Osteoporose na Mulher Idosa: um rastreamento no consultório de enfermagem / Osteoporosis en la mujer de edad avanzada: un rastreo en la práctica de enfermería / Osteoporosis in the Aged Woman: a tracking in the nursing’s office

Objective: To describe characteristics rose in historical nursing of elderly pointing to osteoporosis and the risk of a same Outreach Program of Nursing, Fluminense Federal University. Results: It was found that 48 (12,4%) of elderly nursing historical records had problems related to osteoporosis, which stimulated the construction of an extension project for osteoporosis prevention and health promotion seeking to minimize the problem. It was used as strategy, consultations, distributing informative folder and stimulate the maintenance of healthy habits. Conclusion: This problem goes beyond individuality to reach the public space. An isolated action reaches only the intended population, but when other institutions are engaging in this care will contribute with their customers, which is reflected in the well-being of the entire community.

Objetivo: Relatar características levantadas nos históricos de enfermagem de idosas que apontam para osteoporose e risco para a mesma de um Programa de Extensão de Enfermagem da Universidade Federal Fluminense. Resultados: Identificou-se que 48 (12,4%) históricos de enfermagem de idosas possuíam registros de problemas relacionados à osteoporose, o que estimulou a construção de um projeto de extensão para prevenção de osteoporose e promoção da saúde buscando minimizar o problema. Utilizou-se como estratégia, realizar consultas, distribuir folder informativo e estimular a manutenção de hábitos saudáveis. Conclusão: Este problema extrapola a individualidade para alcançar o espaço público. Uma ação isolada alcança apenas a população a que se destina, mas quando outras instituições se lançam neste cuidado contribuirão com seus clientes, o que se refletirá no bem-estar de toda sua comunidade.

Objetivo: Describir las características planteadas en histórico de enfermería de ancianos que apuntan a la osteoporosis y el riesgo de un mismo Programa de Extensión de Enfermería de la Universidad Federal Fluminense. Resultados: Se encontró que 48 (12,4%) de los mayores registros históricos de enfermería tenían problemas relacionados con la osteoporosis, lo que estimuló la construcción de un proyecto de extensión para la prevención de la osteoporosis y la promoción de la salud que buscan minimizar el problema. Fue utilizado como una estrategia, consultas, distribución de carpeta informativa y estimular el mantenimiento de hábitos saludables. Conclusión: Este problema va más allá de la individualidad para llegar al espacio público. Una acción aislada alcanza sólo la población de destino, pero cuando otras instituciones están participando en este tipo de atención, contribuirá con sus clientes, lo que se refleja en el bienestar de toda su comunidad.

Prevention and treatment of bone loss in patients with nonmetastatic breast or prostate cancer who receive hormonal ablation therapy.

Hormone ablation therapy is a mainstay in the treatment of breast and prostate cancers. However, aromatase inhibitors (AIs) used in postmenopausal women with breast cancer and androgen-deprivation therapy (ADT) used in men with prostate cancer contribute to substantial bone loss, thereby increasing the risk of osteoporotic fractures. Evidence-based guidelines, therefore, urge oncology practices to screen these patients for bone loss and, if needed, provide treatment to maintain bone health. In addition to lifestyle modification and calcium or vitamin D supplementation, bone protection strategies include treatment with bisphosphonates and denosumab, a monoclonal antibody against RANK ligand. Identification of patients at greater risk for bone loss and fracture and proper interventions can reduce fracture rates. Oncology nurses can play an important role in screening these patients. The purpose of this article is to inform oncology nurses about the effects of cancer treatment on bone health, review current prevention and treatment options for cancer treatment-induced bone loss, and discuss recommendations for identifying high-risk individuals.

The performance of an online osteoporosis detection system a sensitivity and specificity analysis.

AIMS AND OBJECTIVES: To develop an online system for the detection of osteoporosis risk and to test its accuracy. BACKGROUND: Osteoporosis is a silent killer; usually, there are no symptoms, such as pain, until bone erosion and fracture occur. The risks of osteoporosis have been underestimated and neglected; as a result, osteoporosis can be as dangerous as heart diseases and cancers that lead to a healthcare crisis. DESIGN: Cross-sectional study. METHODS: The study participants were individuals presenting for routine health examinations at a medical centre in Taiwan from 2006-2007. Women over 30 years of age who underwent dual-energy X-ray absorptiometry scanning for measurement of bone mineral density were eligible for this study. The system for osteoporosis detection and health risk, which was developed in this study, was analysed. RESULTS: The findings indicated a high sensitivity of 75%, specificity of 75%, positive predictive value of 75% and negative predictive value of 75%. In addition, the online osteoporosis detective system had a higher predictive power (24·2% vs. 11%) and a similar cut-off point (33% vs. 27%) compared with the tool designed by the International Osteoporosis Foundation. CONCLUSION: The online system for detection of osteoporosis risk had excellent reliability and validity. It performed well in predicting osteoporosis and the cut-off point used for identifying the risk among women at risk of developing osteoporosis. Therefore, it is suitable for the Asian women and can help women achieve the goals of early detection and health promotion. RELEVANCE TO CLINICAL PRACTICE: Early detection is the only way to prevent osteoporosis. Professional nurses should apply effective technology to promote health care in community-dwelling people.

