Boning Up on Bones

Author: Mark Parkinson RPh:  President  AFC CE

Credit Hours 2.5 - Approximate time required: 150 min. 

Educational Goal:

To provide Adult Foster Care providers with the background information that will help them promote good bone health of their residents.

Educational Objectives:

  1. Instruct about the consequences of poor bone health.
  2. Teach about the anatomy and physiology of bone.
  3. List the factors that limit bone health
  4. Inform about the caregivers role in preventing bone loss


  1. Read the course materials.  2. Click on exam portal [Take Exam].  3. If you have not done so yet fill in Register form (username must be the name you want on your CE certificate).  4. Log in  5. Take exam.  6. Click on [Show Results] when done and follow the instructions that appear.  7. A score of 70% or better is considered passing and a Certificate of Completion will be generated for your records. 


   The information presented in this activity is not meant to serve as a guideline for patient management. All procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this article should not be used by care providers without evaluation of their patients’ Doctor. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication. Nutritional products discussed are not intended for the diagnosis, treatment, cure, or prevention of any disease.


Boning Up on Bones

It has always been my opinion that adult foster care is an under- appreciated and under-utilized portion of the health care continuum.  Whether you run a developmentally disabled, mental health, or elderly care home, the potential to impact a patient’s life for the better is poorly developed. The root of my opinion stems from the fact that so much of a person’s health depends on what happens in-between doctor’s visits. Doctors, pharmacists, and nurses have a great deal of knowledge, but no one has more day-to-day impact on patients’ lives than foster care homes. It is the day-to-day activities over the long run that really determines whether a patient stays healthy or gets ill.

There is no better example of this than bone health.  Other than the odd genetic defect, bone health is largely determined by lifestyle and dietary choices we make over our lifetime. The impact those choices make are very subtle. Bone health problems don’t happen suddenly but develop over a long period of time. The consequences of those choices are usually felt when we age.

According to the National Institute of Health (NIH), “By 2020 half of all Americans over 50 will have weak bones unless we make changes to our diet and lifestyle.”

Those of us who develop weak bones are more likely to suffer significant health issues that will dramatically affect the quality of our lives.

  • Each year, 1.5 million older Americans suffer fractures because their bones have become weak.
  • A broken hip makes you up to four times more likely to die within three months.
  • One in five people with a hip fracture ends up in a nursing home within a year.
  • Those with weak bones become frightened to leave home or engage in activities because they fear they will fall. This leads to isolation and depression.
  • The fear of falling leads to a sedentary lifestyle that is a major risk factor in developing other disease states like diabetes, high blood pressure, obesity, deep vein thrombosis, and spinal disc herniation (lower back pain).
  • Multiple micro fractures in the spine lead to the poor posture “hunched over” look of the elderly and compromises the comfortable feeling that good posture brings in all daily activities.

Weak bones are not inevitable, and poor bone health is not part of the part of the aging process.  The consequences of a lifetime of poor choices can still be impacted by the good day-to-day lifestyle choices we make now.

Which health profession has the most impact on the day-to-day lifestyle and dietary choices of patients?  Adult foster care does.   To make a positive impact, caregivers must know what to do. So let’s bone up on bone health and learn about what the care provider can do to maintain your residents’ bone health.


What Is a bone?

It may sound like a stupid question, but do you really know what a bone is? Most of us know bones as the hard, lifeless material leftover after a meal. That is only part of the story of our bones.  Our skeleton is a complex system of many parts. It contains blood vessels, marrow, cartilage, tendons ligaments, and nerves. It is a dynamic system that constantly functions and serves us in many ways.



Purposes of Our Bones

1. Support

The skeleton provides the framework that supports the body and maintains its shape.  For example, without the rib cage the lungs would collapse.

2. Movement

Movement would be all but impossible without our muscles being anchored to bone.  Joints between the bones enable greater range of motion

3. Protection

Our bones provide a shield to keep vital body parts protected. Imagine what would happen to our delicate parts like the brain and spine cord without bones to protect them.  Our bones and cartilage also acts like a shock absorber, taking the brunt of outside forces like falls. 

4. Blood cell production

The skeleton is the start of our blood cell development in a process called hematopoiesis. Without our bone marrow, we would not have many of the components of our blood supply.  In children, hematopoiesis occurs primarily in the marrow of the long bones, such as the femur and tibia. In adults, it occurs mainly in the pelvis, cranium, vertebrae, and sternum.

