Bone Builders—Osteoporosis Prevention Education

Research Year: 

Osteoporosis –a silent disease that causes porous bones that break easily—is both treatable and preventable. Yet it is the number 1 crippler of women. One in 2 women and one in 5 men will have osteoporosis fractures in their lifetime. The November 2010 report from the Institute of Medicine states adolescents need 1,300 milligrams of calcium per day to support bone growth, women ages 19 through 50 and men up to 71 require on average 800 milligrams daily. Women over 50 and both men and women 71 and older should take in 1,000 milligrams per day on average to ensure they are meeting their daily needs for strong, healthy bones. Yet the 2001 (most recent data) Arizona Behavior Risk Surveillance Survey found over half (51.4 percent) of Arizonans consume less than two of the three recommended) servings of milk or milk products per day. More than half of Arizona's population is in Maricopa County, where there is the highest total number at risk. The U.S. Surgeon General warned in his 2004 report that by 2020, half of all American citizens older than 50 will be at risk for fractures from osteoporosis and low bone mass if no immediate action is taken.

Description of Action: 

The Bone Builders program teaches women of all ages, young adolescent girls, and older men in Arizona how to change their dietary and exercise habits to reduce the risks of osteoporosis and improve bone health. It is a partnership with University of Arizona Cooperative Extension, UA College of Medicine, the Arizona Department of Health Services, Arizona Osteoporosis Coalition and more than 60 partners including county health departments, health providers and interested citizens. The program uses volunteer educators, community classes, the Bone Builders Physical Activity Program, health fairs and a social marketing campaign to spread the message of osteoporosis prevention on Twitter and Facebook.


In 2010, Basic Bone Builders classes were taught for 91 Maricopa County community groups with 918 participants, along with 120 one-on-one sessions. Bone Builders displays and education programs at 18 health and community fairs directly reached about 1,120 women. In one assessment, 347 people attending classes rated their knowledge of osteoporosis risk and prevention an average of 1.12 before the sessions and 4.79 after, out of a 5 point scale with 5 high, a 415 percent increase in knowledge. They rated class quality as 4.95. More than 1,000 ‘Like Mother, Like Daughter’ flyers and 40 posters have been distributed through businesses, doctor offices, day care centers, churches and school districts.

  • For pre-teens, a health educator taught “No Bones About It” to 703 students at middle schools, while “Best Bones Forever” materials were distributed for 1,200 students at another. “No Bones About It” students increased their knowledge through an average of 2.5 MORE correct answers out of 15 questions from the pre- to the post-test.

  • In 2009 Bone Builders, the Arizona Osteoporosis Coalition and Pinal County Cooperative Extension were selected for a national pilot of the BodyWorks/Best Bones Forever (BBF) program. The partnership did BBF outreach at 14 community events with 4,460 individuals. Many included bone density screening. Thirty-seven parents and daughters completed the 10-week Bodyworks classes. Final Bodyworks/Best Bones Forever evaluations are not available because they are still being compiled by the national funder, but participants did express increased knowledge when questioned verbally and 100 percent of daughters expressed excitement about doing weight-bearing exercise.

  • Nine seniors completed at least one fitness assessment for the Bone Builders Physical Activity Program, while six seniors completed the whole series plus the pre-post assessments.  All seniors completing the 9 week physical activity class improved in at least 1 out of 6 fitness assessments. Seniors improved from 10 to 90 percent on individual tests.

  • During the past 6 years, Bone Builders and its partners completed 2,832 ultrasound screenings with education. In 2009, of the 460 women tested, 180 had low bone density, 47 had osteopenia and 16 had osteoporosis. The average age was under 60 years old, when many do not even think about osteoporosis. Of people who completed 386 ultrasound screenings plus education in 2010, 43 had osteopenia and 4 had osteoporosis. If ONE hip fracture can be prevented from early screening/education it would save $81,000 in health costs.

  • had 19,000 visitors in 2010, although data are still incomplete. More than 34,000 people visited the page on high calcium foods; the page on weight-bearing exercise had 32,000 visitors. Referral sources included 530 visitors from the Foundation for Osteoporosis Research & Education; website visitors from other countries included Sweden (592 visitors), Russia (469) and Australia (678). The Bone Builders program received requests for materials from four states and the United Kingdom.

  • Over the past twelve years (1998-2010) Bone Builders staff and volunteers have taught 2,192 classes to 45,000 participants and reached 131,375 people at 687 health fairs. More than 680 volunteers have completed a 2-day workshop taught face-to-face or by live videoconference, simultaneously in Phoenix and Tucson over the past 12 years. The Bone Builders program and its Arizona Cooperative Extension team members were recognized with the 2010 Western Extension Directors Association Award of Excellence in 2010.

Conact Name: 
Sharon Hoelscher Day
Contact E-mail: