The Endocrine The Endocrine SystemSystem

Rachel R. Rachel R. Gabie F. Gabie F. Kyle B.Kyle B.

Steffanie M.Steffanie M.

The Endocrine SystemThe Endocrine System responsible for keeping balance and maintaining responsible for keeping balance and maintaining

homeostasis in the body. homeostasis in the body. important for regulating important for regulating

moodmood growth and developmentgrowth and development tissue functiontissue function metabolismmetabolism sexual functions and reproductive processes within the sexual functions and reproductive processes within the

body.body.

must respond to constant changes in external must respond to constant changes in external environment with the regulation of the internal environment with the regulation of the internal processes inside the body.processes inside the body. feedback loops feedback loops release of hormonesrelease of hormones

Parts: HORMONES Parts: HORMONES produced and secreted

by Endocrine Glands chemicals in the body

that carry messages and information to and from target cells hormones and target

cells have receptors allow the hormone to

latch onto specific cells and the cell to recognize the corresponding hormones

when hormones attach to a cell they: Activate or inactivate

enzymes Stimulate genetic material

(production of enzymes and proteins)

Change the permeability of cells

Parts: ENDOCRINE Parts: ENDOCRINE GLANDSGLANDS

specialized group of specialized group of cells that produce cells that produce and secrete and secrete hormoneshormones

glands are ductless glands are ductless (no tubes) releasing (no tubes) releasing hormones directly hormones directly into bloodstreaminto bloodstream

GlandGland HormoneHormone FunctionFunction

HypothalamusHypothalamus

Links nervous system and endocrine systemLinks nervous system and endocrine systemChemicals control production and secretion of hormones in pituatiry gland Chemicals control production and secretion of hormones in pituatiry gland

Controls feelings of hunger and thirst, emotions and behaviors Controls feelings of hunger and thirst, emotions and behaviors Maintains body temp., water balance, and blood pressureMaintains body temp., water balance, and blood pressure

Pituitary Pituitary ““the master gland”the master gland”

Anterior lobeAnterior loberegulates regulates

thyroid, adrenal thyroid, adrenal and and

reproductive reproductive glandsglands

Thyroid stimulating Thyroid stimulating hormones (TSH)hormones (TSH)

Regulates production and secretion Regulates production and secretion of thyroid hormonesof thyroid hormones

Growth hormoneGrowth hormone Oversees growth, development and Oversees growth, development and protein production protein production

CortiotropinCortiotropin Regulates production and secretion Regulates production and secretion of adrenal (cortex) hormonesof adrenal (cortex) hormones

EndorphinsEndorphins Reduces feelings of painReduces feelings of pain

Posterior lobePosterior lobebalance of balance of

water in the water in the bodybody

Antidiuretic Antidiuretic hormonehormone

Control blood pressure and water Control blood pressure and water retention in kidneysretention in kidneys

OxytocinOxytocin Contraction of uterus during Contraction of uterus during pregnancypregnancy

ProlactinProlactin Initiates milk productionInitiates milk production

Thyroid glandThyroid glandContains iodineContains iodine Thyroid hormonesThyroid hormones

Regulates metabolism Regulates metabolism growth, maturation, body temp. and growth, maturation, body temp. and

weightweight

Parathyroid Parathyroid Parathyroid hormonesParathyroid hormones Bone formation, excretion of Bone formation, excretion of calcium and phosphorouscalcium and phosphorous

GlandGland HormoneHormone FunctionFunctionPineal Pineal Melatonin Melatonin Regulates when you sleep and when Regulates when you sleep and when

you wake, darkness and lightyou wake, darkness and light

ThymusThymusInitiates immune system Initiates immune system

Stops working after pubertyStops working after pubertyThymosin Thymosin Controls production of antibodiesControls production of antibodies

Pancreas Pancreas Insulin Insulin lowers blood sugar level, stimulate lowers blood sugar level, stimulate

metabolism of protein, glucose, fat metabolism of protein, glucose, fat

glucagonglucagon Raises level of blood sugarRaises level of blood sugar

AdrenalAdrenal

Medulla - adrenalineMedulla - adrenaline Responds to stressors (fright, anger, Responds to stressors (fright, anger, low blood sugar, caffeine)low blood sugar, caffeine)

Cortex - corticosteroids (cortisone)Cortex - corticosteroids (cortisone)

aldosteronealdosterone

Corticosteroids- anti-inflammatoryCorticosteroids- anti-inflammatory

Aldosterone- balance of salt and Aldosterone- balance of salt and waterwater

GonadsGonads

Testes- testosteroneTestes- testosterone

male characteristics like deepening male characteristics like deepening of voice, hair (facial and pubic), of voice, hair (facial and pubic),

penis and height growth, production penis and height growth, production of spermof sperm

Ovaries-estrogen Ovaries-estrogen progesteroneprogesterone

Estrogen-female sexual Estrogen-female sexual characteristics and reproduction, characteristics and reproduction,

breast and height growth, increase breast and height growth, increase in body fat, and in body fat, and

Progesterone-prepares uterus for Progesterone-prepares uterus for fertilization and breast of lactationfertilization and breast of lactation

both regulate menstrual cycleboth regulate menstrual cycle

Heart HormonesHeart Hormones

The human heart The human heart releases hormonesreleases hormones Type A and B Type A and B

Natriuretic Peptides Natriuretic Peptides lower blood pressure lower blood pressure

Relaxes arterioles, Relaxes arterioles, stops absorption of stops absorption of sodium by kidneys, sodium by kidneys, prevents secretion prevents secretion of renin and of renin and aldosteronealdosterone

Ventricles release Type B Natriuretic

Peptides

Atria release Type A Natriuretic

Peptides

Kidney HormonesKidney Hormones

The kidney also The kidney also releases hormonesreleases hormones ErythropoietinErythropoietin

Works in bone Works in bone marrow to increase marrow to increase production of RBCproduction of RBC

CalcitriolCalcitriol helps transfer helps transfer

calcium from bone to calcium from bone to blood blood

supports absorption supports absorption of calcium from food of calcium from food in the intestinesin the intestines

HOW DOES IT WORK?HOW DOES IT WORK? body reacts to a stimulusbody reacts to a stimulus

brain sends instructions to brain sends instructions to endocrine systemendocrine system glands glands send feedback and react to send feedback and react to stimulus stimulus

A specific hormone is then A specific hormone is then released into bloodstream released into bloodstream and latch on to target cellsand latch on to target cells

When level of hormone rises the When level of hormone rises the hypothalamus sends message to pituitaryhypothalamus sends message to pituitary Tells organ to stop producing hormone Tells organ to stop producing hormone

When this process does not run smoothly then When this process does not run smoothly then problems with the Endocrine System occur…problems with the Endocrine System occur…

DiabetesDiabetes

DiabetesDiabetes-A disease in which the body does not produce -A disease in which the body does not produce

or properly use insulin.or properly use insulin.

Interesting Fact: 23.6 million children & adults in the Interesting Fact: 23.6 million children & adults in the United States, or 7.8% of the population, who have United States, or 7.8% of the population, who have

diabetes. Nearly one quarter of them have NOT been diabetes. Nearly one quarter of them have NOT been diagnosed.diagnosed.

InsulinInsulin

What is Insulin?What is Insulin? Insulin is a hormone that is necessary for Insulin is a hormone that is necessary for

converting sugar, starches and other food into converting sugar, starches and other food into energy. When we eat food, the body breaks down energy. When we eat food, the body breaks down all of the sugars & starches into glucose. Glucose all of the sugars & starches into glucose. Glucose is the basic fuel for cells. Insulin’s job is to take is the basic fuel for cells. Insulin’s job is to take the sugar from the blood into the cells. Glucose the sugar from the blood into the cells. Glucose building up in the blood causes problems:building up in the blood causes problems:

Cells starved for energyCells starved for energy High Blood Glucose Levels damage eyes, kidneys, High Blood Glucose Levels damage eyes, kidneys,

nerves or heart.nerves or heart.

