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This article provides an overview of osteoporosis, describes current recommendations for its prevention and treatment, and discusses nursing implications. This is part two of a four-part series on postmenopausal health.

Osteoporosis is a common silent disease in older adults presenting with fragility fractures. Lifestyle modifications may be an imperative strategy to minimize the increase of either osteoporosis or osteoporosis-related fractures. Targeted education is one way to promote osteoporosis preventive behaviors. Our aim of this study was to test the feasibility of the Join the Movement to Have Healthy Bone Project (JHBP) that was developed on osteoporosis preventive behaviors for Thai older women. By succeeding in making appropriate lifestyle changes, these women ultimately may reduce the risk of osteoporosis or fractures in later life.

Patients who face chronic, incurable, or life-ending musculoskeletal conditions often receive inadequate care either due to a lack of caregiver awareness or inattention to maintaining the highest quality at the end of life. Palliative care focuses on the comprehensive physical, psychological, social, spiritual, and existential needs of patients with life-threatening or debilitating illness. Orthopaedic nurses and all nurses in general are challenged to incorporate palliative care principles into care planned with patients and families facing end-of-life issues. This article addresses the leadership role the National Association of Orthopaedic Nurses (NAON) has taken to develop a consensus document which endorses the Last Acts Precepts of Palliative Care and affirms the need for palliative care with patients who experience life-threatening illness. A case study is used to illustrate the opportunity a multidisciplinary team has to center care on the individual, while remaining sensitive to the holistic needs of the patient for self-determination at the end of life.

Osteoporosis, a disease characterized by skeletal fragility, represents a major health problem, especially for postmenopausal women. This project is a pilot study exploring the female osteoporotic patient's understanding of her individual pain condition and investigating the potential of a structured nursing program, called the Osteoporotic Pain Program (OPP), to increase the patient's insight, skills and motivation to self help, and possibly reduce pain. Findings in other studies and the expertise of experienced clinical nurses formed the basis for the OPP, which consists of three elements: conversations between nurse and patient, pain curves, and body charts. Qualitative interviews, using a semi-structured guide, were conducted to explore the meaning of the program as seen from the perspective of the patients. Participating in the OPP proved meaningful to patients in two major ways, actively exploring one's pain and feeling empowered. The analysis lead to forming a main category, "Exploring the chronic pain situation", and five subcategories were identified: expressing one's pain, understanding one's pain, justifying one's pain, accepting medication, and entering a ready-to-act mode. Findings indicate that the OPP contributes to challenging the patients. Their self-efficacy increases, their actions change, and pain intensity appears to decrease.

Despite assessment and appropriate interventions, some older people will continue to be at risk of falling. Fractures of the hip and wrist are especially common among this group. The risk of fracture means that a comprehensive falls prevention programme must include an assessment of the individual fracture risk and the instigation of appropriate treatment of bone fragility. Osteoporosis is the main cause of bone fragility in this client group and it is commonly associated with postmenopausal women, although other forms exist. Osteoporosis is also a problem for men as they get older and for individuals taking steroid medications. Community nurses need to be aware of how osteoporosis manifests itself as well as how this condition can be prevented and treated.

Due to osteoporosis, bones are thinner and more fragile, which increases the number of fractures, especially in the hip. Due to the fact that this illness is a serious individual and social problem in today's world, it is therefore extremely important to diagnose it correctly and apply the appropriate treatment. This treatment, usually, is based on some general measures combined with other pharmacological ones, among which these are worthy to note: administering calcium and vitamin D and substitute hormone therapy.

Postmenopausal survivors of breast cancer for whom hormone replacement therapy is contraindicated are at risk for development of osteoporosis. The primary purpose of this article is to describe, in a sample of 30 postmenopausal survivors of breast cancer, their calcium and vitamin D intake compared with recommended dietary guidelines for those nutrients for postmenopausal women not taking hormone replacement therapy and the body mass index of these women as nutritional status risk factors for development of osteoporosis. Bone health and presence of osteoporosis were determined by bone mineral density testing of the spine, hip, and forearm. To obtain calcium and vitamin D intake, including supplements, 3-day diet records were completed; height and weight measures were used to calculate body mass index. The sample participants ranged in age from 42 to 65 years; the majority (56%) had been menopausal or off hormone replacement therapy for 5 years or less, and 70% had completed breast cancer treatment for 5 years or less (except tamoxifen). The majority (63%) were of medium body frame size; 30% were of small frame size. The mean body mass index (27.3) and mean weight (160 lbs) indicate that these women, as a group, were over-weight. Although a large percent (63%) were taking calcium supplements, the mean daily intake (diet and supplements) of calcium (1,353 mg) and vitamin D (403 IU) was less than the recommended dietary guidelines for these nutrients in this population. At study entry, 80% of the women were osteopenic (60%) or osteoporotic (20%) and none was receiving treatment/prevention for osteoporosis; only 1 had a previous known osteoporosis diagnosis. This is a special group of women for whom screening and preventive strategies for osteoporosis are imperative.

