Nursing Interventions For Women With Osteoporosis Discussion Paper

The Significance Of The Study

Osteoporosis refers to a skeletal medical condition of decreased bone’ density and strength, resulting in bone fragility. Osteoporosis makes the bones to be porous and compressible like a sponge, weakening and making it susceptible to breakages from minor falls or bumps (Aggarwal & Masuda, 2018). These type of fractures that results from the reduced bone strength are referred to as ‘fragility fractures’ and are always found among many people across the world. Research shows that one out of two women and one out of five men above the ages of 50 are susceptible to the fragility fractures around many parts of the body such as the wrist, hips, spine among many others.  Nursing Interventions For Women With Osteoporosis Discussion Paper

A normal bone comprises of collagen, protein, and calcium that offers its strength. Bones have numerous functions such as the provision of the support, structure protection of the internal organize storage of calcium and other mineral elements and contain bone marrow that act as blood cells producers.  This means that any medical condition that affects the functionality of the bone renders the body to numerous diseases, functionality, and even death.  Above the ages of 35 years, the is an imbalance on the amount of bone being removed, and the amount of that is laid down as a result of the aging process, a process known as ‘bone thinning’. The bones from the outside look the same, however, from the inside the cortical shell reduces, and the struts become thinner hence leading to the probability of fractures (Vipey et al., 2015). As indicated earlier, osteoporosis occurs in both women; however, it is much common among older women due to the high rate of bone loss during the menopause period and when the sex hormones level drop down.

During the adolescent, the human’s bone structure is always strong with enough mass to sustain the body weight and any bump, however, after some ages of 55 years, the estrogen hormone that protects the bone loss is reduced. After the menopause, the ovaries stop producing the estrogen leading to high-risk factors among the women thus making an average of about 34% women against 17% of men worldwide (Nixon et al., 2016). Over 200 million of women quality of life is seriously jeopardized with the increasing rate of osteoporosis in the world and with the high rate of aging population, there is need to have health interventions to provide guidance and care for them. In the European Union, osteoporosis cost above € 37 billion with some victims projected to increase shortly. The high population of sufferers puts many countries in the world to have large expenditure on the health conditions hence the formations of numerous organizations such as National Osteoporosis Foundation (NOF), and International Osteoporosis Foundations (IOF) (Shams-White et al., 2018). Such organizations, work worldwide to create awareness of the knowledge about osteoporosis with an aim to reduce the prevalence among the populations.

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Question For The Literature Review

The diagnosis of osteoporosis occurs through the measure of bone loss by the use of Dual Energy X-ray, and DXA test that always takes about 15 minutes. A T-score that ranges between -2.5 and lower requires intervention depending on the doctor’s interpretation.

Figure 1 shows changes in bone mass against age, obtained from (Vipey et al., 2015)

Question for the Literature Review

What are the nursing interventions of women with osteoporosis?

Evidence will be conducted through the use of Medline, CINNAL and Scopus database systems that are accessible from the University of Wollongong Library. Other sources search such as Google scholars were used to collect the required information. Based on the search question, the nursing interventions on women with osteoporosis, search terms were derived: Osteoporosis, nursing interventions and osteoporosis among women.

The study is limited in the English language published between 2014 and 2018 and focused on women between the age of 55 years and above. The study found 25 nursing journal articles of which 15 met the selection criteria and were analyzed to come up with the full literature review on the topic.

The studies are examined based on the following two interventions: educational and medical. The educational intervention focuses on the self-efficacy while the medical interventions focus on the use of drugs and estrogen replacement therapy.

Health education plays a significant role in the public as it aims at preventing the spread of diseases and the improvement of people’s lives through the dissemination of information. Health education entails combinations of learning experiences that are undertaken by different stakeholders in promoting a healthy lifestyle. The study conducted by Stupar, Radoj?i?, Tadi?, and Pavlov-Dolijanovi? on the Osteoporosis-related knowledge among 132 Serbian postmenopausal women aimed at identifying the effect of education of osteoporosis on women. The role of osteoporosis education among women is to provide information to affect the beliefs, attitudes and intervention behavior with a major aim to reduce the prevalence of bone fracture (Stupar et al., 2017).

Numerous shows that inadequate knowledge about osteoporosis and risk factors increase the chances of prevalence by about 39% as the women are unable to determine their risks of developing the disease and changing the health-related behaviors (Toh eta l., 2015). The education of osteoporosis prevention can be divided into two: that is knowledge of osteoporosis measurement and the prevention behavior. During the education, women are taught more about osteoporosis with a major focus on the bone anatomy, self-management principles, personal goal setting, pain management, relaxation, nutrient, posture, working with doctors and medication, osteoporosis risk factors, measurement of bone density, and support from groups among many others.