How Diabetes is DiagnosedHow Diabetes is Diagnosed

Fasting Plasma Glucose Test (FPG)Fasting Plasma Glucose Test (FPG) Oral Glucose Test (OGTT)Oral Glucose Test (OGTT)

Both require fasting beforehand.Both require fasting beforehand.

FPG – FPG – BBlood lood GGlucose lucose LLevel between 100-125 evel between 100-125 mg/dl signals pre-diabetes. BGL higher than 126 mg/dl signals pre-diabetes. BGL higher than 126 indicates definite diabetes.indicates definite diabetes.

OGTT – Fast & Drink a glucose-rich beverage. If OGTT – Fast & Drink a glucose-rich beverage. If two hours after BGL is between 140-199 mg/dl two hours after BGL is between 140-199 mg/dl means pre-diabetes. BGL of 200 mg/dl or means pre-diabetes. BGL of 200 mg/dl or higher, person has diabetes.higher, person has diabetes.

o Mg/dl is milligrams per deciliter

Type One DiabetesType One Diabetes Usually diagnosed in children & young adultsUsually diagnosed in children & young adults Issue: Body does not produce InsulinIssue: Body does not produce Insulin

Type Two Diabetes Most common form of Diabetes Issue: The body does not produce enough Insulin OR cells ignore the Insulin.

Gestational Diabetes Diagnosed in Pregnant women who have not had Diabetes before. High Blood Sugar Level during Pregnancy Affects about 4% of all pregnant women - about 135,000 cases of gestational diabetes in the United States each year.

HypoglycemiaHypoglycemia

AKA Low Blood GlucoseAKA Low Blood Glucose Cannot prevent it from happening, but you can Cannot prevent it from happening, but you can

treat it before it gets worse.treat it before it gets worse. Symptoms include: Shakiness, Dizziness, Symptoms include: Shakiness, Dizziness,

Sweating, Hunger, Headache, Pale Skin Color, Sweating, Hunger, Headache, Pale Skin Color, Sudden Behavioral Changes, Clumsy movements, Sudden Behavioral Changes, Clumsy movements, Seizure, Confusion, & Tingling Sensations Around Seizure, Confusion, & Tingling Sensations Around the Mouththe Mouth

Treatment: Glucose Tablets, Fruit Juice, Hard Candy.If you pass out, you need immediate treatment such as an injection of glucagon. DOES NOT give them food or liquids.

HyperglycemiaHyperglycemia

High Blood GlucoseHigh Blood Glucose A result of the body not having enough insulin or A result of the body not having enough insulin or

not using the insulin properly. Can also be not using the insulin properly. Can also be triggered by too much exercise, food, a cold/flu triggered by too much exercise, food, a cold/flu and stress.and stress.

Symptoms: High Blood Sugar, High Levels of Symptoms: High Blood Sugar, High Levels of Sugar in Urine, Frequent Urination, Increased Sugar in Urine, Frequent Urination, Increased Thirst.Thirst.

Treatment: Exercise. If BGL is above 240 mg/dl, check urine for ketones. If ketones are present, DON’T exercise. Exercising while ketones are present could actually raise your BGL.

KetoacidosisKetoacidosis

Diabetic Coma that occurs when the body does Diabetic Coma that occurs when the body does not have enough insulin. It is life threatening.not have enough insulin. It is life threatening.

Symptoms: Shortness of Breath, Breath that Symptoms: Shortness of Breath, Breath that Smells Fruity, Nausea & Vomiting, and a Very Dry Smells Fruity, Nausea & Vomiting, and a Very Dry Mouth.Mouth.

Most common in Type 1 Diabetics, but can occur Most common in Type 1 Diabetics, but can occur in Type 2s.in Type 2s.

