The pathophysiology and treatment of postmenopausal osteoporosis. An evidence-based approach to estrogen replacement therapy.

Osteoporosis is one of the most common and debilitating diseases of postmenopausal women. Recent advances in understanding the bone remodeling unit have clarified the pathophysiologic processes that contribute to bone loss after the onset of estrogen deprivation. Epidemiologic studies have suggested a protective effect from long-term estrogen replacement therapy on fracture risk. This article examines the key role estrogens play in bone remodeling and the current evidence that estrogen treatment in postmenopausal women reduces the likelihood of osteoporotic fractures.

Comparative clinical pharmacology and therapeutic use of bisphosphonates in metabolic bone diseases.

The bisphosphonates are a class of synthetic compounds used in the treatment of various metabolic bone diseases, including hypercalcaemia of malignancy, Paget's disease, postmenopausal osteoporosis and corticosteroid-induced bone loss. Although there have been numerous studies comparing first, second and third generation bisphosphonates with placebo, there has been a paucity of comparative research investigating the effectiveness of these substances with other pharmacological agents. Still, the available evidence indicates that the bisphosphonates are well tolerated and effective therapeutic agents for various metabolic bone diseases. It seems certain that within the next 5 years, this class of drugs will emerge as one of the foremost options for treating Paget's disease and osteoporosis.

Osteoporosis and African-American women.

African-American women are missing from the list of risk factors for osteoporosis although over 300,000 currently have osteoporosis. Possible bone structure differences such as greater peak bone mass, a slower rate of bone loss after menopause, and better quality of bone microarchitecture in African-American women have not been supported by research. Approaches such as calcium intake, hormone replacement therapy, and medications which prevent and treat osteoporosis need to be undertaken.

Health-related quality of life in osteoporosis.

The increasing prevalence and complexity of osteoporosis mandates that healthcare providers take a comprehensive view of the scientific investigation, treatment, and management of the disease. Despite recent pharmacologic advances, the enhancement of quality of life for patients with osteoporosis remains an elusive goal. The measurement of disease- specific quality of life in osteoporosis has recently improved with the development of three new tools specifically designed for this purpose. This paper provides an overview of the newly developed questionnaires along with some suggestions for the improvement of quality of life for this growing segment of the population.

Diagnosis and management of hypothyroidism in pregnancy.

Hypothyroidism is not a common occurrence in pregnancy, but it is important that nurse practitioners recognize it early. Complications of hypothyroidism in pregnancy are pregnancy-induced hypertension, preeclampsia, abruptio placentae, low birth weight and stillbirth, and fetal distress in labor. Careful monitoring of pregnant women for hypothyroidism and correction with levothyroxine therapy can prevent these complications. During pregnancy, the thyroxine needs of women with hypothyroidism are increased, and their dosage of levothyroxine should be individualized. Nurse practitioners can provide holistic care to the woman with hypothyroidism to ensure optimal maternal and fetal health.

Domains of health-related quality of life in elderly women with osteoporosis.

Osteoporotic spinal fractures can be painful, debilitating, and contribute to impaired HRQL of elderly women. The OQLQ is a validated disease-specific instrument developed to measure HRQL in women with spinal fracture caused by osteoporosis. Future intervention studies should test nursing interventions to decrease the burden of suffering for women with this increasingly prevalent, chronic disease.

Teaching nursing students evidence-based nursing.

Nurse educators face many challenges in the current healthcare environment. Educational methods, philosophies, and the content of curricula need to be reexamined to meet the needs of professional nurses who will practice in the next millennium. Evidence-based nursing is one approach that may enable future healthcare providers to manage the explosion of new literature and technology and ultimately may result in improved patient outcomes. The authors provide an introduction to evidence-based nursing as well as a description of the process in two separate undergraduate nursing programs.

Tai Chi as a method of fall prevention in the elderly.

Falls often lead to the fracture of bones in the elderly population. Fall incidence is increasing with the concomitant rise in the elderly population. Recently, some nontraditional methods of fall prevention have been explored. This article provides some background information about the ancient practice of Tai Chi as well as a brief review of the current literature exploring the effectiveness of Tai Chi in health promotion and fall prevention.