Search Strategy

Self-efficacy refers to personal confidence in performing a particular behavior in numerous situations (Ki-Soo et al., 2017). In studies conducted on the role of education on the osteoporosis, whereby the all the participants were all women from various profession and institutions, self-efficacy was found as the major contributor to the management of the diseases.   Janiszewska, Kulik, ?o?nierczuk-Kieliszek, Drop, Firlej and  Gajewska, conducted a study on 151 women who have undergone educational training and conclude that self-efficacy is instrumental in the treatment.in health education, self-efficacy entails different factors such as knowledge, attitude skills, and behavior change (Janiszewska et al., 2017). Among these factors, behavior change is the fundamental of self-efficacy and has been used among many programs and interventions. Self-efficacy is influenced by four main sources that are: mastery experience, vicarious experience, verbal persuasion, and physiological and emotional states.

Mastery experience influences self-efficacy through all the successful experiences, while repeated failures reduce/lowers self-efficacy (Elders et al., 2017). The osteoporosis education, allows women to have experiences in keeping the calcium, vitamin and other nutrients intake diary or even having regular weight-bearing exercises to prevent osteoporosis. The success of these educational experiences and mastery of the techniques increase the self-efficacy of the participants that eventually help them to reduce while at home or even after the education system.

The vicarious experiences help in improving self-efficacy through seeing people of the similar condition who are strong. Through osteoporosis education, groups are always formed to enhance the participant’s belief about the effect of doing various activities that have made other people manage the condition. The verbal persuasion is used by health education professionals to disseminate reliable and persuasive information. The verbal encouragement during the educational intervention increases the self-efficacy of the women to achieve the set goals in managing the medical condition. Lastly, the physiological and emotional status helps in increasing the positive mood of depressed women.

Studies show that self-efficacy creates the behavior change leading to increased rate of weight-bearing exercise and calcium intake increases the strength of the bone. However, some studies also report that weight-based exercise is less effective among the older women who feel too old to perform the activities hence are only left with nutrition intervention.

A healthy diet is important throughout the life in building the strong bones and reduction of the strength. Women are always taught to feed adequately during childhood and after the menopause period to provide a better chance of the bones to withstand a loss in the old age. Calcium foods such as milk, cheese, baked beans, and rice among many others makes the bones strong (Bharathi & Baby, 2017). Vitamin D foods such as sunlight, grilled salmon, soya milk, boiled chicken egg help to regulate the way the body uses calcium in the body. Women are taught how to select rich foods to enhance their dietary intake through calcium and vitamin rich food choosers.

Summary Of The Evidence

Exercise helps in building strong bones during the early years and helps in increasing the strength of the bones through life. Bone is living tissues that are affected by the forces and loads put upon it by becoming stronger. Constant and frequent body movement causes the muscles to pull on the bones, increasing the strength hence reducing the probability of experiencing any fall. During education, women are taught on what kind of exercise is right for them since the choice of the wrong exercise might lead to fracture (Svege et al., 2016). Nursing Interventions For Women With Osteoporosis Discussion Paper For example, a woman with high fracture risk is prone to fragility hence jogging exercise is not recommended. Therefore nay choice of exercise must be tailored according to each patient’s situation as discusses by doctors and physiotherapist.

The high rate of osteoporosis among the post-menstrual results from the estrogen deficiency that accelerate the bone turnover, thus enhancement of the parathyroid hormones (PTH) increase the intake of calcium and vitamin among the women; promoting the osteoclast process.  Study conducted by Cium?rnean,   Milaciu, Alb,   Moldovan   and Sâmpelean, conducted a research on 4235 participants and found out that increase on the drug’s use increased the bone mineral density.

Due to the roles of estrogen receptors in the osteoclast apoptosis, estrogen replacement therapy is a significant way of preventing osteoporosis among the post-menopausal women. Numerous studies indicate that lumbar spine, femoral neck, and total hip-bone mass density changes through the hormonal replacement therapy are hence reducing the bone turnover (Costello, Sprung & Coulter, 2017). However, due to high-risk factors such as thromboembolic disorders, stroke, and endometrial cancers among others, the process is not recommended as a first measure of osteoporosis treatment.

Selective estrogen receptor modulators such as lasofoxifene, raloxifene and bazedoxifene are also used to improve the estrogen in the body. These are FDA approved non-steroid synthetic drugs that reduce vertebral fracture among the osteoporosis women by increasing the trabecular bone mass in the axial skeleton.

Oral bio phosphates are one of the long-term interventions used among women especially those that are post-menstrual period.   Bio phosphate act by interfering with particular paths of the intracellular in osteoclast leading to cellular toxicity. The bio-phosphate binds to hydroxyapatite thus absorbed by bone preventing osteoplastic (Cium?rnean et al., 2017, p.36). Different drugs such as ‘antiresoptives’ are designed to slow down the activity of the cell that breakdown the old bone(osteoclasts), while other drugs such as ‘anabolic’ drugs stimulate the creation of new bones(osteoblasts). Since these drugs work differently, the combination of the use yields a good result among the women.

