I found another way to get a picture
of my new great nephew in our presentations.
There he is. Remember his name is Calvin,
this was just about a week after he was born.
There's my niece and her husband, Marcus.
And I love all three of them.
And I wanted to bring this in really to help you think about
what is the difference between Calvin's bones
and his parents bones?
Because they're right around in their early 30s.
So that's what I want to walk you through.
But you know what, this is actually a pretty good strategy.
Whenever I have a patient that is difficult,
and you will have them in your practice,
I try to picture someone about the same age
in my own world that I really love.
And I think about giving the kind of care to someone
if it was Haley, or Marcus, or Calvin
coming into the hospital.
I really want to make sure they get top level care.
So I'm always checking myself and my motivations
and how I interact with people to make sure
I'm giving the same level of care
that I would give to someone from my own family.
So let's take a look at the first 30 years.
Now, you know the bones go through a process of called ossification.
Now, ossification makes the bones hard,
makes them stronger and denser, and that is what you want,
particularly with these long bones. Right?
So like every picture, you see cartilage, you see the red marrow.
And this is like what an infant's bone looks at
less than one year.
Now, let's look at what a child's bone looks like
one to 10 years.
Compare the differences.
Look at the things that are similar, and that are different
when you're an infant and when you're aging
through the first 10 years of life.
Well, we're really seeing some differences,
when they're an adolescent between 10 to 20 years.
Remember the bone of the infant, mostly cartilage, super flexible,
then as we age, it's going to become ossified
and much firmer, denser, and stronger.
Now, you hit your peak bone mass about age 30 to 35.
Now, if you look at these bones,
the ones on the far end over here with an infant,
that's what Calvin's bones, my great nephew looks like.
He's the baby.
His parents bones look like the other end of the spectrum,
because they're likely at their peak bone mass.
We just talked about the peak bone mass, right?
About 30 to 35 years.
Now we're going to focus on as we age past that.
So if you hit your peak between 30 to 35,
then past that age, your bones are starting to have
loss or deteriorating.
Now you see the picture there, right?
We've got a little osteoblast,
because he's got his builder cap on. And he's saying...
And the reason he's saying that is because as we age,
our osteoblasts are not as active, right?
Their activity level decreases.
And so therefore, are the architecture of our bones
starts to deteriorate.
Now, why is that?
Well, as the osteoblasts, the builders of our bone,
if they're not as active as they used to be,
then our bones are not going to be as strong as they used to be.
Because remember, they build the structure
and the strength of our bones.
So when you think about aging, think about a little guy,
they're saying, "oof"
that's why there is less activity of your osteoblasts.
We know them to be the builders.
And that is why the architecture of your bone weakens
as do your bones.
So let me show you a graph.
This will kind of help you see what it is.
Let's start with what the axes are.
So really your up and down access, the one that goes this way,
that represents bone mass.
So that's the total mass of skeletal, calcium in grams.
Pretty exciting stuff, I know.
Stay with me, because it really does make a difference.
Do not memorize these numbers. Don't try to sketch this out.
This is an example of when we want you just to get the big idea.
Now bone density decreases at a rate of about 0.5% per year.
So this axis is bone mass.
And we're demonstrating that by the total mass
of skeletal calcium in grams.
The axis that goes this way is age in years.
So let's look at the blue colored line, right?
That's right at the top.
Those are going to represent males.
So both males and females at age zero,
they start off with not a lot of calcium.
Remember, their bones are mostly cartilage,
then put your finger on the blue line and follow that up.
And you have men and women, you'll notice the difference, right?
But we're at about 30-ish years where you have that dark line,
and that tells us that's their peak bone mass.
Now, you will notice,
males have a higher peak bone mass than females do.
Okay, cool. So what can you learn from this graph?
Well as babies, we don't have a lot of calcium.
Then as we age, it goes up, up, up, up, up
till about our 30 to 35 years,
that's when we have the best, strongest bones
if everything has progressed normally.
Now males, what's their calcium level in their bones
compared to females?
There you go. Males have a higher level.
Now, let's stick with the male. But after that age of 30-35,
you notice the line start going downward
for both females and males.
Now, the male line look at that kind of has a real gentle slope.
We know it's about 0.5% a year,
but it just has a gentle slope after 35.
Look at the female. Ooh...
Yeah. There's a much more significant drop off.
That's why female clients tend to be
at an increased risk for osteoporosis.
Now, we'll go into detail on osteoporosis and another level
but hormones are involved.
It's pretty cool for you to understand how that all happens.
But for right now, what we want you to take away from this slide is
what happens over a lifespan?
We start with not very much calcium,
because we're all cartilage and super flexible.
We also don't walk at that point in our life,
we keep building, building, building, building, building
ossifying, strong calcium mineral deposits in our bones
until about 30 to 35.
And then the males will have a gradual decline,
the females will have a, ooh,
a much more significant decline by the time they're in their 80s.
Okay, that's always what you want to do
when someone puts a graph, or a picture in a textbook
or in our presentations,
we want you to know there's a reason.
You take the time with an image like this,
because that means there's a really important concept behind it
that you'll need to take away from it.
So, in test questions or when you're dealing with patients,
I know right away, if I'm dealing with an elderly or aging patient,
I'm worried about their bone health, and I'm worried about their safety.
I know it's a bigger risk to them if they fall
than if a 30 to 35 year old falls.
So those are things you can start to be thinking about
when you ask those questions.
Why would a nurse need to know this information?
How would it help you keep a patient safe?
Because I know I always address safety and bone health
with my geriatric clients.
Now, we want to blow this back up again with women
because we've got some extra hormone issues going on here.
Because women about five to seven years
after menopause,
they start having this estrogen decline, right?
So, if someone is five to seven years after menopause
or not taking estrogen replacements,
they're going to lose the density at a much quicker rate.
Before we were talking about, oh, 0.5%.
But this is why...,
this is why their drop is a lot more significant.
Because after menopause, if they have an estrogen decline,
they are not taking replacement therapy.
And that is a complicated discussion with their health care provider,
they lose bone at a faster rate than men do.
So, I'm going to be particularly am worried or concerned,
appropriately concerned about female patients after menopause.