Fatores associados à qualidade de vida de idosos com osteoporose residentes na zona rural / Factors associated to the quality of life for elderly people with osteoporosis, living at rural areas / Factores asociados a la calidad de vida de ancianos con osteoporosis residentes en zonas rurales

Inquérito domiciliar transversal que objetivou mensurar a qualidade de vida de idosos rurais com osteoporose e verificar seus fatores associados. Utilizaram-se os instrumentos: estruturados World Health Organization Quality of Life-Bref (WHOQOL-BREF) e Health Organization Quality of Life Assessment for Older Adults (WHOQOL-OLD). Procedeu-se análise descritiva, teste t-Student, Mann Whitney e regressão linear múltipla (p <0,05). Predominou o perfil: sexo feminino, 60-- 70 anos, casada, 4 -- 8 anos de estudo, renda de 1 salário mínimo, aposentados por idade, dona de casa, regular satisfação das necessidades, casa própria quitada e que moravam com o cônjuge. Os menores escores associaram-se ao maior número de morbidades, à ausência de escolaridade e à menor idade. Evidencia-se a necessidade de ações de acompanhamento e monitoramento das condições de saúde desta população, visando minimizar o impacto na qualidade de vida.

Cross-sectional household survey whose objective was to measure the quality of life of rural elderly with osteoporosis, and verify the factors associated to them. The Instruments used were: structured, World Health Organization Quality of Life-Bref (WHOQOL-BREF) and Health Organization Quality of Life Assessment for Older Adults (WHOQOL-OLD). We proceeded with a descriptive analysis, applying t-Student test, Mann Whitney test and multiple linear regression (p<0.05). The predominance was composed by females, 60 -– 70 years of age, married, 4-– 8 years of study, a minimum wage income, retired by age, a homemaker, satisfaction in meeting regular needs, full payout house owners living with their spouses. The lowest scores were associated to a greater number of morbidities, to the lack of education and to the minor age. This study put in evidence the need of actions, such as follow-up and monitoring the health of this population in order to minimize the impact on quality of life.

Pesquisa domiciliar transversal que tuvo como objetivo medir la calidad de vida de los ancianos rurales con osteoporosis y determinar los factores asociados. Los instrumentos utilizados fueron: estructurado, la calidad de la Organización Mundial de la Salud de la Vida-Bref (WHOQOL-BREF) y Calidad de la Salud Organización de Evaluación de la Vida de los Adultos Mayores (WHOQOL-OLD). Se realizó un análisis descriptivo, prueba t de Student, prueba de Mann Whitney y la regresión lineal múltiple (p<0,05). El sexo femenino, 60 -– 70 años, casado, 4-– 8 años de estudio, renda de un salario mínimo, la edad de jubilado, si es ama de casa, satisfacción regular de las necesidades, casa propia y si viven con su pareja. Los resultados más bajos se asociaron con un mayor número de morbilidades, la falta de educación y de menor edad. Este estudio resalta la necesidad de seguimiento y vigilancia de la salud de esta población con el fin de minimizar el impacto en la calidad de vida.

Fracture liaison service in a non-regional orthopaedic clinic--a cost-effective service.

Fracture liaison services (FLS) aim to provide cost-effective targeting of secondary fracture prevention. It is proposed that a dedicated FLS be available in any hospital to which a patient presents with a fracture. An existing orthopaedic clinic nurse was retrained to deliver a FLS. Proformas were used so that different nurses could assume the fracture liaison nurse (FLN) role, as required. Screening consisted of fracture risk estimation, phlebotomy and DXA scanning. 124 (11%) of all patients attending the orthopaedic fracture clinic were reviewed in the FLS. Upper limb fractures accounted for the majority of fragility fractures screened n=69 (55.6%). Two-thirds of patients (n=69) had reduced bone mineral density (BMD). An evidence based approach to both non-pharmacological and pharmacotherapy was used and most patients (76.6%) receiving pharmacotherapy received an oral bisphosphonate (n=46). The FLS has proven to be an effective way of delivering secondary prevention for osteoporotic fracture in a non-regional fracture clinic, without increasing staff costs.

Outcomes of an osteoporosis disease-management program managed by nurse practitioners.

