by fractures—fractures that occur following minimal trauma or, in some cases, with no trauma. Fractures are common and place an enormous medical and personal burden on the aging individuals who suffer them and take a major economic toll on the nation. Osteoporosis can be prevented, diagnosed, and treated before fractures occur. Importantly, even after the first fracture has occurred, there are effective treatments to decrease the risk of further fractures. Prevention, detection, and treatment of osteoporosis should be a mandate of primary care providers. Since the National Osteoporosis Foundation (NOF) first published the Guide in 1999, it has become increasingly clear that many patients are not being given appropriate information about prevention and many patients are not receiving appropriate testing to diagnose osteoporosis or establish osteoporosis risk. Most importantly, many patients who have osteoporosis-related fractures are not being diagnosed with osteoporosis and are not receiving any of the Food and Drug Administration (FDA)-approved, effective therapies. This Guide offers concise recommendations regarding prevention, risk assessment, diagnosis, and treatment of osteoporosis in postmenopausal women and men age 50 and older. It includes indications for bone densitometry and fracture risk thresholds for intervention with pharmacologic agents. The absolute risk thresholds at which consideration of osteoporosis treatment is recommended were guided by a cost-effectiveness analysis. Synopsis of major recommendations to the clinician Recommendations apply to postmenopausal women and men age 50 and older. Universal recommendations Recommend regular weight-bearing and muscle-strengthening exercise to improve agility, strength, posture, and balance; maintain or improve bone strength; and reduce the risk of falls and fractures. Assess risk factors for falls and offer appropriate modifications (e.g., home safety assessment, balance training exercises, correction of vitamin D insufficiency, avoidance of central nervous system depressant medications, careful monitoring of antihypertensive medication, and visual correction when needed). Advise on cessation of tobacco smoking and avoidance of excessive alcohol intake. Biochemical markers of bone turnover can aid in risk assessment and serve as an additional monitoring tool when treatment is initiated. More frequent BMD testing may be warranted in certain clinical situations. The interval between repeat BMD screenings may be longer for patients without major risk factors and who have an initial T-score in the normal or upper low bone mass range. No pharmacologic therapy should be considered indefinite in duration. After the initial treatment period, which depends on the pharmacologic agent, a comprehensive risk assessment should be performed. There is no uniform recommendation that applies to all patients and duration decisions need to be individualized. In adults age 50 and older, after a fracture, institute appropriate risk assessment and treatment measures for osteoporosis as indicated. Fracture liaison service (FLS) programs, where patients with recent fractures may be referred for care coordination and transition management, have demonstrated improvement in the quality of care delivered. It is characterized by low bone mass, deterioration of bone tissue and disruption of bone architecture, compromised bone strength, and an increase in the risk of fracture. According to the WHO diagnostic classification, osteoporosis is defined by BMD at the hip or lumbar spine that is less than or equal to 2.5 standard deviations below the mean BMD of a young-adult reference population. Osteoporosis is a risk factor for fracture just as hypertension is for stroke. The risk of fractures is highest in those with the lowest BMD; however, the majority of fractures occur in patients with low bone mass rather than osteoporosis, because of the large number of individuals with bone mass in this range. Osteoporosis affects an enormous number of people, of both sexes and all races, and its prevalence will increase as the population ages. Although osteoporosis is less frequent in African Americans, those with osteoporosis have the same elevated fracture risk as Caucasians. Medical impact Fractures and their complications are the relevant clinical sequelae of osteoporosis. The most common fractures are those of the vertebrae (spine), proximal femur (hip), and distal forearm (wrist). However, most fractures in older adults are due at least in part to low bone mass, even when they result from considerable trauma. A recent fracture at any major skeletal site in an adult older than 50 years of age should be considered a significant event for the diagnosis of osteoporosis and provides a sense of urgency for further assessment and treatment. The most notable exceptions are those of the fingers, toes, face, and skull, which are primarily related to trauma rather than underlying bone strength. Postural changes associated with kyphosis may limit activity, including bending and reaching. Multiple thoracic fractures may result in restrictive lung disease, and lumbar fractures may alter abdominal anatomy, leading to constipation, abdominal pain, distention, reduced appetite, and premature satiety. Vertebral fractures, whether clinically apparent or silent, are major predictors of future fracture risk, up to 5-fold for