Fighting the Epidemic: Bone Health and Osteoporosis.

Osteoporosis is an increasing public health problem that impacts quality of life. Fractures are a common consequence of poor bone health, resulting in enormous health care, personal, and socioeconomic burden. Bone health can be managed, and osteoporosis can be prevented and diagnosed before a fracture or subsequent fracture. Nurses should consider bone health assessment and counseling as part of their standard for all patients. The evidence-based information presented regarding prevention, screening, diagnosis, and treatment is intended to fight the osteoporosis epidemic, resulting in a reduction of the treatment gap and reduced fracture risk among those to whom nurses provide care.

Osteoporosis knowledge and related factors among orthopedic nurses in Hunan province of China.

A low level of knowledge and awareness of specifics regarding osteoporosis among orthopedic nurses can compromise the quality of patient education and nursing care. There are significant variations in education levels among Chinese nurses, however, little is known about the awareness of osteoporosis among orthopedic nurses in China. The objective of this study was to assess the level of osteoporosis knowledge and identify factors that correlated with knowledge levels. A cross-sectional survey was conducted among orthopedic nurses at 13 tertiary hospitals in Hunan Province, China. Knowledge was assessed by the Osteoporosis Knowledge Assessment Test (OKAT). A total of 558 nurses completed the survey and 530 valid questionnaires were returned with a response rate of 95%. Each question had three response options of "True", "False" and "Don't know." The mean of scores from all OKAT questions was 11.4 (range 2-17; SD = 2.5). Factors associated with a better knowledge included age (36-45 years) marital status (married) and education (bachelor degree or above). Only 93 nurses (18%) had previously attended formal training regarding osteoporosis. Orthopedic nurses had moderate-to-low levels of knowledge regrading osteoporosis. The survey highlighted the potential areas for improvement, especially among younger single nurses with lower educational levels. In-depth education may contribute to improving service quality and offering better tutoring for fragility fracture patients through increased awareness and knowledge.

Men's perceptions of living with osteoporosis: a systematic review of qualitative studies.

BACKGROUND: One in five men will experience an osteoporosis-related fracture in their lifetime. However, osteoporosis is widely perceived as a women's disease and few studies focus specifically on men. Our objective was to identify qualitative evidence to understand men's perceptions of osteoporosis and fracture. METHODS: We conducted a systematic review following standardized guidelines. We identified qualitative studies that included men aged 18 years and over using the terms: osteoporosis, fragility or low-trauma fracture, bone health; and perceptions or experiences with osteoporosis and fractures. We appraised the quality of data and used a meta-aggregative approach to synthesize findings. RESULTS: We identified four publications, based on three studies (n = 61 participants); one of the publications was a secondary analysis. The following themes were developed from the literature: (1) perceived healthcare gap for men; (2) strong focus on women, with a need for support from spouses and health professionals; and (3) three general responses to men's osteoporosis self-management: limiting lifestyle, minimizing importance of diagnosis, and risk taking. CONCLUSIONS: The most striking finding from this review was the lack of available qualitative evidence. However, it emerged that the present focus of osteoporosis as a women's disease may influence how men develop self-management strategies. These data highlight the need to include men in future osteoporosis health-related conversations and interventions. SYSTEMATIC REVIEW REGISTRATION: CRD42018093999.

Nurse Practitioner Fracture Liaison Role: A Concept Analysis.

BACKGROUND: With the worldwide growing aging population, the high prevalence of osteoporosis-related fractures is associated with high morbidity and mortality. Healthcare costs for treating fractures and subsequent complications will increase to $25 billion by 2025. PURPOSE: This article articulates a comprehensive concept analysis of the nurse practitioner fracture liaison (NPFL) role to provide new insights into the role of nurse practitioner in osteoporosis care coordination. METHODS: Walker and Avant's concept analysis framework was used to identify the attributes, antecedents, consequences, and empirical referents of the NPFL role. Model cases illustrated real-life examples of the NPFL role. CONCLUSION: The impact of NPFL role is rather novel in promoting healthy bone living at local, national, and international communities. Linking the refined outcome of the concept analysis of the NPFL role to osteoporosis care helps close osteoporosis care gaps, improve healthcare outcomes, and alleviate financial burden by reducing secondary fracture and complications.

First in the Nation: One Unit's Journey to Achieving Fragility Fracture Certification.

Osteoporosis is related to more than 2 million fractures and $19 billion in healthcare costs each year (). A fragility fracture (FF) is a low-energy fracture of the distal radius, proximal humerus, ankle, or proximal femur (hip) from minimal trauma such as a fall from a standing height. In addition to cost, FFs often result in the loss of independence and productivity (). In 2015, our orthopaedic unit received the first certification ever awarded for FFs. Fragility fracture certification is a new certification demonstrating that a healthcare facility complies with national patient care standards and uses evidence-based practice guidelines to deliver quality outcomes. Orthopaedic nurses have a critical role in optimizing future bone health and fracture prevention. Our story describes the process and challenges faced becoming the first organization in the nation to be successfully surveyed for The Joint Commission's Fragility Fracture Certification.