PURPOSE: To detail the outcomes of an osteoporosis disease-management program where nurse practitioners (NPs) have taken a leadership role in screening, diagnosing, and treating patients at risk for osteoporosis. DATA SOURCES: An electronic medical record (EMR) was used to collect demographic, pharmacy, dual x-ray absorptiometry (DXA) scan, and fracture data from a population of over 625,000 patients with one or more risk factors for osteoporosis. Monthly reports were generated and distributed to the NPs to assist them in identifying patients that required screening or treatment. CONCLUSIONS: Over a 6-year period there was a 263% increase in the number of screening DXA scans done each year, a 153% increase in the number of patients on anti-osteoporosis medications each year, and a 38.1% decrease in the expected hip fracture rate. IMPLICATIONS FOR PRACTICE: NPs play an important leadership role in managing osteoporosis within a large health maintenance organization. The screening and interventions used can be applied by any NP in any practice setting on an individual basis to reduce hip fracture rates in the United States.

Bone loss. An emerging problem following obesity surgery.

The incidence of obesity worldwide has increased markedly in the past 2 decades, with estimates of increases of 50% in the United States alone. Research indicates that weight loss produced by diet alone is not sustained and that 75% of dieters regain most of the weight lost within 1 year and 90% within 2 years. Morbid obesity is associated with comorbid conditions, including heart disease, hypertension, diabetes, mechanical arthropathy, sleep apnea, and numerous other serious disorders and a shortened life expectancy. Because of limited success with medical management, surgical treatment of morbid obesity has been used increasingly, especially with the development of laparoscopic procedures, including Roux-en-Y gastric bypass (RYGB). RYGB is associated with low surgical mortality, marked decreased food intake, and significant, sustained weight loss. However, in this emerging, unique population there is growing appreciation that these procedures may be associated with the development of bone loss and skeletal fragility because of altered nutrient metabolism. Despite the threat of skeletal fragility and fracture, there is limited data addressing the effects of bariatric surgery on bone metabolism and bone loss.

Hypogonadal hypogonadism and osteoporosis in men.

In recent years, osteoporosis in men has become increasingly recognized as an important clinical and public health problem. Many similarities exist in various aspects of osteoporosis in men and women, but this article focuses on the sex difference, bone biology, epidemiology, and consequences of fractures. Although maintenance of bone integrity depends on the action of sex hormones in both sexes, menopause is a much more obvious indicator of estrogen deficiency than is the subtle decrease of testosterone in aging men. This often leads to delay and neglect of diagnosis. The need to identify and screen men at a particular risk for osteoporosis, as when hypogonadism is induced for treatment of prostate cancer, has become important.

[Long-term care insurance system and osteoporosis].

The Long-term Care Insurance is the principal system that supports the Japanese elderly more than 24 million in number. The recipients of this system are increasing rapidly and get up to 3 million now. In Japan, hip fracture is one of the primary causes that make the elderly bedridden. In our study with the cases of hip fractures, 51.6% of the whole patients were self-reliant before fracture, but 25.6% one year after fracture. Keep it in mind that half of the self-reliant elderly will need support after fracture and encourage patients and their families to apply for certification of need for support.

Height change and bone mineral density: revisited.

PURPOSE: To evaluate the relationship between height change, osteoporosis risk factors, and bone mineral density. SAMPLE: Secondary data collected on 168 healthy women, ages 50 to 65 years, who had a dual energy x-ray absorptiometry screening of the hip and spine to determine bone mineral density. METHOD: A quantitative secondary analysis of data that replicated in part a study by Hunt (1996). FINDINGS: The relationships between height change, osteoporosis risk factors, and bone mineral density were not significant for this group of healthy postmenopausal women. However, these women did not meet daily minimum requirements for dietary calcium intake and daily exercise. IMPLICATIONS: The good news is that healthy women ages 50 to 65 years still have time to engage in osteoporosis preventing behaviors to prevent bone loss and eventual height loss. The use of measured height change, as an indicator for osteoporosis risk, is a cost-saving tool and should be considered as one component of a comprehensive osteoporosis health appraisal incorporating daily calcium intake and exercise. Further research, with more precise measurement of height, needs to be done to evaluate the relationship between height change, osteoporosis risk factors, and bone mineral density.

Prevention of fractures in older people who fall.

Despite assessment and appropriate interventions, some older people will continue to be at risk of falling. Fractures of the hip and wrist are especially common among this group. The risk of fracture means that a comprehensive falls prevention programme must include an assessment of the individual fracture risk and the instigation of appropriate treatment of bone fragility. Osteoporosis is the main cause of bone fragility in this client group and it is commonly associated with postmenopausal women, although other forms exist. Osteoporosis is also a problem for men as they get older and for individuals taking steroid medications. Community nurses need to be aware of how osteoporosis manifests itself as well as how this condition can be prevented and treated.