Ketones – acids that build up in bloodKetones – acids that build up in blood Appear in urine when the body doesn’t have Appear in urine when the body doesn’t have

enough insulinenough insulin Treatment takes place in the hospitalTreatment takes place in the hospital

Hyperosmolar Hyperglycemic Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)Nonketotic Syndrome (HHNS)

Mostly occurs in older persons, can occur in both Mostly occurs in older persons, can occur in both types of Diabetes, but more frequently in Type 2. types of Diabetes, but more frequently in Type 2. Triggered by an illness or infection.Triggered by an illness or infection.

BGL rises, Body attempts to rid sugar from BGL rises, Body attempts to rid sugar from system through urine. Excretory System begins to system through urine. Excretory System begins to over work itself, resulting in extreme over work itself, resulting in extreme Dehydration.Dehydration.

Warning Signs: BGL over 600 mg/dl, Dry Mouth, Warning Signs: BGL over 600 mg/dl, Dry Mouth, Extreme Thirst, Warm Dry Skin, Fever, Sleepiness Extreme Thirst, Warm Dry Skin, Fever, Sleepiness & Confusion, Loss of Vision, Hallucinations, & & Confusion, Loss of Vision, Hallucinations, & Weakness on One Side of the Body.Weakness on One Side of the Body.

Foot ProblemsFoot Problems Foot Problems:Foot Problems: NeuropathyNeuropathy Foot callusesFoot calluses UlcersUlcers Skin changesSkin changes Poor circulationPoor circulation Can lead to Can lead to

amputationamputation

Can increase circulation with special diabetic

socks ↓

Diabetes MedicationsDiabetes Medications Insulin: Beta Cells inside Insulin: Beta Cells inside

the Pancreas no longer the Pancreas no longer make insulin or do not make insulin or do not utilize it properly. Type 1 utilize it properly. Type 1 Diabetics inject Insulin Diabetics inject Insulin Shots, Some Type 2 Shots, Some Type 2 Diabetics need insulin.Diabetics need insulin.

Sulfonylureas: Stimulate Sulfonylureas: Stimulate Beta Cells to make InsulinBeta Cells to make Insulin

DPP-4 Inhibitors: Prevent DPP-4 Inhibitors: Prevent breakdown of naturally breakdown of naturally occurring GLP-1. Only occurring GLP-1. Only lowers BGL when lowers BGL when necessary.necessary.

Aplha-Glucoside Inhibitors: Lower BGL by blocking the breakdown of starches in the intestine. Slows the rise in BGL after a meal. Oral Combination Therapy: Combining any of the types of pills above. Pills do not work for everyone.

Treatment Methods ContinuedTreatment Methods Continued

Blood Test with a glucose meter

Insulin Injection

Transplantation to replace malfunctioning parts: Kidney Pancreas Islet

Glucose tablets (such as Glucerna) when Blood Level Sugar drops Healthy Diet Exercise

Pancreatic Pancreatic CancerCancer

Pancreatic CancerPancreatic Cancer Pancreas secretes Pancreas secretes

hormones that hormones that regulate the regulate the metabolism of metabolism of sugars and enzymes sugars and enzymes that help digestionthat help digestion

Leading cause of Leading cause of cancer deathcancer death In 2008: 37,680 new In 2008: 37,680 new

casescases 34,290 deaths34,290 deaths

http://www.mayoclinic.com/health/pancreatic-cancer/DS00357http://www.cancer.gov/cancertopics/types/pancreatic

CausesCauses Cells in the pancreas undergo a Cells in the pancreas undergo a

mutation and multiply, rapidly forming mutation and multiply, rapidly forming a tumora tumor

Pancreatic Cancer Cell

Symptoms Symptoms

Symptoms usually do not appear Symptoms usually do not appear until the cancer is advanceduntil the cancer is advanced

