With many ignoring prevention, osteoporosis education increases
Hip fracture risk equal to combined risk of breast, uterine, ovarian cancer
Most women know osteoporosis is a disease of weakening bones, causing fractures in old age. But it is far more serious than most women realize and begins at a much younger age. What's more, it's avoidable.
"Most women aren't afraid of osteoporosis in the same way that they're panicked about getting cancer," says Mary Salario, RN, BSN, manager of the Breast Center/Osteoporosis Center at Woman's Hospital in Baton Rouge, LA.
However, the National Osteoporosis Foundation in Washington, DC, reports that a woman's risk of hip fracture is equal to her combined risk of breast, uterine, and ovarian cancer. "And you ultimately can die from complications resulting from fractures," says Salario. "Osteoporosis causes physical disabilities and tremendous pain that alter people's lives, so it's very serious." (For more on osteoporosis, see p. 42.)
The foundation's latest poll found that although many women have a high awareness of osteoporosis, they also have a variety of misconceptions. (For more on the poll, see p. 43.) It's during menopause, when estrogen loss contributes to bone loss, that women really start paying attention to the disease. But the truth is, women need to maintain bone mass throughout their lives, says Salario.
"The problem is that osteoporosis is a `silent' disease," Salario says. "There are no symptoms, so people don't pay much attention to it until it's too late." (See journal review on osteoporosis prevention, p. 47.)
A cure in sight
The figures are startling: 10 million Americans have it, and another 18 million are on the road to getting it, the foundation reports. But it doesn't have to be that way. Due to recent medical breakthroughs and preventive measures, osteoporosis can be eliminated, says Mariano Garcia, MD, endocrinologist and medical director of the Osteoporosis Center at Healthsouth Doctor's Hospital in Coral Gables, FL.
"In the past two years, new medications, such as Fosamax [Merck and Co., West Point, PA] and Evista [Eli Lilly, Indianapolis] have given physicians an effective way to truly prevent and treat osteoporosis. Fosamax actually increases bone mass," Garcia says.
Now with a cure in sight for osteoporosis, Garcia decided to reach as many women's groups as possible to raise the public's awareness level. He also held lectures at the hospital, which were publicized by direct mailers sent to homes and through the media.
"It became a matter of searching for people who were at risk for osteoporosis and finding them so that we could treat them," he says.
Stepping up education
To reach women, the National Osteoporosis Foundation is expanding its publicity campaign from a week to the month of May this year. And numerous women's health centers are focusing on osteoporosis education and screening year-round. Women center managers say supporting educational efforts ultimately has its rewards in bringing more women to the centers for testing and using the facility.
The Breast Center/Osteoporosis Center at Woman's Hospital in Baton Rouge, LA, offers a multidisciplinary approach, from education and testing to follow-up treatment.
"We've seen an increase of double in the number of women utilizing our center since its inception in 1986," says Salario, who attributes this increase to more baby boomer women entering menopause.
A physician referral is required for a bone density scan. A woman has a one-on-one session with a nurse, who obtains her medical history, gives a lifestyle questionnaire, educates her on the disease, and counsels her on the importance of estrogen.
Then patients undergo a bone densitometry scan, measuring the bone marrow density of the lumbar spine and hip areas. The results are compared to the patient's age group and also to an average woman's bone density at age 30, the cut-off point for acquiring bone mass. The densitometer includes software that calculates standard bone marrow measurements for different age groups. The cost to the patient for the nurse counseling session, bone scan, and radiologist reading is $170.
The center offers follow-up physical therapy. Patients also can participate in a group exercise program led by an exercise physiologist. These classes help transition patients - who initially are afraid to exercise on their own - to an outside fitness center.
A personalized diet plan
A registered dietitian meets with the patient and maps out a diet providing adequate calcium. Social workers help women deal with the psychological toll of living with osteoporosis.
"We also work closely with the hospital's menopause service, which is affiliated with our center," says Salario. "We've learned that our talks on menopause - which include discussing osteoporosis - actually draw larger audiences than lectures just on osteoporosis." The menopause service includes a one-on-one consultation and educational session with a nurse and costs the patient $35.
Woman's Hospital has orchestrated a Community Outreach Program in which nurses, physical therapists, dietitians, and the medical director speak to community groups. (For a profile of another community education program, see p. 44.)
"Although post-menopausal women is a high category, we also receive younger women at the center for testing and treatment," adds Salario, pointing out that other factors contribute to osteoporosis, including certain medications such as steroids or diseases.
Salario says the time and money spent on community awareness programs is worth it because they ultimately lead patients to the center.
"We also make physicians aware of what services we have through direct marketing pieces, so they will utilize our center," she says. "And we try to reach not only OB/GYNs, but oncologists, orthopedists, and other specialists because we get referrals from all types of physicians."
Jane Moore, RN, BSN, LNC, CCRC, with the Osteoporosis Diagnostic and Treatment Center at Winthrop University Hospital in Mineola, NY, agrees that public awareness has helped the increase in women seeking bone testing.
"The disease has gotten a lot of press, and women, in general, are taking more responsibility of their health care," says Moore. "This, in turn, is driving physicians to become more aware of women's health needs."
The Osteoporosis Diagnostic and Treatment Center has created a multifaceted program including education, private counseling, community outreach, research, testing, and treatment.
The center also developed Home Osteoporosis Program of Education. Nurses conduct the program several times a year, featuring four-hour classes covering all aspects of the disease - including clothing options for women who are disfigured from the disease.
"The classes are small, about 10 to 12 women, so it's less intimidating. We do this to encourage feedback," Moore says. "Refreshments are also served to add to the informal, comfortable setting."
Program gives women advice
A patient-run Osteoporosis Support Group provides women with a sympathetic ear and practical advice. Spouses are invited to learn how to better support their wives.
Still, misinformation is out there, Moore concedes, so educational efforts are ongoing. "Some women believe that once they take medication, they don't need a healthy lifestyle. But that's not true," she say. "Drugs don't do it all."
The Women's Wellness Center at Healthsouth Doctor's Hospital in Coral Gables, FL, works with the hospital's osteoporosis program. Patients diagnosed with osteoporosis are enrolled in an exercise program, such as low-impact aerobics, light weights, or walking. Exercise gives patients a sense of well-being, increases bone density, and promotes blood flow to the ligaments and bones, Garcia says.
Patients also are prescribed medication to prevent bone loss and build bone mass, and they are placed on a nutrition plan, with plenty of calcium and vitamin D.
"However, patients who take calcium need to be aware that a lot of supplements are made from oyster shell calcium. This is a problem because oyster beds in the ocean are being contaminated with a high content of mercury," he says. "Taking one to two months of calcium supplements is no big deal, but over 10 years, it is."
Patients need to check the source of their calcium, he suggests. Garcia recommends calcium citrate.
Patients also participate in a physical therapy program that teaches fall prevention. "Ninety percent of falls occur at home, at night, going to the bathroom," says Garcia. "We teach people to make sure they have adequate lighting and check for things they could trip on, such as loose rugs. Sometimes, we send visiting nurses to homes to check for risks."
Bone testing and reading the results costs patients $150; fitness classes with supervision cost $45/month; without supervision is $30 per month.
In addition to community educational programs, The Women's Center also offers free bone density screening once a year. Screening is limited to the first 100 people who sign up.
Lisa Seif, director of public relations for Healthsouth, says, "Having a strong osteoporosis program is an ever-evolving thing. You can never stop educating people and getting the word out. There will always be new doctors on staff and new people who move into your community."
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