5. Storage

Our bones are a bank that stores vitally important minerals that we use in our day-to-day lives, primarily calcium and phosphorus. If we don’t get enough of these essential materials in our diet, our bodies will a withdrawal from the stores in our bones. 

6. Hormone regulation

Bone cells release a hormone called osteocalcin, which contributes to the regulation of blood sugar (glucose) and fat deposition. Osteocalcin increases both insulin secretion and sensitivity, in addition to boosting the number of insulin-producing cells and reducing stores of fat. In return, the skeletal system is greatly affected by other hormones like estrogen.


Basic Structures of Our Bones

Bone material is a matrix of flexible and solid material.  What gives our bones flexibility is a protein called collagen. It forms a flexible netlike framework. Upon this framework specialized bone-building cells deposit the compounds calcium phosphate and calcium carbonate. These mineral compounds give the bone its strength. 

The bone is composed of two types of skeletal tissue laid down in layers. The outer layer or cortex is made up of a hard compact material called the cortical or compact bone.  It accounts for about 80 percent of adult bone mass. It may look like a solid material, but look closely enough and you’ll see it is filled with microscopic columns called osteons. Each column contains living bone cells and boney material wrapped around a central canal the Haversian canal. Each osteon column is connected to each other by other canals called Volkmann’s canals. The cortical bone is covered on the outside by a layer called the periosteum layer and on the inside by the endosteum layer.

Underneath the endosteum is the second type of skeletal tissue called the cancellous bone. It is also called trabecular or spongy bone, not because it’s soft like a sponge but because it’s very porous like a sponge.  It’s so porous that cancellous bone has 10 times the surface area of cortical bone. The porous spaces of the cancellous material is filled with bone marrow and hematopoietic stem cells, which are later transformed into platelets and red and white blood cells.

The longer larger bones have a center shaft that does not contain boney material but is filled with bone marrow.


The Activity Inside the Bone

The matrix material of both types of bone tissue is an active place where minerals are constantly being laid down and removed. The work is done by three types of specialized cells, osteocytes, osteoblasts, and osteoclasts.

Osteoblasts are bone-forming cells and are found mainly on the surface areas of the bone.

Osteocytes are osteoblasts that have become surrounded by the boney material they produced. When they are encased, they cease forming new bone material and are more associated with maintaining bone function.

Osteoclasts are cells that breakdown bone tissue by secreting enzymes that dissolve the mineral portion of the bone. The dissolved minerals are then transported out of the bone via bodily fluids to be used elsewhere.

All three cell types are sensitive to chemical signaling as seen in hormones and are involved in changing bone mass due to stresses on the bone.


Bones As We Age

At first glance, bones may appear to be a solid, unchanging support system.  In reality, bones serve many purposes and are constantly changing to meet ALL the demands placed upon them.  They change considerably as we age.

Before we are born, our bones start out mostly as cartilage. This helps the body go through the many changes it faces.  Then in a process called ossification, cartilage is replaced by bony material as the body starts to grow. 

Initially, newborn and infant bones are filled mainly with cancellous bone tissue filled with blood-producing red marrow.  As the infant grows, a portion of the cancellous tissue is replaced by the more supportive cortical bone tissue.

In our early developmental years, our bones need to grow a lot. In a process called Modeling new bone material is laid down in patterns that support this massive growth.  The body is geared to direct minerals and nutrients toward the needs of growth.

 The body continues the growth process until it reaches maturity between the ages of 18 to 30 years old. After that the skeletal system shifts functions from growth to maintenance and support.

In our mature years the same bone cells continue to lay down new bone and break down old bone but the balance between the two has changed.  Growth is no longer needed so bone processes switch to Remodeling, basically a turning over of bone mass. It has been estimated that most of adults bone mass is replaced every ten years.

In the long run the skeletal system changes according to what is needed at the time.  Growth is just one factor of need. If we work hard and put stress on the bone it responds by bulking up the bone to handle the added of stress. This explains why right handed people have bigger bones in their right arm. Dentists utilize this process to change teeth. They apply braces to the teeth that put stress on the bone. The braces guide the teeth in new growth and force the remodeling of the existing bone material.