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Osteoporosis Educational Intervention

Most of the chosen journals had a cross-sectional study on the impact of education among the osteoporosis women, and the articles were purposively chosen to provide the required information on the topic (Wu, Yu & Zhou, 2017). Majority of the studies reported positive experiences of the women after the osteoporosis interventions that make them relevant among the large population in the world.

The literature review was based on the nursing interventions on osteoporosis among women, and more than half of the studies were conducted with more than 100 participants in different countries, generalizing to be valid. However, there is attrition bias in some studies that made to identify the participants in the researches.

The relevance and impact of finding and identified gaps

The evidence retrieved from these studies offer common nursing interventions strategies among the osteoporosis women across the world (Yousef, 2017). Health partners and osteoporosis patients thus have added information on the best strategies in nursing practices and managing osteoporosis conditions. However, the limitations of the evidence are that it limited on the nursing interventions on women rather than the whole population, since osteoporosis affects all ages.

Conclusion

Through the use of different search database systems, 15 articles found relevant to the topic were analyzed to identify the nursing interventions among the osteoporosis women. Despite the limitations of references, the found articles provide enough information and the major were education programs and medical treatment. Most of the participants in the studies showed positive experience from the various interventions.

The study on the nursing intervention of women with osteoporosis is significant following the high rate of women suffering from the medical condition. From the studies carried out by several researchers such as Stupar, Radoj?i?, Tadi?, and Pavlov-Dolijanovi? and many others on the Osteoporosis-related knowledge among 132 Serbian postmenopausal women indicate that a lot of money is spent in treating and managing the disease. The method used in both primary and secondary data collection; mixed methods ensures that the researchers were accessible to the relevant information. Janiszewska, Kulik, ?o?nierczuk-Kieliszek, Drop, Firlej and Gajewska, used qualitative and quantitative research methods of data collection and analysis. The inclusion and exclusion of participants were based on age above 45 years, thus this exluded young woman of 18-30 years, of which some suffered osteoporosis too.

The results of most of the studies corre late osteoporosis with post-menopause age; an age that shows most of the women’s estrogens levels have reduced to minimum. This means that the rate of bone strength is reduced leading to a high probability of fracture. Most of the studies indicate d the use of education as the main intervention of nursing of women with osteoporosis. Education ensures that all women know the right food to take and avoid, improve their self-efficacy and adopt relevant medical interventions such estrogen replacement and drug use.

Self-Efficacy

References

Aggarwal, L., & Masuda, C. (2018). Osteoporosis: A quick update. Journal of Family Practice, 67(2), 59–65. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=127851780&site=ehost-live

Cium?rnean, L., Milaciu, M. V., Alb, M. G., Moldovan, R. T., & Sâmpelean, D. P. (2017). The   Efficiency in Postmenopausal Osteoporosis Treatment. Balneo Research Journal, 8(2), 33–39. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=123263477&site=ehost-live

Costello, B. T., Sprung, K., & Coulter, S. A. (2017). The Rise and Fall of Estrogen Therapy: Is Testosterone for “Manopause” Next? Texas Heart Institute Journal, 44(5), 338–340. https://doi.org/10.14503/THIJ-17-6360

Elders, P. J. M., Merlijn, T., Swart, K. M. A., van Hout, W., van der Zwaard, B. C., Niemeijer, C. van Schoor, N. M. (2017). Design of the SALT Osteoporosis Study: a randomised pragmatic trial, to study a primary care screening and treatment program for the prevention of fractures in women aged 65 years or older. BMC Musculoskeletal Disorders, 18, 1–10. https://doi.org/10.1186/s12891-017-1783-y

Janiszewska, M., Kulik, T., ?o?nierczuk-Kieliszek, D., Drop, B., Firlej, E., & Gajewska, I. (2017). General self-efficacy level and health behaviours in women over the age of 45 years who have undergone osteoporosis treatment. Menopausal Review / Przeglad Menopauzalny, 16(3), 86–95. https://doi.org/10.5114/pm.2017.70584

Ki-Soo Park, Jun-Il Yoo, Ha-Young Kim, Sunmee Jang, Yongsoon Park, Yong-Chan Ha, Ha, Y.-C. (2017). Education and exercise program improves osteoporosis knowledge and changes calcium and vitamin D dietary intake in community dwelling elderly. BMC Public Health, 17, 1–8. https://doi.org/10.1186/s12889-017-4966-4

Nixon, A., Doll, H., Kerr, C., Burge, R., & Naegeli, A. N. (2016). Interpreting change from patient reported outcome (PRO) endpoints: patient global ratings of concept versus patient global ratings of change, a case study among osteoporosis patients. Health & Quality of Life Outcomes, 14, 1–12. https://doi.org/10.1186/s12955-016-0427-5

Shams-White, M. M., Chung, M., Fu, Z., Insogna, K. L., Karlsen, M. C., LeBoff, M. S.Weaver, C. M. (2018). Animal versus plant protein and adult bone health: A systematic review and meta-analysis from the National Osteoporosis Foundation. Nursing Interventions For Women With Osteoporosis Discussion Paper