Vitamin D and bone status in elderly women.

Elderly women are the fastest growing segment of the population. Because of their increased longevity, they are more likely to develop chronic bone diseases such as osteoporosis. The maintenance of a proper balance of calcium, vitamin D, and parathyroid hormone (PTH) is essential to sustain healthy bones throughout life. Women in northern climates may be particularly susceptible to the development of osteoporosis due to their lack of exposure to sunlight, which ultimately leads to vitamin D deficiencies. A correlational study of 53 women in northern New England revealed that vitamin D insufficiency and decreased bone density was common in these elderly women during the fall and early winter months despite vitamin D supplementation.

Diagnostic imaging and biochemical markers of bone turnover.

The diagnosis and monitoring of osteoporosis has evolved markedly in the last several decades. Nurses caring for patients with osteoporosis and those working in prevention settings must have an understanding of the tools currently available to diagnose the disease and measure treatment response. The purpose of this article is to describe current diagnostic imaging techniques and biochemical markers of bone turnover in osteoporosis.

The pathophysiology of osteoporotic vertebral fractures.

Osteoporosis is an increasingly prevalent chronic metabolic bone disease, characterized by low bone mass that subsequently leads to bone fractures. Vertebral fractures are the most common and the most debilitating of osteoporotic fractures. People with osteoporotic vertebral fractures present a unique challenge to rehabilitation nurses. A better understanding of the complex pathophysiological processes that contribute to this disability will help nurses provide more comprehensive care and education to this growing segment of the population. This article presents an overview of normal physiology and a discussion of the pathophysiological changes that occur in the skeletal, endocrine, and neurological systems throughout the development of osteoporotic vertebral fractures.

Update on pharmacologic therapies for osteoporosis.

Osteoporosis is an increasingly prevalent chronic and debilitating disease. It is a metabolic disorder characterized by decreased bone mass that subsequently leads to bone fractures. Osteoporotic fractures occur most commonly in the hip, spine, distal radius, and ribs. Historically, pharmacologic options for the treatment of osteoporosis have been limited to hormone replacement therapy, vitamins, and mineral supplements. These previous treatments have been effective for many patients with osteoporosis. However, for many other patients, treatment with hormone replacement therapy, calcium, and vitamin D has been contraindicated or ineffective. Recently, several newly developed medications have become available for the treatment of osteoporosis in the United States. These new therapies have expanded the choices of pharmacologic options for primary health care providers and their patients. Pharmacologic therapy coupled with individualized diet, exercise, and fracture prevention counseling can help to decrease the severity and consequences of osteoporosis for growing numbers of Americans.

Women and coronary heart disease.

Coronary heart disease (CHD) is the leading cause of death in men and women in the United States. The incidence of CHD during midlife is lower in women than men, but the gap narrows with each decade. Because women have a longer life span than men, the absolute numbers of CHD deaths are roughly equal. Effective diagnosis of CHD in women requires the recognition of gender differences in presentation and pathogenesis. Women present with atypical symptoms and are less likely to have adequate primary prevention. This article discusses the differences between men and women in CHD and examines the assessment, diagnosis, and clinical management of CHD in women.

Onychomycosis: diagnosis and systemic treatment.

Onychomycosis, a persistent fungal infection affecting the toenails and fingernails, can interfere with standing, walking, and exercising. Associated physical impairments can result in paresthesia, pain, discomfort, and loss of manual dexterity. Patients may also suffer from loss of self-esteem and social interaction. A definitive diagnosis is crucial for effective treatment, because many other skin and nail disorders mimic onychomycosis. Diagnosis involves microscopic potassium hydroxide preparation, cultures, nail biopsy, and histologic analysis. Treatment can include topical and systemic antifungal therapies as well as nonpharmaceutical methods. This paper discusses pathophysiology, diagnosis, and treatment options for this common nail dystrophy, including the newer antifungal medications now available.