subsequent vertebral fracture and 2- to 3-fold for fractures at other sites. Wrist fractures are less disabling but can interfere with some activities of daily living as much as hip or vertebral fractures. Pelvic fractures and humerus fractures are also common and contribute to increased morbidity and mortality. Fractures can also cause psychosocial symptoms, most notably depression and loss of self-esteem, as patients grapple with pain, physical limitations, and lifestyle and cosmetic changes. Medicare currently pays for approximately 80 of these fractures, with hip fractures accounting for 72 of fracture costs. The process of bone remodeling that maintains a healthy skeleton may be considered a preventive maintenance program, continually removing older bone and replacing it with new bone. Bone loss occurs when this balance is altered, resulting in greater bone removal than replacement. The imbalance occurs with menopause and advancing age. With the onset of menopause, the rate of bone remodeling increases, magnifying the impact of the remodeling imbalance. The loss of bone tissue leads to disordered skeletal architecture and an increase in fracture risk. Figure 1 shows the changes within cancellous bone as a consequence of bone loss. Individual trabecular plates of bone are lost, leaving an architecturally weakened structure with significantly reduced mass. Increasing evidence suggests that rapid bone remodeling (as measured by biochemical markers of bone resorption or formation) increases bone fragility and fracture risk.Figure 2 shows the factors associated with an increased risk of osteoporosis-related fractures. These include general factors that relate to aging and sex steroid deficiency, as well as specific risk factors, such as use of glucocorticoids, which cause decreased bone formation and bone loss, reduced bone quality, and disruption of microarchitectural integrity. Fractures result when weakened bone is overloaded, often by falls or certain activities of daily living. The clinician’s clinical skills and past experience, incorporating the best patient-based research available, are used to determine the appropriate therapeutic intervention. The potential risks and benefits of all osteoporosis interventions should be reviewed with patients and the unique concerns and expectations of individual patients considered in any final therapeutic decision. In general, the more risk factors that are present, the greater is the risk of fracture. Osteoporosis is preventable and treatable, but because there are no warning signs prior to a fracture, many people are not being diagnosed in time to receive effective therapy during the early phase of the disease. Many factors have been associated with an increased risk of osteoporosis-related fracture (Table 1 ). Dehydration is also a risk factor for falls. Many of these diseases have very specific therapies, and it is appropriate to complete a history and physical examination before making a diagnosis of osteoporosis on the basis of a low BMD alone. In patients in whom a specific secondary, treatable cause of osteoporosis is being considered (Table 1 ), relevant blood and urine studies (see below) should be obtained prior to initiating therapy. Any adulthood fracture may be an indication of osteoporosis and should be evaluated accordingly. Consider hip and vertebral fractures as indications of osteoporosis unless excluded by the clinical evaluation and imaging. Patients with recent fractures, multiple fractures, or very low BMD should be evaluated for secondary etiologies. Osteoporosis affects a significant number of men, yet the condition often goes undetected and untreated. The evaluation of osteoporosis in men requires special consideration as some of the laboratory testing to assess underlying causes in men differs from those in women. Screening BMD and vertebral imaging recommendations for men are outlined in Table 8. Table 8 Additional bone densitometry technologies CT-based absorptiometry: Quantitative computed tomography (QCT) measures volumetric integral, trabecular, and cortical bone density at the spine and hip and can be used to determine bone strength, whereas pQCT measures the same at the forearm or tibia. High-resolution pQCT (HR-pQCT) at the radius and tibia provides measures of volumetric density, bone structure, and microarchitecture. In postmenopausal women, QCT measurement of spine trabecular BMD can predict vertebral fractures, whereas pQCT of the forearm at the ultradistal radius predicts hip but not vertebral fractures. There is insufficient evidence for fracture prediction in men. QCT and pQCT are associated with greater amounts of radiation exposure than central DXA or pDXA. Trabecular Bone Score (TBS) is an FDA-approved technique which is available on some densitometers. It may measure the microarchitectural structure of bone tissue and may improve the ability to predict the risk of fracture. The following technologies are often used for community-based screening programs because of the portability of the equipment. Results are not equivalent to DXA and abnormal results should be confirmed by physical examination, risk assessment, and central DXA. Peripheral dual-energy x-ray absorptiometry (pDXA) measures areal bone density of the forearm, finger, or heel. Measurement by validated pDXA devices can be used to assess vertebral and overall fracture risk in postmenopausal