Effect of tailored educational intervention to improve self-care maintenance and quality of life in postmenopausal osteoporotic women after a fragility fracture: the Guardian Angel® study.

Osteoporosis has a significant impact on affected patients. Healthcare providers should encourage postmenopausal women to improve self-care maintenance behaviors and quality of life following a fragility fracture. The aims of this study were to a) develop two new instruments for measuring, respectively, self-care maintenance and quality of life, in postmenopausal women with osteoporosis; b) evaluate the effectiveness of a tailored educational intervention to improve self-care maintenance and quality of life after a fragility fracture in postmenopausal women. For the first aim, a cross-sectional study will be performed; for the second aim, a multicenter, quasi-experimental, interventional design will be used. A convenience sample of postmenopausal women admitted to 44 hospitals in Italy with a diagnosis of bone fragility fracture will be enrolled and surveyed at 7, 30, 60 and 180 days after discharge. Trained nurses will conduct the educational intervention. The new instruments will allow the measurement of self-care and quality of life in postmenopausal women following a fragility fracture. Through tailored educational interventions, women can be helped to take their medications correctly, adopt a healthy lifestyle, reduce the occurrence of bone fractures, and have a better quality of life.

An experience of field work learning for healthcare providers: new perspectives between disadvantages and critical issues.

INTRODUCTION: The learning models used in traditional education are not very effective for the continuing education of healthcare providers. Fieldwork learning is an active learning method that is feasible in the workplace and is also suitable for professionals who possess a style of experiential learning. Guardian Angel 2.0® is a fieldwork learning project designed to promote educational skills in nurses to improve the self-care and quality of life in women affected by osteoporosis. The purpose of this article is to present the Guardian Angel 2.0® project and its results. METHODS: The Guardian Angel 2.0® effort lasted nine months and involved 212 nurses in the north, centre and south of Italy. A socio-demographic questionnaire, an evaluation scale of the learning process and a participants' satisfaction questionnaire were used to evaluate and monitor the fieldwork learning project. RESULTS: Out of the 212 nurses who participated in the project, 119 (70%) completed it. The mean age of these participants was 48 years (± 7.98), and 83.5% were female. About half of the participants (52.0%, 55.4% and 45.0%, respectively) were good (a) at respecting deadlines, (b) at using the methodological instruments and (c) the information tools properly. Almost all nurses considered the project to be very relevant (96.4%). In regards to the project's quality, the nurses perceived it as excellent (51.0%) and very good (48.5%). Finally, the project was considered very useful or useful by 100% of nurses. CONCLUSIONS: The general satisfaction of nurses was high. The fieldwork learning was relevant and useful for developing educational skills in nurses. It would therefore be appropriate to use fieldwork learning in clinical settings to improve the existing experience of healthcare providers and thereby reduce the difficulties of transforming the knowledge from a theoretical to a practical level and to promote the development of new behaviours when the existing ones become obsolete or inefficient.

Framing moving and handling as a complex healthcare intervention within the acute care of older people with osteoporosis: a qualitative study.

AIMS AND OBJECTIVES: To investigate healthcare staff's views and experiences of caring for older hospitalised adults (aged 60+) with osteoporosis focusing on moving and handling. Specific objectives were to explore the composition of manual handling risk assessments and interventions in osteoporosis. BACKGROUND: Osteoporosis is a skeletal disease that reduces bone density and causes increased fracture risk. Incidence rises with age and osteoporotic fractures cause increased morbidity and mortality. It is a major global health problem. In the UK older hospitalised adults are normally screened for falls risk but not necessarily for osteoporosis. As presentation of osteoporosis is normally silent until fractures are evident, it is frequently undiagnosed. Healthcare staff's knowledge of osteoporosis is often suboptimal and specific manual handling implications are under-researched. DESIGN: An exploratory qualitative content analysis research design informed by critical realism. METHODS: The purposive sample comprised 26 nursing and allied health professionals. Semi-structured interviews addressed topics including knowledge of osteoporosis, implications for acute care, moving and handling and clinical guidelines. Qualitative content data analysis was used. RESULTS: Awareness of osteoporosis prevalence in older populations varies and implications for nursing are indistinct to nonspecialists. In-hospital fractures potentially linked to suboptimal moving and handling seemed rare, but prospective studies are needed. Categories of 'Understanding moving and handling as routine care or as a healthcare intervention', with further categories 'healthcare practitioners' capacities and capabilities for dealing with people with osteoporosis' and 'the structural and organisational context for moving and handling' are reported alongside safety, frailty and dependency dimensions. CONCLUSIONS: This study informs moving and handling in higher risk groups such as osteoporosis. Clinical knowledge/expertise is required when adapting generic manual handling guidelines to specific patients/contexts. Patients' experiences of moving and handling have received limited attention. RELEVANCE TO CLINICAL PRACTICE: Increased focus on musculoskeletal conditions and moving and handling implications is required.

Evaluation of osteoporosis risk and initiation of a nurse practitioner intervention program in an orthopedic practice.

UNLABELLED: The purpose of this study was to assess whether education and referral by a nurse practitioner could improve treatment adherence in patients with low bone mineral density in the orthopedic office. Our customized project did show some improvement but resistance to care continues in this unique population of patients. INTRODUCTION: Osteoporosis and osteopenia are significant clinical problems. Nearly 50% of adults over the age of 50 are osteopenic (Looker et al. in Osteoporos Int 22:541-549, 2011). Many patients with osteoporosis are not taking calcium or vitamin D, or any active treatment, even after dual energy X-ray absorptiometry (DXA) and demonstration of low bone mineral density (Dell et al. in J Bone Joint Surg Am 91(Suppl 6):79-86, 2009). One hypothesis to explain low adherence with osteoporosis treatment is lack of patient education. This study was designed to compare a control group with an education-intervention group (receiving patient education from a nurse practitioner) to determine any effect of education on treatment adherence. METHODS: A total of 242 females and 105 males were studied as a control: a total of 292 females and 155 male were studied in the education group. Patients in the education group received educational materials and were counseled by a single nurse practitioner. Patients had a DXA performed and patients with osteoporosis or osteopenia were followed to assess treatment. At 12 months, patients received follow-up phone calls to determine patient use of calcium, vitamin D, and/or an active treatment. Results between the groups were compared. RESULTS: Significantly more patients began calcium and vitamin D after education (p = 0.04); significantly more patients were taking or were recommended for an active treatment after education (p = 0.03). Thirty percent of patients either did not follow up or refused active treatment for osteoporosis. Approximately 50% of patients with osteoporosis were not taking an FDA-approved pharmacologic agent for osteoporosis treatment, despite education. CONCLUSION: After patient education and referral to endocrinology, significantly more patients began calcium and vitamin D supplementation. However, up to 50% of patients with osteoporosis would not complete follow-up visits and/or did not adhere to treatment recommendations for osteoporosis.

Agreement between physicians' and nurses' clinical decisions for the management of the fracture liaison service (4iFLS): the Lucky Bone™ program.

UNLABELLED: We determined if nurses can manage osteoporotic fractures in a fracture liaison service by asking a rheumatologist and an internist to assess their clinical decisions. Experts agreed on more than 94 % of all nurses' actions for 525 fragility fracture patients, showing that their management is efficient and safe. INTRODUCTION: A major care gap exists in the investigation of bone fragility and initiation of treatment for individuals who have sustained a fragility fracture. The implementation of a fracture liaison service (FLS) managed by nurses could be the key in resolving this problem. The aim of this project was to obtain agreement between physicians' and nurses' clinical decisions and evaluate if the algorithm of care is efficient and reliable for the management of a FLS. METHODS: Clinical decisions of nurses for 525 subjects in a fracture liaison service between 2010 and 2013 were assessed by two independent physicians with expertise in osteoporosis treatment. RESULTS: Nurses succeeded in identifying all patients at risk and needed to refer 27 % of patients to an MD. Thereby, they managed autonomously 73 % of fragility fracture patients. No needless referrals were made according to assessing physicians. Agreement between each evaluator and nurses was of >97 %. Physicians' decisions were the same in >96 %, and Gwet AC11 coefficient was of >0.960 (almost perfect level of agreement). All major comorbidities were adequately managed. CONCLUSIONS: High agreement between nurses' and physicians' clinical decisions indicate that the independent management by nurses of a fracture liaison service is safe and should strongly be recommended in the care of patients with a fragility fracture. This kind of intervention could help resolve the existing care gap in bone fragility care as well as the societal economic burden associated with prevention and treatment of fragility fractures.

[Guided clinical practice guidelines: how to blunt the weapon of evidence]. / Linee Guida guidate. (Come spuntare le armi dell'evidenza).

The public should trust practice guidelines only if the recommendations accurately reflect the underlying evidence about benefits and harms to individual patients. However, the process of development of clinical practice guidelines is fraught with problem, conflicts and controversies. A few examples, starting from the guidelines on osteoporosis are presented and commented on.

Exploring New Zealand orthopaedic nurses' knowledge of osteoporosis.

