Healthy People 2030: Occupational Health Nurse Understanding Osteoporosis Objective of Prevention and Treatment

The Healthy People 2030 Osteoporosis Objective aims to prevent and control fractures and disabilities. Recommendations are to reduce cases among adults aged 50 and above from the 2020 baseline of 7.3% to 5.5% (Office of Disease Prevention Health Promotion, n.d.). An estimated 10.2 million adults aged 50 years and older have osteoporosis, and another 43.4 million have low bone mass, which increases fracture risk (Wright et al., 2014). Loss of bone mass and bone density reduces bone strength and causes chronic poor health outcomes and increased medical costs. Among managed care plan enrollees, the average costs for each patient aged above 50 with an osteoporotic fracture was $31,863 ($56,094 SD); the vast majority also received rehabilitation services averaging $18,025 ($41,318 SD) (Williams et al., 2020). Osteoporosis risks increase with age; women have the greatest risk. Other risks include parental history of hip fracture, tobacco use, sedentary lifestyle, alcohol consumption, small-boned thin frame, low-calcium intake, estrogen deficiency from early menopause or prolonged amenorrhea, and prolonged use of medications for lupus, asthma, thyroid deficiencies, and seizures (NIH Osteoporosis and Related Bone Diseases National Resource Center, n.d.; U.S. Preventive Services Task Force [USPSTF], 2018).

Sedentary lifestyles are a leading cause of low bone mineral density (BMD). Occupational and environmental health nurses can teach about prevention and treatment, promote healthy behavioral changes, and coordinate worksite awareness programs and screening. Primary prevention strategies include teaching all workers the importance of weight-bearing exercise to strengthen bones and lessen bone mass loss. At least 120 to 300 minutes of moderate-intensity or aerobic activity weekly helps reduce hip fracture risks (USPSTF, 2018). Worksite walking trails and other weight-bearing activities that promote bone health may encourage participation among co-workers. Occupational health nurses (OHN) could collaborate with physical therapists or exercise physiologists about balance training and muscle-strengthening activities and registered dietitians about dietary sources of calcium; encouraging vitamin D supplements to support bone health is also important (USPSTF, 2018).

Secondary prevention includes screening, pertinent to reduce fractures among high-risk sedentary workers. To diagnose osteoporosis, the USPSTF recommends screening with bone measurement tests for all women aged 65 years and older plus postmenopausal women younger than 65 years who are at increased risk for osteoporosis per formal clinical risk assessment tool screening. Most treatment guidelines recommend using BMD, as measured by central dual-energy x-ray absorptiometry (DXA), to define osteoporosis and the treatment threshold. Information about DXA and other USPSTF recommended clinical risk assessment tools the occupational health nurse could use to find women at high risk for osteoporosis is available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening. The occupational health nurse should confirm workers understand any medication therapy, namely, bisphosphonates, raloxifene, parathyroid hormone, and estrogen. Bisphosphonates can cause esophageal irritation; teach workers to take the medication with a full glass of water and avoid lying down afterward for at least 30 minutes (USPSTF, 2018).

Tertiary prevention for workers diagnosed with osteoporosis may indicate assuring job accommodations or flexible working hours, teaching how to support good posture, and training about special or new equipment and modified work tasks. Another important strategy is to assure workers know about assistive devices that reduce fall risks along with how to perform safe lifts: always avoid twisting the torso or bending at the waist. Helpful resources are available from American Bone Health: https://americanbonehealth.org/. The Bone and Joint Initiative USA, https://www.usbji.org/, hosts Bone and Joint Action Week annually October 12–20, an ideal time for worksite bone health awareness activities. By implementing these prevention strategies, occupational health nurses can help meet the Healthy People 2030 osteoporosis objective and protect the employer’s bottom line.