Nursing and Prevention of Osteoporosis
Lin Aixian, Zhao Wenya, Guan Xiaoli, Luo Shengzhen
Yangjiang People’s Hospital, Yangjiang City, Guangdong Province, 529500, China
This paper summarises multiple intervention measures preventing osteoporosis and secures the unobstructed performance of treatment to improve the curative effects and self-care level of patients.
Key words: osteoporosis, prevention, nursing
Osteoporosis (OP) is a kind of systematic bone metabolic disease with features of low bone mass and the damage of bone tissues microstructure, which will lead to increased bone fragility and improved risks for fracture. The disease is common among the elderly, but it also affects people of all ages.
Osteoporosis can be divided into primary osteoporosis and secondary osteoporosis. Primary osteoporosis refers to osteoporosis without other diseases, while secondary osteoporosis is the reduction of bone tissues caused by different systematic or endocrinal and metabolic diseases. Besides, osteoporosis can further be divided into localised osteoporosis and generalised osteoporosis by position. With the ageing of populations, its ranking rises to seventh among global common diseases and frequently-occurring diseases.
In China, 90 million people have suffered from osteoporosis and almost all people over 70 years old have the disease. It has become a big health problem for the elderly since fractures caused by it take on the rising trend and it leads to decreasing or loss of independent living among the elderly. How we can scientifically prevent osteoporosis and intervention through nursing to improve self-protection has become a hot topic in the medical fraternity.
1. Symptoms and signs of osteoporosis
Osteoporosis without complications itself does not carry pain, malformation or other symptoms and signs. The diagnosis of the disease depends on the checking of bone density. Vertebral X-ray plain film is abnormally later than the indication of bone density but earlier than the indication of symptoms and signs. Vertebral compression fracture tends to happen unconsciously, while coughing, sneezing and upon slight injury. Fresh vertebral fracture has local pains and the sign of percussion pain within several weeks. Many vertebral compression patients have humpbacks and decreased height. Non-vertebral fracture patients have more serious pains and malformation.
2. Diagnosis standards and classification
2.1 Diagnosis standards
In 1994, WHO proposed diagnosis standards of osteoporosis (applying to female adults) that defines 1-2.5 standard deviation lower as osteopenia and lower than 2.5 standard deviation as osteoporosis by comparing the bone marrow density or BMD and bone mineral content of patients with peak bone mass. The diagnosis standards of osteoporosis proposed by China define BMD between average value – one standard deviation and average value – two-standard deviation as osteopenia and BMD lower than average value – two-standard deviation as osteoporosis.
Osteoporosis can be divided into systematic osteoporosis and localised osteoporosis. It can be also divided into primary osteoporosis (including postmenopausal osteoporosis and senior osteoporosis), secondary osteoporosis (osteoporosis caused by drug factor, endocrine factor, congenital factor, chronic disease or other factors) and idiopathic osteoporosis (including osteoporosis in pregnancy and lactation period).
3. Prevention measures
Osteoporosis is a preventable disease but with unconfirmed curative effects, so prevention is more realistic and important than treatment. The prevention measures of osteoporosis include maintaining the normal development of bones, ensuring that peak bone mass is met, reducing bone loss caused by age growth and other factors, ensuring the completeness of skeletal structure and the prevention of fracture. Sufficient calcium and vitamin D as well as normal sports load in childhood and adolescence can increase the accumulation of bone mass, optimise the peak of ossification and slow the loss of bone which may cause fracture. The women in pregnancy and lactation period should regularly have BMD measured and supplement calcium. Postmenopausal women should closely measure bone mass and receive estrogen and calcitonin treatment. Paraplegic patients should maintain metabolic balance through diet and the exercise of body functions, paying attention to predisposing factors that include nationality, age, heritage, laTE menarche or early menopause, lack of sports, skinny and small body, smoking, drinking and other unhealthy dietary habits, taking thyroid agent, arthritis, diabetes, gastrectomy and so on.
3.1 Basic prevention measures
3.1.1 Moderate and disciplinary physical activities
Sports is one of the most effective methods preventing osteoporosis, with advantages of safety and economy. Mechanical stimulation is necessary for the normal growth and development of bones and can furthest limit the decrease of BMD along with age growth. Sharkey NA and Wiuiams CI proposed that sports can prevent osteoporosis and osteoarthrosis.
The International Osteoporosis Foundation on World Osteoporosis Day in 2005 highlighted the importance of sports for bone health: 1) Moderate sports in childhood and adolescence contributes to the improvement of peak bone mass; 2) Epidemiological evidence shows that physical activities are related to the lowering of hip fracture of males and females; 3）The exercise of back muscles can lower risks for vertebral fracture and humpback; 4) Researches show that therapeutic sports can maintain or increase the BMD of postmenopausal women; 5) For frail elderly, exercise can improve balance abilities and confidence and contributes to the prevention of tumbling down; 6) Intensive activities training can improve the strength and functions of the elderly after hip fracture and hip replacement.
He Chengqi thinks that 1) Sports can adjust bone metabolism, enhance the formation of bones and restrain osteolysis through mechanical functions. 2) It can influence calcium balance of body through neuroregulation and endocrine regulation. 3) It contributes to the improvement of mental state and appetite and increases the intake of nutriments. 4) Outdoor sports and exposure to sunlight can enhance the transformation of cholesterol to vitamin D and increase the absorption of calcium. 5) It can strengthen muscle strength, improve balance ability and coordination, improve the ability of neuromuscular system to resist trauma, protect bones and prevent senior people from tumbling down and fracture. Continuous sports contributes to the maintenance of bone mass.
Sports preventing osteoporosis should be systematic. Appropriate ways, time and strength should be chosen according to individual age, gender, health condition and fitness trait. Beneficial sports for bones include weight-bearing exercise (such as skelping, jumping and walking upstairs) and resisted movement (including the training of strengthening muscle strength). Generally, young people should choose sports requiring larger exercise amounts (such as weight-bearing, resistance sports and impact sports).
Ailinget and other researchers think resisted movement and high-impact sports can better increase BMD compared with relatively low-impact exercise (including walking). The elderly should choose strength training, such as jogging and fitness dance, and gradually increase the amount of exercise; the elderly with poor habitus should choose tai chi and strolling. The appropriate strength of the exercise is reflected that: after sports, you feel good and are in a good mood, you will quickly recover upon rest even if you are feeling tired; your whole body does not feel obviously sour or uncomfortable, and the strength is in proportion to BMD.
3.1.2 Enough calcium and vitamin D
Sufficient calcium ingestion throughout one’s life is important for preventing osteoporosis. Among existing osteoporosis prevention measures, calcium supplement is one of the easiest, safest and most economic measures. Vitamin D can enhance the absorption of calcium in intestinal ducts, and the lack of vitamin D is one of the main causes inelderly osteoporosis and osteoporosis fracture. The Chinese Nutrition Society suggests the ingestion of 800mg of calcium every day, the recommended dose in getting ideal bone peak value and maintaining bone health; while 1000mg every day is the recommended dose for postmenopausal women and elderly people. The Chinese elderly get 400mg of calcium from their diet every day, and they need to supplement 500-600mg of calcium on average every day. And China osteoporosis diagnosis guidelines stipulate that the suggested dose of vitamin D is 200IU/d for adults and 400～800IU/d for the elderly.
3.1.3 Hormone replacement
Estrogen replacement therapy is the most effective measure preventing and treating osteoporosis for elderly women. In recent years, most European and American scholars think postmenopausal women should start long-term estrogen replacement therapy within three years, insisting on long-term preventive calcium supplement to safely and effectively push back osteoporosis.
3.1.4 Traditional Chinese medicine prevention
Traditional Chinese medicine is of the view that deficiency in the kidney is the root cause for osteoporosis, and people should improve their liver and kidney functions before the quinquagenarian period to improve the negative balance between ossification and bonehew.
3.2 Look out for and treat the cause of secondary osteoporosis, regularly measure BMD of the women in pregnancy and lactation period, and supplement calcium moderately.
Health knowledge is an important influencing factor to determine if people adopt healthy living, so promoting health knowledge of osteoporosis among osteoporosis patients can help them develop healthy living ways and prevent the development of osteoporosis and complications. In nursing work, providing people with the knowledge of osteoporosis through various ways is essential.
4.1 Mental nursing
Osteoporosis brings patients agony and inconvenience, requiring long-term treatment. It can influence the self-care ability of patients, so osteoporosis patients feel low, pessimism, irritation and other negative emotions. Communicate with patients through friendly and appropriate language to eliminate their worries, conduct targeted psychological counseling for them according to their education level, hobbies and life habits and help them learn about the prevention, pathology and rehabilitation of osteoporosis. These can help them keep a healthy mental state, mobilising resistance within the body as well as active treatment.
4.2 Health education
Health education projects include 1) Providing information of what are osteoporosis and its complications, its harm, how to prevent it and who is in the dangerous period, and guiding patients to implement corresponding treatment measures and self-care; 2) Developing good living habits including quitting from smoking and drinking, and drinking less caffeine beverages. Researches show that women ingesting more than 300mg of caffeine are more likely to lose vertebral sclerotin; people should do more outdoor activities and expose themselves to sunlight more to enhance the synthesis of vitamin D by skin. People should value BMD examination and people over 60 should better measure their BMD every year; 3) paying attention to the methods of exercise. Violent or vibrational sports are not appropriate for osteoporosis patients and they should watch out for tumbling, collision, and tripping in case of fracture.
4.3 Diet nursing
Patients should be informed that sufficient nutrition is the precondition for rehabilitation and they should pay attention to balanced nutrition, combination of foods and food that is cooked for not too long. Staple foods, mainly including rice and coarse cereals, should be variant and combined well. For non-staple food, patients should eat more foods containing calcium and vitamin D. Food and beverages containing calcium are milk, fish, shrimp, seafood, soy and soy products, chicken egg, oatmeal, nuts, bone soup, green vegetables and fruits. Patients with insufficient gastric acid secretion should add some vinegar to enhance the absorption of calcium. Foods with generous amounts of vitamin D include fish, mushroom and eggs. Diet should include moderate amounts of protein.
5. Prevention of osteoporosis
The prevention of osteoporosis aims at two groups: one is high risk group mainly including postmenopausal women, the other one is ordinary people. Risk factors for osteoporosis apply to Caucasians and people in the East, as well as emaciation, insufficient calcium and nutrient intake, insufficient sports, smoking, drinking alcohol, coffee and ovariectomy.
Postmenopausal women with these risk factors and without other contraindications are encouraged to use estrogen prevention. Because insufficient peak bone mass is the attributed pathogenic factor for bone density decrease and osteoporosis, a balanced diet should be awarded attention in childhood, adolescence or even infancy, especially in the case of calcium ingestion. If necessary, calcium can be taken orally (refer to the following for the choice of calcium).
Children and teenagers should be encouraged to do more sports. Patients with osteopenia or osteoporosis should pay attention to the choice of sports and exercise amount.
Additionally, since the elderly have lower emergency response and reaction abilities, their daily protection should be valued, in actions such as standing up after lunch and getting up at night, to reduce risks of tumbling and the occurrence of fracture related to osteoporosis.
 Nan DK. Rehabilitation medicine. Beijing Publishing House; 2002: 231.
 Zhang J, Ge N, Huang XL, et al. The assessment of drug treatment of osteoporosis. Chinese Journal of Practical Internal Medicine. 2006; 26(4): 313－315.
 Harry K Genant. Translated by Zhao YL. Prevention and treatment work report and prevention suggestions of Osteoporosis in WTO. China Bone Tumor and Bone Disease. 2002; 1(5):247－250.
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