The processes of modeling and remodeling are limited by what materials we take in to replenish what is used up. You can’t make a dollar’s worth of bone with 50 cents of material acquired from the food we eat. 

The crucial points for caregivers to understand about the processes of bone growth and support can be made easier if you think of the bones as a bank vault. The body starts out with a very small bank account of minerals but has tremendous growth potential. In the beginning most of the minerals we bring into our account goes into making the bank vault bigger. After a while we stop making the vault bigger and instead make the walls of our vault stronger.  We fill up the vault with the resources that will be needed later in life. As the need arises we dip into the supplies held in our bank account.  With each meal we replenish our account with new minerals. If there isn’t enough in reserve to meet our day to day needs then our bodies start to use the materials in the walls of our vault. If we have made our vault big and strong enough then taking some from the walls won’t affect our bank vault that much. But if the walls aren’t thick enough then it will be easier to break the bank and cause problems. 

This story’s bank vault theme can be seen prominently in the metabolism of calcium. The mineral calcium is used throughout our body, especially in the nervous system and muscles. That includes the brain and heart. It is a priority of the body to always have enough calcium in the blood stream to keep things running smoothly. But only 1 percent of our body’s calcium is found in the blood.  When more is needed, it has to come from the bones.  Ninety-nine percent of the body's calcium is stored in the bones and teeth.

 Inherent Limitations


The skeletal system works remarkably well considering all the changes it goes through and how variable dietary mineral intake can be. There are some limitations, though, that can lead to breaking the bone bank.

Bone Loss Due to Age and Disease

Bone loss due to age is a normal reaction to the environmental and metabolic changes that occur as we advance in years.

  1. Our daily routines change as we age. We engage less and less in activities that put bone-building pressure on our skeleton. It is a natural response to lose some of our bone mass.
  2. Maintenance of the skeletal system is dependent on a complex system of hormones and other body systems. As we age or through disease these control systems start to wear down, resulting in bone mass loss. This is particularly common in post-menopausal women. On average, a woman loses 10 percent of her bone mass during the menopause transition.

Calcium Regulating Hormones

Parathyroid Hormone

Calcitriol (Active Vitamin D)




Growth Hormone/Insulin-Like Growth Factor

Thyroid Hormone



Another example of how aging contributes to bone loss is a combination of an aging body and a change in habits. Calcitriol that comes from vitamin D is used by our body to help absorb calcium from our diet. Our bodies make vitamin D when sunlight strikes our skin. Older adults tend to stay indoors away from vitamin D-giving sunlight. They also naturally feel cold easier, so they wear more clothing.  This also prevents the sun from reaching their skin.  As a result, the body can’t make enough vitamin D to process the calcium that it takes in. To maintain blood calcium levels an increased amount of calcium has to come from the skeleton. As a result, we start to lose bone mass.


Even though there are many ways we can voluntarily build bone mass, the genes we are born with play a major part of how our bodies are built. There are those who naturally have smaller bones so they are at greater risk for bone-loss-related problems or have other inherited bone-loss factors.

At-risk groups:

  • Women (menopause)
  • Caucasian people of Asian descent
  • Families with congenital abnormalities. Having a parent or sibling with osteoporosis puts you at greater risk, especially if your mother or father experienced a hip fracture.
  • Body frame size. Men or women who have small body frames tend to have a higher risk because they may have less bone mass to draw from as they age.

art 6



Lifestyle Inadequacies

We can’t feel or sense the mineralization or de-mineralization process so most of the time we can’t tell how healthy our bones are.  There are no outward signs to let us know how our actions are affecting our bones.  The lack of outward symptoms to warn us of danger leads many of us to make unwise choices.  Many of us unknowingly start to lead lifestyles that lead us straight into future bone loss trouble.



Contributing lifestyle factors for bone loss:

  • Poor diet- Healthy bones depends so much on what we eat. For healthy bones, you must have adequate amounts of calcium, phosphorous, and vitamins C, D, and K.
  • Excessive alcohol- More than one drink a day for women and two drinks a day for men can cause bone loss.
  • Excessive caffeine- Too much caffeine interferes with calcium absorption.
  • Smoking- Tobacco also prevents calcium absorption.
  • Eating disorders or just trying to be thin is closely related to an inadequate diet.
  • Sedentary lifestyle- plainly put: no exercise = bone mass loss.