Symptoms include:Symptoms include: Jaundice- yellowing of skin and whites of eyesJaundice- yellowing of skin and whites of eyes Loss of appetiteLoss of appetite Weight lossWeight loss DepressionDepression Upper abdominal painUpper abdominal pain

Jaundice Eye

Effects in the BodyEffects in the Body

JaundiceJaundice Pain in the abdomenPain in the abdomen Bowel obstruction- digested food that Bowel obstruction- digested food that

is blocked from getting into the is blocked from getting into the intestinesintestines

Weight loss- can be caused by Weight loss- can be caused by vomiting or the body having trouble vomiting or the body having trouble processing foodprocessing food

TreatmentsTreatments Surgery- removing the Surgery- removing the

tumor from the tumor from the pancreas (only pancreas (only possible if cancer is possible if cancer is found in the first found in the first stage)stage)

Placing a stent (tube) Placing a stent (tube) in small intestines to in small intestines to keep it open to keep it open to prevent bowel prevent bowel obstructionobstruction

Chemotherapy- drugs Chemotherapy- drugs used to kill the cancer used to kill the cancer cellscells

Radiation therapy- Radiation therapy- high-energy beams high-energy beams used to kill cancer used to kill cancer cellscells

TreatmentsTreatments

Targeted drug therapy- drugs attack Targeted drug therapy- drugs attack specific cancer cells within the bodyspecific cancer cells within the body

Clinical trials- patients participate in Clinical trials- patients participate in studies of new treatments in order to studies of new treatments in order to test their effectiveness test their effectiveness

OsteoporosisOsteoporosis

OsteoporosisOsteoporosis An endocrine disease that weakens bones and An endocrine disease that weakens bones and

makes them more prone to fracturemakes them more prone to fracture Osteoporosis means “porous bone”Osteoporosis means “porous bone”

Technically defined as when bone mass decreases past -2.5 standard deviations below peak bone mass

General Info General Info Osteoporosis is most common in women Osteoporosis is most common in women

after menopause but can also effect menafter menopause but can also effect men Every bone is at risk of weakening but the Every bone is at risk of weakening but the

hip and spine are the most dangerous hip and spine are the most dangerous and some of the most common to break.and some of the most common to break.

1 in 5 postmenopausal women suffer 1 in 5 postmenopausal women suffer from Osteoporosisfrom Osteoporosis

CausesCauses Decreased mineral content in bones Decreased mineral content in bones

make them weakermake them weaker This can happen because too many minerals are This can happen because too many minerals are

being reabsorbed into the bodybeing reabsorbed into the body

Bones become weaker in women after Bones become weaker in women after menopause due to decrease in estrogen menopause due to decrease in estrogen productionproduction Estrogen is important to bone development Estrogen is important to bone development

because it prevents bone breakdown, and because it prevents bone breakdown, and regulates bone re-absorption, which is how bone regulates bone re-absorption, which is how bone fluid is converted into blood fluidfluid is converted into blood fluid

CausesCauses

Men can suffer From Osteoporosis in Men can suffer From Osteoporosis in the same way that women do, due to the same way that women do, due to insufficient amounts of the hormones insufficient amounts of the hormones testosterone, and/or androgen. testosterone, and/or androgen.

Causes Causes Bone Cycle defection- the body fails Bone Cycle defection- the body fails

to produce the same amount of bone to produce the same amount of bone that is being used up over time. that is being used up over time. In a healthy body, bone is replaced at the In a healthy body, bone is replaced at the

same rate that it deterioratessame rate that it deteriorates

Examples of defects in bone cycleExamples of defects in bone cycle Lack of calcium and/or phosphate, which Lack of calcium and/or phosphate, which

strengthen bonestrengthen bone Body does not properly absorb calcium or Body does not properly absorb calcium or

phosphatephosphate Over absorption of minerals into bodyOver absorption of minerals into body