women. There is insufficient evidence for fracture prediction in men.A composite parameter using SOS and BUA may be used clinically. Validated heel QUS devices predict fractures in postmenopausal women (vertebral, hip, and overall fracture risk) and in men 65 and older (hip and nonvertebral fractures). QUS is not associated with any radiation exposure. Open in a separate window Diagnosis The diagnosis of osteoporosis is established by measurement of BMD or by the occurrence of adulthood hip or vertebral fracture in the absence of major trauma (such as a motor vehicle accident or multiple story fall).The difference between the patient’s BMD and the mean BMD of the reference population, divided by the standard deviation (SD) of the reference population, is used to calculate T-scores and Z-scores. Peak bone mass is achieved in early adulthood, followed by a decline in BMD. The rate of bone loss accelerates in women at menopause and continues to progress at a slower pace in older postmenopausal women (see Fig. 3 ) and in older men. An individual’s BMD is presented as the standard deviation above or below the mean BMD of the reference population, as outlined in Table 5. BMD has been shown to correlate with bone strength and is an excellent predictor of future fracture risk. Instead of a specific threshold, fracture risk increases exponentially as BMD decreases. Although available technologies measuring central (lumbar spine and hip) and peripheral skeletal sites (forearm, heel, fingers) provide site-specific and global (overall risk at any skeletal site) assessment of future fracture risk, DXA measurement at the hip is the best predictor of future hip fracture risk. DXA measurements of the lumbar spine and hip must be performed by appropriately trained technologists on properly maintained instruments. DXA scans are associated with exposure to trivial amounts of radiation. In premenopausal women, men less than 50 years of age, and children, the WHO BMD diagnostic classification should not be applied. In these groups, the diagnosis of osteoporosis should not be made on the basis of densitometric criteria alone. Who should be tested. The decision to perform bone density assessment should be based on an individual’s fracture risk profile and skeletal health assessment. Utilizing any procedure to measure bone density is not indicated unless the results will influence the patient’s treatment decision. Table 6 outlines the indications for BMD testing. BMD measurement is not recommended in children or adolescents and is not routinely indicated in healthy young men or premenopausal women unless there is a significant fracture history or there are specific risk factors for bone loss. Most vertebral fractures are asymptomatic when they first occur and often are undiagnosed for many years. Proactive vertebral imaging is the only way to diagnose these fractures. Independent of BMD, age, and other clinical risk factors, radiographically confirmed vertebral fractures (even if completely asymptomatic) are a sign of impaired bone quality and strength and a strong predictor of new vertebral and other fractures. Vertebral imaging can be performed using a lateral thoracic and lumbar spine X-ray or lateral vertebral fracture assessment (VFA), available on most modern DXA machines. VFA can be conveniently performed at the time of BMD assessment, while conventional X-ray may require referral to a standard X-ray facility. Indications for vertebral imaging Because vertebral fractures are so prevalent in older individuals and most produce no acute symptoms, vertebral imaging tests are recommended for the individuals defined in Table 7. A follow-up vertebral imaging test is also recommended in patients who are being considered for a medication holiday, since stopping medication would not be recommended in patients who have recent vertebral fractures.The WHO algorithm used in this Guide was calibrated to US fracture and mortality rates; therefore, the fracture risk figures herein are specific for the US population. Economic modeling was performed to identify the 10-year hip fracture risk above which it is cost-effective, from the societal perspective, to treat with pharmacologic agents. FRAX underestimates fracture risk in patients with recent fractures, multiple osteoporosis-related fractures, and those at increased risk for falling. Specifically, the WHO algorithm has not been validated for the use of lumbar spine BMD. NOF recommends treatment of individuals with osteoporosis of the lumbar spine as well as the hip. The use of BMD from nonhip sites is not recommended.Conversely, these recommendations should not mandate treatment, particularly in patients with low bone mass above the osteoporosis range. Decisions to treat must still be made on a case-by-case basis. Additional bone densitometry technologies The following bone mass measurement technologies included in Table 8 are capable of predicting both site-specific and overall fracture risk. However, T-scores from these technologies cannot be used according to the WHO diagnostic classification because they are not equivalent to T-scores derived from DXA.These include an adequate intake of calcium and vitamin D, lifelong participation in regular weight-bearing and muscle-strengthening exercise, cessation of tobacco use, identification and treatment of alcoholism, and treatment of risk factors for falling. Adequate intake of calcium and vitamin D Advise all individuals to obtain an adequate intake of dietary calcium. Providing adequate daily calcium and vitamin D is a safe and inexpensive way to help reduce fracture risk. A balanced diet rich in low-fat dairy products, fruits, and vegetables provides calcium as well as numerous nutrients needed for good health. If adequate dietary calcium cannot be obtained, dietary supplementation is indicated up to the recommended daily intake. Lifelong adequate calcium intake is necessary for the acquisition of peak bone mass and subsequent maintenance of bone health. The skeleton contains 99 of the body’s calcium stores; when the exogenous supply is inadequate, bone tissue is resorbed from the skeleton to maintain serum calcium at a constant level. There is no evidence that calcium intake in excess of these amounts confers additional bone strength. Table 9 illustrates a simple method for estimating the calcium content of a patient’s diet. Increasing dietary calcium is the first-line approach, but calcium supplements should be used when an adequate dietary intake cannot be achieved.NOF recommends an intake of 800 to 1000 international units (IU) of vitamin D per day for adults age 50 and older. Some calcium supplements and most multivitamin tablets also contain vitamin D. Supplementation with vitamin D 2 (ergocalciferol) or vitamin D 3 (cholecalciferol) may be used. Vitamin D 2 is derived from plant sources and may be used by individuals on a strict vegetarian diet. Many older patients are at high risk for vitamin D deficiency, including patients with malabsorption (e.g., celiac disease) or other intestinal diseases (e.g., inflammatory bowel disease, gastric bypass surgery), chronic renal insufficiency, patients on medications that increase the breakdown of vitamin D (e.g., some antiseizure drugs), housebound patients, chronically ill patients and others with limited sun exposure, individuals with very dark skin, and obese individuals. Since vitamin D intakes required to correct vitamin D deficiency are so variable among individuals, serum 25(OH)D levels should be measured in patients at risk of deficiency. Among the many health benefits, weight-bearing and muscle-strengthening exercise can improve agility, strength, posture, and balance, which may reduce the risk of falls. In addition, exercise may modestly increase bone density. NOF strongly endorses lifelong physical activity at all ages, both for osteoporosis prevention and overall health, as the benefits of exercise are lost when people stop exercising. Weight-bearing exercise (in which bones and muscles work against gravity as the feet and legs bear the body’s weight) includes walking, jogging, Tai Chi, stair climbing, dancing, and tennis. Muscle-strengthening exercise includes weight training and other resistive exercises, such as yoga, Pilates, and boot camp programs. Before an individual with osteoporosis initiates a new vigorous exercise program, such as running or heavy weight-lifting, a clinician’s evaluation is appropriate. Fall prevention Major risk factors for falling are shown in Table 2. In addition to maintaining adequate vitamin D levels and physical activity, as described above, several strategies have been demonstrated to reduce falls. These include, but are not limited to, multifactorial interventions such as individual risk assessment, Tai Chi and other exercise programs, home safety assessment, and modification especially when done by an occupational therapist, and gradual withdrawal of psychotropic medication if possible. Appropriate correction of visual impairment may improve mobility and reduce risk of falls. There is a lack of evidence that the use of hip protectors by community-dwelling adults provides statistically significant reduction in the risk of hip or pelvis fractures. Also, there is no evidence that the use of hip protectors reduces the rate of falls. In long-term care or residential care settings, some studies have shown a marginally significant reduction in hip fracture risk. There is additional uncertainty as to which hip protector to use, as most of the marketed products have not been tested in randomized clinical trials. Cessation of tobacco use and avoidance of excessive alcohol intake Advise patients to stop tobacco smoking. NOF strongly encourages a smoking cessation program as an osteoporosis intervention. Recognize and treat patients with excessive alcohol intake. Moderate alcohol intake has no known negative effect on bone and may even be associated with slightly higher bone density and lower risk of fracture in postmenopausal women. Pharmacologic therapy All patients being considered for treatment of osteoporosis should also be counseled on risk factor reduction including the importance of calcium, vitamin D, and exercise as part of any treatment program for osteoporosis. Prior to initiating treatment, patients should be evaluated for secondary causes of osteoporosis and have BMD measurements by central DXA, when available, and vertebral imaging studies when appropriate. Biochemical marker levels should be obtained if monitoring of treatment effects is planned. An approach to the clinical assessment of individuals with osteoporosis is outlined in Table 10. In the absence of head-to-head trials, direct comparisons of risk reduction among drugs should be avoided. Who should be considered for treatment.