Osteoporosis Causes and Risk Factors Osteoporosis is a major health concern that affects millions of people globally, primarily the elderly population, and poses significant challenges in healthcare management. Nursing care for osteoporosis focuses on patient education, prevention, early detection, and treatment of the disease to reduce the risk of fractures and other complications. This article explores various aspects of osteoporosis, including bone mass density (BMD), the relationship between pregnancy and osteoporosis, the prevalence of the disease, the associated fracture risks, skeletal deformities, and fractures, as well as the psychological and economic burdens of osteoporosis. Additionally, it discusses nursing research contributions to the understanding and management of this chronic condition.
What is Bone Mass Density and Osteoporosis?
Bone mass density (BMD) is a crucial measure used to assess bone health and strength. It accounts for approximately 70% of bone strength and is measured in grams of mineral content per area of bone. BMD is reflective of both peak bone mass achieved during youth and the amount of bone loss that occurs with aging. The National Institutes of Health (NIH, 2000) recognizes BMD as a key indicator for diagnosing osteoporosis, a condition characterized by low bone density and increased bone fragility, leading to a higher risk of fractures.
Osteoporosis is not only caused by accelerated bone loss during aging but also by suboptimal bone growth during childhood and adolescence. As highlighted by Drugay (1997), osteoporosis can be considered a “pediatric disease with geriatric consequences.” The quality of bone, which includes its micro and macro structure, biochemical composition, and integrity, also plays a significant role in determining bone strength. A 50-year-old woman with low bone density has a significantly lower fracture risk than an 80-year-old woman with the same bone density, underscoring the importance of bone quality in the progression of osteoporosis (Kolata, 2003).
Pregnancy and Osteoporosis
Pregnancy-associated osteoporosis is a rare and temporary condition that usually occurs during the third trimester or the postpartum period of a first pregnancy. Symptoms include back pain, loss of height, and vertebral fractures. Lactation is also linked with transient bone loss, but full recovery of bone density typically occurs within six months (National Women’s Health Information Center, 2003). The condition is often self-limiting, but it highlights the importance of monitoring bone health during and after pregnancy, especially for women with other risk factors for osteoporosis.
Prevalence of Osteoporosis
Osteoporosis is a widespread condition, particularly among older adults. According to the World Health Organization (WHO, 2003), the prevalence of osteoporosis in the United States ranges from 3.9% among Caucasian women aged 50-59 to 47.5% for those over 80 years old. The National Osteoporosis Foundation (NOF, 2002) estimated that in 2002, 55% of Americans aged 50 and older had either osteoporosis or low bone mass, a figure expected to increase to 61 million by 2020.
Prevalence varies by gender, race, and ethnicity. Women, particularly those who have undergone menopause, experience more rapid bone loss than men. Of the 44 million Americans estimated to have osteoporosis or low bone mass in 2002, 32% were men and 68% were women (NOF). Asian and Caucasian women tend to have the lowest bone mineral densities, while African-American women generally have the highest. Additionally, Mexican-American women have intermediate BMD values compared to the two groups, and Japanese and Native American women tend to have lower peak BMD levels (NIH, 2000).
Osteoporosis and Fracture Risk
Osteoporosis is often referred to as a “silent” disease because it progresses without noticeable symptoms until a fracture occurs. The risk of fractures increases with declining bone density, and several factors contribute to this risk. The National Osteoporosis Risk Assessment (NORA) study identified primary risk factors for fractures, including female gender, advancing age, and estrogen deficiency due to menopause (Siris et al., 2001).
Other key risk factors include low body weight, a small frame, a personal history of fractures after age 50, a family history of osteoporosis, smoking, low calcium and vitamin D intake, and an inactive lifestyle. Additionally, limited sun exposure, particularly among older adults and those living in higher latitudes, can reduce vitamin D production, essential for calcium absorption (Feskanich, Willett, & Colditz, 2003). Lifestyle factors like alcohol consumption and caffeine intake have shown inconsistent results regarding their impact on osteoporosis risk, but the NORA study found that moderate alcohol consumption reduced the likelihood of osteoporosis (Siris et al., 2001).
Osteoporosis and Skeletal Deformities and Fractures
Osteoporosis can lead to skeletal deformities and fractures, resulting in significant physical, financial, and psychosocial consequences. Fractures of the hip, spine, and wrist are the most common and have profound effects on an individual’s quality of life. Hip fractures, in particular, are associated with lengthy hospital stays, nursing home admissions, and increased mortality. Up to 20% of patients die within one year of a hip fracture, and 30% of those who survive will experience a second hip fracture (NOF, 2003).
Vertebral fractures can cause kyphosis, commonly known as a “dowager’s hump,” which leads to various health complications, including gastrointestinal and respiratory issues, back pain, and functional limitations in movement. These fractures significantly affect a person’s ability to perform daily activities, leading to a decreased quality of life.
Osteoporosis and Psychological Issues
Osteoporosis also has considerable psychological ramifications. The fear of falling or sustaining a fracture can lead to anxiety, depression, anger, and a loss of self-esteem. These psychological challenges can further limit physical activity, exacerbating the condition and increasing the risk of fractures. Social isolation is another common outcome, as individuals with osteoporosis may become less mobile and more dependent on others for care (Gueldner, 2000).
The chronic nature of osteoporosis also places a burden on families and caregivers, leading to increased stress and strain on social and healthcare systems. As the global population ages, the prevalence of osteoporosis and its associated psychological and physical consequences are expected to rise, making it a significant public health issue.
Osteoporosis and Economic Burden
The economic impact of osteoporosis is substantial. In the United States, the NOF (2003) estimated that the cost of osteoporotic fractures was $17 billion annually in 2001 dollars. This figure includes the costs of hospital admissions, outpatient services, and long-term nursing home care. Because the majority of osteoporotic fractures occur in the elderly, the financial burden is largely borne by Medicare and other healthcare systems.
The global economic burden of osteoporosis is also significant, with the WHO (2003) estimating that the incidence of hip fractures worldwide was 1.66 million in 1990, a number expected to rise as populations age. Hip fractures, in particular, are associated with long hospital stays, rehabilitation, and, in some cases, permanent nursing home placement. These factors contribute to the overall financial strain on healthcare systems worldwide.
Nursing Research and Osteoporosis
Nursing research plays a crucial role in the understanding and management of osteoporosis. A recent literature search in the CINAHL database (1997-2003) revealed 333 articles on nursing research related to osteoporosis, with 43 published in 2003 alone. These studies covered topics such as the management of hip fractures, the impact of physical activity on bone health, and knowledge of osteoporosis among patients and healthcare professionals.
One notable nursing research project profiled the incidence of osteoporosis in peri- and postmenopausal women in Pennsylvania and New York (Gueldner et al., 2003). The study found that nearly 24% of women had low bone mass or osteoporosis, emphasizing the importance of early screening and education on bone health. The research also highlighted the significant role of estrogen in maintaining bone strength and the need for further studies on alternative therapies to hormone replacement therapy (HRT) in light of its associated risks.
Another key finding from this research was the importance of accurate height and weight measurements during healthcare visits, as self-reported height was significantly lower than measured height. This discrepancy underscores the need for objective assessments in clinical practice to ensure accurate diagnosis and treatment of osteoporosis.
Conclusion
Osteoporosis is a widespread condition that affects millions of people worldwide, particularly older adults and postmenopausal women. The disease is characterized by low bone density and increased fracture risk, leading to significant physical, psychological, and economic burdens. Nursing care plays a critical role in the prevention, early detection, and management of osteoporosis, with a focus on patient education, lifestyle modifications, and appropriate medical interventions.
Nursing research continues to contribute valuable insights into the management of osteoporosis, including the identification of risk factors, the development of effective screening tools, and the exploration of alternative therapies to HRT. As the global population continues to age, the prevalence of osteoporosis is expected to rise, making it essential for healthcare providers to stay informed about the latest advancements in osteoporosis care and treatment. Nurses, in particular, are uniquely positioned to provide holistic, patient-centered care that addresses the physical, emotional, and social needs of individuals with osteoporosis.