CausesCauses Low levels of Calcium can trigger the Low levels of Calcium can trigger the

parathyroid gland to produce excess parathyroid gland to produce excess amounts of parathyroid hormoneamounts of parathyroid hormone Parathyroid hormone, or PTH, is responsible for maintaining calcium levels in the blood

When blood calcium levels are low, more PTH is produced, causing calcium to be drawn out of bone and into the bloodstream

SymptomsSymptoms

In early stages, no symptoms may be presentIn early stages, no symptoms may be present Symptoms in later stages include:Symptoms in later stages include:

Back pain (resulting from weakened vertebrae)Loss of height (due to disk compression)

Overall pain (due to bone compression throughout body)Fractures

Hip fracture

PreventionPrevention

Proper exercise is important in Proper exercise is important in maintaining bone densitymaintaining bone density

Sufficient intake of Vitamin D is Sufficient intake of Vitamin D is necessary for calcium to be absorbed necessary for calcium to be absorbed into boneinto bone Sufficient intake of calcium is also necessary Sufficient intake of calcium is also necessary

for bone growth and strengthfor bone growth and strength

TreatmentTreatment

BisphosphonatesBisphosphonates Most common drug treatment for osteoporosisMost common drug treatment for osteoporosis These drugs work by inhibiting osteoclast cells, These drugs work by inhibiting osteoclast cells,

which are responsible for bone resorptionwhich are responsible for bone resorption Fosamax, Actonel and Boniva are examplesFosamax, Actonel and Boniva are examples

TreatmentTreatment Hormone therapyHormone therapy

Not as popular as bisphophonate treatment Not as popular as bisphophonate treatment due to side effects of hormonesdue to side effects of hormones

Breast cancer is a possible side effectBreast cancer is a possible side effect

Estrogen, and drugs that mimic it fall into this Estrogen, and drugs that mimic it fall into this categorycategory

Hormone therapy works by replacing or Hormone therapy works by replacing or mimicking the body’s hormones that decrease mimicking the body’s hormones that decrease after menopauseafter menopause

These hormone promote healthy bone These hormone promote healthy bone development development

Recap!Recap! The Endocrine System maintains homeostasis in the body and The Endocrine System maintains homeostasis in the body and controls growth and development, tissue function, metabolism, controls growth and development, tissue function, metabolism, sexual functions and reproductive processes, as well as moodsexual functions and reproductive processes, as well as mood

The Endocrine System does this by releasing hormones, The Endocrine System does this by releasing hormones, produced and secreted by Endocrine Glands, directly into produced and secreted by Endocrine Glands, directly into the the

bloodstreambloodstream

When the Endocrine System is not working properly it can cause:When the Endocrine System is not working properly it can cause:

(Visit (Visit http://www.noah-health.org/en/endocrinehttp://www.noah-health.org/en/endocrine// for a continued list of disorders)for a continued list of disorders)

DiabetesPancreatic CancerOsteoporosis Fertility / Infertility Problems

Growth DisordersMetabolic SyndromeMany more

SOURCESSOURCES http://www.montana.edu/wwwai/imsd/alcohol/Vanessa/vwendocrine.htmhttp://www.montana.edu/wwwai/imsd/alcohol/Vanessa/vwendocrine.htm http://www.som.tulane.edu/classware/pathology/medical_pathology/http://www.som.tulane.edu/classware/pathology/medical_pathology/