Osteoporosis, a disease characterized by low bone mass, microarchitectural deterioration of bone, and susceptibility to bone fractures, can lead to debilitating pain and deformity. The disease represents a major health problem, particularly in older women. Approximately 1.5 million people in the United States suffer osteoporosis-related fractures annually, and many never gain full recovery. The direct annual health expenditures related to osteoporosis fractures were estimated at $13.3 billion in 1994, but quality of life costs related to osteoporosis are even more profound. Identifying people at risk for osteoporosis and early treatment can minimize its destructive effects. Nurses play an important role in the development of strategies to reduce the incidence of osteoporosis and osteoporosis-related fractures, pain, and deformity to help older adults lead healthy, productive lives in their later years.

Osteoporosis affects over 40 million women each year. This insidious disease is most common to women, especially over the age of 50. Osteoporosis leads to an increased risk of fracture, subsequently impacting morbidity and mortality and the quality of life in affected women. The nurse is an integral partner by helping women confront this condition through risk identification, preventive techniques, new treatment modalities, education, and follow-up.

Osteoporosis affects about 8 million Americans, mostly women. The incidence and cost of the disease are rising as the population and its life expectancy increase. Each year 1.5 million individuals with osteoporosis suffer debilitating fractures of the spine, hip, or forearm. The primary health care provider is positioned to detect osteoporosis and its risk factors before signs and symptoms occur. Early detection can be achieved through any one of several diagnostic modalities, including bone mineral density tests and the use of biochemical markers. Once a clinician determines that a patient has many risk factors, bone mineral density testing should be performed. If the test results confirm the clinician's suspicion, therapeutic options should be discussed. Although treatment options exist, the most effective method of dealing with osteoporosis is prevention, including modification of risk factors (for example, diet and lifestyle) and the use of hormone replacement therapy, raloxifene, or alendronate therapy.

Research shows that osteoporotic fractures all too often cause an irreversible decline in the quality of life. To help these patients, here's what you need to know about primary and secondary prevention.

1. Occupational health nurses have a prime opportunity to promote a healthy and stable population of working women through teaching osteoporosis risk reduction behaviors and conducting periodic osteoporosis risk assessments. 2. Health teaching about osteoporosis prevention is needed to foster health promotion and risk reduction behaviors among pre-, peri-, and postmenopausal women to lessen the incidence of fractures and secondary consequences. 3. By incorporating primary and secondary prevention strategies into occupational health nursing practice, great strides can be made in guiding women to initiate osteoporosis prevention behaviors to promote a more healthy and less restrictive lifestyle in later years.

The continuing scientific controversy regarding the use of calcium supplements for the prevention of osteoporosis during menopause presents a challenge to the nurse practitioner. There is little doubt that estrogen prevents bone loss following menopause, but there is a growing doubt among many researchers whether calcium supplementation beyond 800 mg/per day produces any benefit at all in preventing postmenopausal osteoporosis. Yet, the medical consensus in this country continues to recommend 1500 mg of calcium per day for menopausal women. The practitioner's clinical questions relate to the effectiveness, cost, and compliance of calcium prescription. An alternate recommendation and protocol are presented here.

The purpose of this study was to determine if women who undergo hormone replacement therapy postmenopausally, will demonstrate less osteoporosis than women who do not undergo HRT. The osteoporosis subjects were 195 women who volunteered to participate in an NIH-sponsored double-blind clinical trial entitled Safety and Efficacy of Fluoride Therapy in Osteoporosis. A convenience sample of 78 controls was obtained by inviting women seeking regular medical attention to join an epidemiological investigation of osteoporosis. The data were analyzed using Chi-square and Student's t-ratio. The study concludes that future retrospective and prospective analyses appreciate the complexity of the problem in terms of individual risk for osteoporosis.