Drug-induced Bone Loss

Long-term use of certain medications can cause accelerated bone loss. This is a very complicated topic. I could write several hours just on bone loss due to drugs alone. Since caregivers have little impact on drug therapy decisions, we’ll just let the doctors worry about that topic for now. There are a few groups of residents who are at greater risk than others so caregivers can help compensate for bone loss.

Watch out for residents who take:

Steroid inhalers for asthma

Anti-seizure medications

Anti-hormone (testosterone and estrogen) medication used in treating breast and prostate cancer.

Stomach acid blockers (proton pump inhibitors)

This is one area where developmentally disabled (DD homes) may have greater concern than other care homes.  It is not that uncommon for their residents to be on asthma, seizure, and PPIs medications all at once in the bone-forming years.  If you have one of these special residents in your home, it would be wise to counsel with the doctor specifically about their bone health.

 Bones Big Enough for a Lifetime

Let’s take a look at the big picture. In the beginning of life, the body makes massive changes in the bone. Over time, the skeleton starts to settle down and gradually build up bone mass. Generally speaking, a reaches its peak bone mass in its 30s. After that, the body switches directions, and bone mass starts to decrease. Under normal conditions, bone loss is very slow and we have enough bone mass to last a lifetime.  Unfortunately there are plenty of issues that can go wrong. Things can happen that interfere with building up the proper amount of bone mass, so there isn’t enough mass to last a life time.  Other factors can accelerate normal bone loss to the point where the bone can no longer properly handle the stresses put upon it. Outwardly we can’t feel the bone weakness until after the bone breaks.

 Image result for osteoporosis


When a patient loses so much bone material that the skeleton can no longer support body actions, that person has osteoporosis. Osteoporosis is a disorder of porous bone. If you could see the bone under a microscope, normally dense material has become thin and the strong matrix of cancellous bone is so porous that it has become brittle.   Minor falls and normal physical stresses can lead to broken bones.  The most likely place for breaks to occur is in the cancellous (trabecular) bone tissue of the wrist, hip, or spine. Any broken bone can cause severe pain. For patients with osteoporosis, that pain may not go away even after the break heals. Osteoporosis also causes a loss in height as micro fractures cause the vertebrae to compress. Micro fractures also can lead to poor posture, (making the sufferer to become stooped or hunched), which results in chronic back pain.

Discovery and Diagnosis

Osteoporosis is often discovered by the doctor when the patient sustains a low-trauma fracture. The diagnosis is confirmed by measuring the patient’s bone mass by the use of specialized x-ray machines and comparing it to the bone density of a healthy bones. The doctor evaluates the x-ray readings [Dual-energy x-ray absorptiometry (DXA)] and compares them to an index of bone mass. They then do some statistical analysis and come up with some number-crunching values called z-scores or t scores.  Z- scores is a comparison to the normal bone density for that of person of the same age and sex. A T-score is a comparison to young adult bones.

For those of you who are interested (probably a very low percentage of readers) the most common diagnosis of osteoporosis is made with a T-score of 2.5 standard deviations below a young adult healthy bone. 

Osteoporosis is a serious medical concern. It can lead to chronic pain, disability, institutionalization, social isolation, depression, and death. It leads to 432,000 hospital admissions, almost 2.5 million medical office visits, and about 180,000 nursing home admissions annually in the America. For 2005, the medical costs have been estimated at $17 billion. Hip fractures alone account for 14 percent of all fractures and 72 percent of fracture costs.

Osteoporosis costs the patient dearly and is a heavy burden on our society.  It is well worth the caregiver’s efforts to prevent it or treat it with maintenance therapy if occurs their residents.


 Caregiver’s Role- Prevention and treatment

Osteoporosis is not part of the normal aging process. It can be prevented and treated by making simple but powerful lifestyle choices and if needed medication therapies.  Adult foster care providers are in a unique position to have the most impact on lifestyle choices, more than any other member of the health care team.  It will take daily caregiving efforts and a long-term point of view from both the resident and the caregiver. The good daily actions you take now will be of benefit for years and even decades to come.

Areas of Focus

There are four areas of therapeutic focus when working toward the goal of obtaining and maintaining healthy bones. They are the same for children and the elderly; it is just matter of how much is required. Adult foster care providers are in control of three of them and have significant impact on the fourth.

