Osteoporosis

Abstract

Occupational and environmental health nurses should educate workers about healthy lifestyle choices such as proper nutrition and exercise to prevent osteoporosis and reduce the risk of fractures.

In the United States, more than 53 million individuals either have been diagnosed with osteoporosis or are at high risk for the disease; low bone mass places these individuals at risk for additional bone loss and fractures (National Institutes of Health [NIH], 2015). Osteoporosis affects men and women of all races. However, White and Asian women, especially older women who are past menopause, are at highest risk. As individuals age, bone mass is lost faster than it is created. By age 65 to 70, most men and women are losing bone at the same rate.

Osteoporosis is a bone disease that causes bones to become weak and brittle. Bone is a living tissue that is constantly broken down and replaced. Osteoporosis occurs when the creation of new bone does not equal removal of old bone.

Typically, no symptoms are identified in the early stages of bone loss. Once bones are weakened by osteoporosis, signs and symptoms include “back pain, caused by a fractured or collapsed vertebra; loss of height over time; a stooped posture; and a bone fracture that occurs much more easily than expected” (Mayo Clinic, 2016, para 1). Osteoporosis-related fractures commonly occur in the hip, wrist, or spine.

Risk factors for osteoporosis are age, race, lifestyle choices, and health conditions and related treatments. Lower sex hormone levels can weaken bone. “The reduction of estrogen levels in women at menopause is one of the strongest risk factors for developing osteoporosis” (Mayo Clinic, 2016, Risk Factors). Dietary factors include low calcium intake, eating disorders, and gastrointestinal surgery such as surgery to reduce the size of the stomach or to remove part of the intestine.

A bone density test can measure the strength and density of bones. A bone mineral density (BMD) test (i.e., central dual-energy X-ray absorptiometry [DXA] scan) estimates the risk for fractures and measures osteoporosis treatment response: normal bone density, osteopenia, or osteoporosis. Osteopenia refers to bone density that is lower than normal peak density, but not low enough to be classified as osteoporosis.

Osteoporosis can often be prevented and treated. Occupational and environmental health nurses should educate workers about healthy lifestyle choices such as proper nutrition and exercise to prevent further bone loss and reduce the risk of fractures. Therapeutic medications (e.g., bisphosphonates, estrogen agonist/antagonist, calcitonin, and hormone therapy) can also be used to prevent or treat osteoporosis (NIH, 2015).

Calcium and vitamin D are essential for strong bones. Men and women between the ages of 18 and 50 need 1,000 milligrams of calcium a day. This amount increases to 1,200 milligrams when women turn 50 and men turn 70 (Mayo Clinic, 2016). Good sources of calcium include low-fat dairy products, dark green leafy vegetables, canned salmon or sardines with bones, soy products such as tofu, and calcium-fortified cereals and orange juice. Vitamin D improves calcium absorption and bone health. Adults aged 50 and older need 800 to 1,000 international units (IU) of vitamin D a day through food or supplements (National Osteoporosis Foundation, 2014).

Exercise can build strong bones and slow bone loss. Strength training should be recommended along with weight-bearing and balance exercises. Strength training strengthens muscles and bones in arms and upper spine; weight-bearing exercises such as walking, jogging, and stair climbing affect the bones in the legs, hips, and lower spine (Mayo Clinic, 2016). Balance exercises can also reduce the risk of falling. Occupational and environmental health nurses should also educate workers on fall prevention at work and at home.

Smoking increases the rate of bone loss. Occupational and environmental health nurses can implement smoking cessation programs to reduce employees’ risk of osteoporosis as well as respiratory and cardiac diseases. Nurses should also advise that alcohol consumption greater than two drinks a day may decrease bone formation.