New_for_99/endocrin/sld007.htmNew_for_99/endocrin/sld007.htm http://www.virtualcancercentre.com/anatomy.asp?sid=17http://www.virtualcancercentre.com/anatomy.asp?sid=17 http://kidshealth.org/teen/your_body/body_basics/endocrine.htmlhttp://kidshealth.org/teen/your_body/body_basics/endocrine.html http://health.howstuffworks.com/adam-200091.htmhttp://health.howstuffworks.com/adam-200091.htm http://training.seer.cancer.gov/module_anatomy/unit6_3_endo_glnds.htmlhttp://training.seer.cancer.gov/module_anatomy/unit6_3_endo_glnds.html http://www.healthsystem.virginia.edu/uvahealth/adult_endocrin/chart.cfmhttp://www.healthsystem.virginia.edu/uvahealth/adult_endocrin/chart.cfm http://www.becomehealthynow.com/article/bodynervousadvanced/956/http://www.becomehealthynow.com/article/bodynervousadvanced/956/ http://library.thinkquest.org/3007/endocrine.html http://library.thinkquest.org/3007/endocrine.html http://pms.about.com/od/glossary/g/70807_hypothala.htmhttp://pms.about.com/od/glossary/g/70807_hypothala.htm http://www.maexamhelp.com/id94.htmhttp://www.maexamhelp.com/id94.htm http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/K/http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/K/

KidneyHormones.htmlKidneyHormones.html http://content.revolutionhealth.com/contentimages/images-image_popup-http://content.revolutionhealth.com/contentimages/images-image_popup-

adrenal.jpgadrenal.jpg

Sources cont.Sources cont.

http://www.diabetes.org/home.jsphttp://www.diabetes.org/home.jsp http://www.diabetes.org/type-1-diabetes.jsphttp://www.diabetes.org/type-1-diabetes.jsp http://www.diabetes.org/type-2-diabetes.jsphttp://www.diabetes.org/type-2-diabetes.jsp http://www.diabetes.org/type-2-diabetes/complications.jsphttp://www.diabetes.org/type-2-diabetes/complications.jsp http://www.diabetes.org/type-2-diabetes/treatment-conditions. http://www.diabetes.org/type-2-diabetes/treatment-conditions. http://www.emcom.ca/images/hormone.gifhttp://www.emcom.ca/images/hormone.gif http://www.teachnet.ie/farmnet/images/Endocr2.gif http://www.teachnet.ie/farmnet/images/Endocr2.gif http://static.howstuffworks.com/gif/adam/images/en/biliary-obstruction-http://static.howstuffworks.com/gif/adam/images/en/biliary-obstruction-

indication-picture.jpgindication-picture.jpg http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/17156.jpghttp://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/17156.jpg http://apps.uwhealth.org/health/adam/graphics/images/en/10274.jpghttp://apps.uwhealth.org/health/adam/graphics/images/en/10274.jpg http://www.iposture.com/images/pho_learn_fh_osteoporosis-1-posture2.jpghttp://www.iposture.com/images/pho_learn_fh_osteoporosis-1-posture2.jpg http://www.nlm.nih.gov/MEDLINEPLUS/ency/images/ency/fullsize/18026.jpghttp://www.nlm.nih.gov/MEDLINEPLUS/ency/images/ency/fullsize/18026.jpg http://www.assetchemist.co.uk/images/uploads/Actonel.bmphttp://www.assetchemist.co.uk/images/uploads/Actonel.bmp http://images.google.com/imgres?imgurl=http://www.genericmedicine.com/http://images.google.com/imgres?imgurl=http://www.genericmedicine.com/

pimages/Fosamax.gif&imgrefurl=http://www.genericmedicine.com/pimages/Fosamax.gif&imgrefurl=http://www.genericmedicine.com/&h=98&w=158&sz=10&hl=en&start=9&usg=__dFewd8z4kluwgR-&h=98&w=158&sz=10&hl=en&start=9&usg=__dFewd8z4kluwgR-EMSODnrZdC78=&tbnid=8zSa7iZ_P1Jx9M:&tbnh=60&tbnw=97&prev=/imagesEMSODnrZdC78=&tbnid=8zSa7iZ_P1Jx9M:&tbnh=60&tbnw=97&prev=/images%3Fq%3DFosamax%26gbv%3D2%26hl%3Den%26ie%3DUTF-8%3Fq%3DFosamax%26gbv%3D2%26hl%3Den%26ie%3DUTF-8

http://www.boniva.com/images/boniva_logo.gifhttp://www.boniva.com/images/boniva_logo.gif