They are:

  • Avoid risks
  • Nutritional support and healthy diets
  • Plenty of exercise
  • Medication

Avoid Risks

Let’s review the behaviors that increase bone loss from a caregiver’s point of view.

  • Alcohol- This is a no brainer. I don’t for see any responsible caregivers serving up cocktails for their residents.
  • Smoking- Just one more reason to have a tobacco-free home. This can be a bit more challenging for mental health homes. Smoking has been linked to mental illness as patients unknowingly try to relieve mental health symptoms through smoking. Properly educating mental health residents and rewarding proper choices can help break the habit. Nicotine addiction can be broken in as little as two weeks. Caregivers can help by making it uncomfortable to smoke, breaking up smoking routines, and pointing out that smoking is a very poor choice in relieving mental illness symptoms. 
  • Caffeine- Another addiction that can be problematic. In regards to bone health, it’s a balancing act. No caffeine is best, but moderation in the amount of caffeine from all sources is doable for most care homes.
  • Sedentary Lifestyle- If caregivers view themselves as babysitters; they want their clients to sit around doing nothing. (bad choice in my opinion) If caregivers view themselves as medical professionals, they will schedule activities (a better, more fulfilling role in my opinion). Caregivers should take advantage of community and family resources for possible resources. Assigning residents minor chores is not out of the question either. Residents like to have a purpose.
  • Falls- Caregivers should regularly inspect their home and remove slip and trip hazards. Remember, even minor falls can be life threatening for residents with severe osteoporosis.


Nutritional Support

Having healthy bones depends largely on having enough bone-building materials in the first place. Caregivers must remember that bones are not unchanging tissues. Bone mineral materials are constantly being pulled away for use by the body. So replacement should be constant as well. Where does that mineral come from and how much is needed should be a prime concern for caregivers.



How Much Calcium

Getting enough calcium is a prime concern for building and maintaining bone. The largest amount of calcium is needed in the bone-building years between the ages of 9 and 18. Daily requirements reduce somewhat in the adult years but increase for women after menopause and everyone after the age of 70.

Calcium requirements


Daily amount in mg

0 to 6 months


6 to 12 months


1 to 3 years


4 to 8 years


9 to 18 years


19 to 50 years


51- to 70-year-old males


51- to 70-year-old females


>70 years old



Warning- large doses of calcium can be constipating. If the problem arises, don’t reduce the calcium. Increase the resident’s fluid, fiber, and whole-body activity. Notify the doctor of persistent irregularity problems.


How Much - Vitamin D

Vitamin D is an essential part of the digestion of calcium. Without vitamin D, we can’t absorb enough calcium in our gut and maintain the bone we do have.  The bone disease rickets is essentially caused by a lack of vitamin D.


Daily Amount in IU

0 to 12 months


1 to 13 years


14 to 18 years


19 to 50 years


51 to 70 years


> 70 year old


IU- International Units

Vitamin D lasts a long time in our bodies so normally there is a healthy amount floating around. Daily amounts are just topping off the tank, so to speak. If the patient’s overall concentration is down, the doctor will prescribe mega doses to build up reserves.  There is a green liquid-filled, football-shaped jell tab prescription of vitamin D that has 50,000 IU. It’s usually prescribed once a month.

There are several other vitamins and minerals that are important to bones but are too numerous to write about them all. They will all be covered with a properly balanced diet or a daily routine of vitamin and mineral supplements.  An important note about multivitamins and mineral pills: One size does not fit all. Nutritional needs change as we age, so choose age-appropriate products to get the optimal mix of vitamins and minerals.

Healthy Diets

The typical American diet lacks all the nutrients needed for healthy bones. Caregivers must make a conscious effort to make healthy meals for their residents. Milk and other dairy products are the traditional source of calcium in our diets. Three servings a day is a good benchmark to aim for. Teenage residents should get four.  Other sources of calcium are green leafy vegetables, broccoli, soybeans, and fish products with edible bones in them (sardines and salmon). You can even buy calcium-fortified products like orange juice.

In a perfect world, you could give all the bone health nutrients that your residents need from the foods you serve them. During shopping trips, you would consult packaging information on the products you buy. Then you can place the proper foods into a well-balanced menu.  Have a handy reference chart of the nutritional values of raw vegetables and fruits to easily consult when shopping. 