BACKGROUND: Osteoporosis is a highly prevalent yet preventable disease. Nurses can play a major role in the prevention of osteoporosis and preventive treatment of patients who have had an osteoporotic fracture. PURPOSE: This study explored whether New Zealand orthopaedic nurses have the knowledge to provide osteoporosis prevention education, and also examined these nurses' perceptions of their role in the diagnosis and prevention of osteoporosis. METHODS: A questionnaire assessing osteoporosis knowledge was sent to a convenience sample of orthopaedic nurses. Data were analyzed quantitatively for the knowledge component, and qualitatively for the nurses' perception of their role, perceived barriers, and educational preferences. RESULTS AND CONCLUSION: Findings reveal that New Zealand orthopaedic nurses have inadequate osteoporosis knowledge and this is a barrier to educating patients regarding osteoporosis. Adherence to published recommendations for the management of osteoporosis has been inconsistent. Confusion about who should lead osteoporosis prevention is evident and it seems that nurses play a passive role.

Changing measures to evaluate changing bone.

Osteoporosis is a silent, progressive disease affecting millions of Americans, costing $23.5 billion annually (). Fragility fractures, painful and costly sequelae of osteoporosis, are frequently underdiagnosed and undertreated partially because of limited assessment measures. Currently, bone mineral density measured by dual-energy x-ray absorptiometry is the surrogate marker of bone health () but has shortcomings predicting fragility fractures. Bone turnover markers and magnetic resonance spectroscopy are promising techniques for earlier, more accurate assessment of bone physiology and structure. Bone turnover markers reflect the dynamic nature of living bone (), thus providing a more comprehensive picture of bone health. Magnetic resonance spectroscopy may hold predictive power in determining fast and slow bone mineral density losers (). The use of these tools may assist with diagnosis of osteoporosis, allowing earlier determination of the effectiveness of prescribed therapies to improve bone health.

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.

Using nurse-led liaison to prevent further fractures.

Osteoporosis-related fractures are common and associated with substantial morbidity and mortality. Having one such fracture at least doubles the risk of experiencing another. Nurse-led assessment of future fracture risk and of any underlying osteoporosis can ensure treatment is offered to reduce the risk of another fracture. However, many hospitals do not offer a fracture liaison service, although evidence shows these services deliver high-quality care in a systematic way and are cost effective. In Glasgow, hip fracture rates have fallen over a decade since a fracture liaison service, was introduced while fracture rates have risen elsewhere. Nurses working in hospitals that do not have secondary prevention services should advise patients to seek these through their GP.

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.

Onset aging conditions of adults with an intellectual disability associated with primary caregiver depression.

Caregivers of adults with an intellectual disability experience depressive symptoms, but the aging factors of the care recipients associated with the depressive symptoms are unknown. The objective of this study was to analyze the onset aging conditions of adults with an intellectual disability that associated with the depression scores of their primary caregivers. A cross-sectional survey was administered to gather information from 455 caregivers of adults with an intellectual disability about their symptoms of depression which assessed by a 9-item Patient Health Questionnaire (PHQ-9). The 12 aging conditions of adults with an intellectual disability include physical and mental health. The results indicate that 78% of adults with an intellectual disability demonstrate aging conditions. Physical conditions associated with aging include hearing decline (66.3%), vision decline (63.6%), incontinence (44%), articulation and bone degeneration (57.9%), teeth loss (80.4), physical strength decline (81.2%), sense of taste and smell decline (52.8%), and accompanied chronic illnesses (74.6%). Mental conditions associated with aging include memory loss (77%), language ability deterioration (74.4%), poor sleep quality (74.2%), and easy onset of depression and sadness (50.3%). Aging conditions of adults with an intellectual disability (p<0.001) was one factor that significantly affected the presence of depressive symptom among caregivers after controlling demographic characteristics. Particularly, poor sleep quality of adults with an intellectual disability (yes vs. no, OR=3.807, p=0.002) was statistically correlated to the occurrence of significant depressive symptoms among their caregivers. This study suggests that the authorities should reorient community services and future policies toward the needs of family caregivers to decrease the burdens associated with caregiving.

Identification, prevention, and treatment of children with decreased bone mineral density.

Osteoporosis in children is the presence of decreased bone mineral density in association with a significant fracture history. The amount of bone accretion in childhood and early adulthood is predictive of the risk of osteoporosis and fracture in later adulthood. A myriad of disorders and medications are associated with decreased bone mineral density in childhood. In addition, lifestyle factors including poor dietary habits and minimal physical activity are associated with low bone mass. Because of the limited attention given to childhood osteoporosis, this review was undertaken to examine the diagnostic criteria, etiologies, prevention of and treatment strategies for osteoporosis in children and adolescents.