Which condition would the nurse cite as the most common cause of fracture in postmenopausal patients?

Burden of Osteoporosis

Osteoporosis affects 16% of women (about 8.6 million individuals) and 4% of men (1.6 million), with 1.5 million fragility fractures per year.10 Due to the increasing numbers of fragility fractures in an aging population, future costs will overwhelm the health care system. Increased screening and early treatment to avoid these costly and life-altering fragility fractures would help to address the current health care system’s diminishing resources. Despite the knowledge that prevention of

Pathophysiology of Osteoporosis and the Role of Genetics

Bone is a living tissue and is constantly changing. The osteocytes or bone cells are of two types: Osteoclasts are bone cells that resorb or dissolve bone and osteoblasts are cells that form bone. Density of bone reaches its peak in a woman in her late 20s. Remodeling of bone occurs as one ages. Cells start to dissolve (the process of resorption), while new bone cells deposit osteoid (the process of formation).4 Bones must remain light and yet strong to absorb stress from high-impact exercise.

Race and Ethnicity

Skeletal fragility with resultant predisposition to fracture can occur in any race, ethnicity, gender, or age, but is more prevalent in postmenopausal, thin, Caucasian women.15, 16, 17, 18 This concern is not solely an American phenomenon. In developed regions where screening is offered, countries grapple with the methodology of how to screen their high-risk populations. Prevalence rates of osteoporosis in Taiwanese adult women are 11.4%.19 Norwegian and British women have a 50% lifetime risk

Risk Factors

Risk factors for osteoporosis may be either fixed or modifiable.4 A systematic review was conducted from 6 databases, demonstrating that only low body weight in a healthy population of Caucasian women, aged 40–60, was an important demographic that predicted potential future fracture and should be used for screening in high-risk populations.18 Good or fair evidence was shown that alcohol, caffeine, and reproductive history were not risk factors. A more recent study24 found that earlier screening

Screening and Diagnosis of Osteoporosis

Because of the silent nature of the disease, providers should not wait until a woman is older than 65 to start screening for osteoporosis. If a younger postmenopausal woman has characteristics that put her at higher risk, such as low body weight, Caucasian or Asian race, a history of premature menopause, a chronic autoimmune disease, or if they have had long-term steroid use, they should be screened earlier. Identifying high-risk women individually is important so that tailored care can be

Evaluation of Osteoporosis With Imaging

Currently in the United States, the DEXA scan is the gold standard for testing BMD. DEXA bone densitometry is currently the best standardized method available not only to diagnose osteoporosis but to estimate fracture risk accurately.4, 6, 29 The DEXA scan measures spine and hip bone density with low doses of radiation, the equivalent to less than one-tenth of a standard chest x-ray, and less than exposure to a day’s natural radiation.29 The hip density is used for treatment determination.

Management of Osteoporosis

Prevention of bone loss is the first step in management of this disease. Optimal bone growth occurs in youth, with the peak bone mass achieved in the mid-20s.4 A 10% increase in bone mass in children reduces the risk of an osteoporotic fracture during adulthood by 50%.4 In addition to the role of genetics, environmental factors have an enormous impact on bone health. A cross-sectional study on Scottish women was performed, to examine the influence of diet on the development of osteoporosis.

Red flags Indicating Specialty Referral

Women who have disorders that cause bone loss and fractures from low trauma, parathyroid disease, autoimmune diseases such as lupus, or take high-dose corticosteroids should be managed by either endocrinology or rheumatology. Further workup to exclude such conditions may be done by primary care, to include screening for parathyroid hormone, ionized serum calcium, and a 24-hour urine for calcium excretion.

Conclusion

Primary prevention of fragility fractures is the most cost-effective and proactive approach to sustaining bone health. The risk of sustaining a fragility fracture increases with age due to decreases in bone BMD and the increasing risk for falls as women age. Primary prevention of osteoporotic fractures is not occurring within our health care systems. Nurse practitioners must be prepared to screen appropriate women for a disease that is often silent. Customizing the management and care for each

Karen D. French, MSN, FNP-C, is an assistant professor at Azusa Pacific University, Azusa, CA, and can be contacted at [email protected].

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