In the real world, that is pretty hard to accomplish.  A few tips that will help caregivers include planning a menu and making a list of the proper foods to buy before you go shopping.  Cook from scratch whenever circumstances permit. This will help avoid overly processed foods that are poor in nutrition. Whole grains are always the best. Select foods across the color spectrum. This helps ensure variety. A broader spectrum of foods helps to ensure a broader spectrum of nutrients is consumed.  Snacks of cheese, raw vegetables, yogurt, and the always-popular milk and whole grain cookies are an easy way to sneak in more nutritional foods into the diets of even the pickiest of eaters.

Plenty of ExerciseDealing With Dementia

Our bones are built to respond to the physical demands we put upon them. The more stress we put on the bones, the stronger they can become.  When we work hard, the muscles and tissues around the bone send chemical signals to the bone-building cells that make them work harder. In addition, when we exercise our bones, tiny micro fractures occur. The bone-building cells repair this damage with new stronger bone. Caregivers can take advantage of these processes to build bone mass in their residents with an active lifestyle.

How Much Time

Children and teens should get at least an hour of physical activity every day. Adults should get at least 30 minutes every day. Moderate weight-bearing exercise is the best and easiest to continue over time.  Examples are walking, jogging, dancing, gardening, and household chores like vacuuming.

Tips for Caregivers

Exercise programs in care homes can be very problematic. Here are a few tips that might help.

Taking Walks

Taking walks is a perfect fit for care homes. It’s a weight-bearing exercise. It helps work on balance and coordination. It’s easy to schedule into the daily routine. It’s easy to do in groups. In addition, you get sunshine on the skin, making vitamin D. 

Low-impact Exercise

You can reduce the possibility of injury by using low-impact exercise machines. Elliptical, gliders, and steppers are low impact and give more full-body exercise. Stationary bikes require less supervision. Use timers that alert you when the resident is done so you can be there when they stop. Always be with in supervising distance. Place the equipment in front of a TV or window to help fight exercise boredom.

Check Off Charts

Using charts that exercisers must check off gives a sense of accomplishment. It also helps the caregiver supervise exercise routines and reinforce good habits.

peddler 2


Can't Walk

For those residents who can’t walk, try using hand weights. Exercise stretch bands can give a more full-body workout. Mini peddlers can be placed on table tops and worked by hands instead of feet.  For more exercise ideas, go to the computer and type in “chair exercises for seniors.”


 Take It Easy

The rule of thumb is start low and go slow. Establishing long-term habits is more important than quick strengthening results. Exercise does not have to be continuous for good bone health. A 30-minute routine can be broken up into 10-minute segments. The hour needed for children can be achieved throughout the day.

Doctors and Bone Health

Doctors can be a great resource for help as caregivers and their clients work on bone health. There are many classes of medication that can help in many ways. Doctors must approve any multivitamin or mineral supplement, but they are usually open to requests. It never hurts to phrase requests in the form of a question. Example- I’m concerned about Mr. Smith getting enough sunshine this winter, do you think he needs a vitamin D supplement? Consult with doctors before starting any strenuous exercise regime.

If you have any concerns, communicate with the doctor. Call them, send them an email, and write them a note. Doctors may be in charge of all things medical, but they are ultimately just a servant to the needs of your resident. In your role as a patient advocate, it’s your job to utilize every resource available to keep them healthy and happy.



If your clients continue in inadequate lifestyles, it is inevitable that at some future point weaken bones will break. It is a sad fact that as many as half of all women and one fourth of all men older than 50 will fracture a bone at some point due to osteoporosis. Teenagers who fail to achieve their full peak bone mass will never be able to make it up later on in life.

Fortunately, there are plenty of things you as their caregiver can do to help avoid the pitfalls of weakened bones. Whether your resident is young and building bone or older and trying to preserve as much as they can, the simple steps but long-term efforts of having a balanced diet, getting plenty of sunshine and exercise, and utilizing the doctor as much as possible will help ensure that there will be enough bone to last a lifetime.

As always, good luck in your caregiving efforts.

Mark Parkinson RPh



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8. Bone. Wikipedia the Free Encyclopedia Oct. 13 2015

9. Oddom Demontiero, Christopher Vidal, and Gustavo Duque, Aging and bone loss: new insights for the clinician. National Center for Biotechnology Information, National Institute of Health. Apr. 4 2012

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16. Vitamin D Fact Sheet for Health Professionals. National Institute of Health. Nov 10 2014


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