Page 398 - Encyclopedia of Nursing Research

OSTeOPOROSIS n 365

are many questions that arise within this BMD. The World Health Organization’s def-
framework to guide the investigator. inition of osteoporosis is based on the BMD
The NIH estimates that 50% of women of the hip or spine compared with the mean O
and 25% of men will suffer an osteopo- density of the normal young adult (NOF,
rosis-related fracture in their lifetime, 2010). A BMD score that is 2.5 SD below that
costing an estimated $14 billion in direct norm is diagnostic for osteoporosis. Other
expenditures (NIH, 2010). Currently, it is diagnostic tests include x-rays, bone scans,
estimated that 10 million Americans have examination of present risk factors, and var-
osteoporosis, whereas up to 33 million ious laboratory tests such as blood calcium
have low BMD and osteopenia and are at and vitamin D levels (NIH, 2010).
risk for osteoporosis (Knudtson, 2009). Of Payment for osteoporosis screening and
those 10 million, 8 million are women and subsequent follow-up has clinical implica-
2 million are men (National Osteoporosis tions. Although BMD tests are the gold stan-
Foundation [NOF], 2010). ethnicity is also a dard for osteoporosis diagnosis, many private
factor, with Caucasian and Asian women at insurers do not cover the cost. Medicare
highest risk for osteoporosis and Black and began paying for a screening DeXA in 1998
Hispanic women at lower risk (NIH, 2010). and will cover a screening DeXA every
Fractures related to osteoporosis occur 24 months and every 12 months for those on
more frequently than myocardial infarc- treatment for the disease. Anders, Turner,
tions, stroke, and breast cancer combined. and Wallace (2006) propose the use of clinical
As the U.S. population ages, the projected decision rules to guide the diagnostic pro-
economic impact of osteoporosis-related cess. Several valid instruments are available,
fractures continues to rise (Knudtson, including the Osteoporosis Risk Assessment
2009). Genetics and age are the major non- Instrument, the Age, Body Size, No estrogen,
modifiable risk factors for osteoporosis, and the Osteoporosis Self-assessment Tool.
but lifestyle contributes to relative risk of Tools such as the Fracture Risk Assessment
developing osteoporosis. Diets low in cal- Tool (FRAX) can predict risk for fractures
cium, lack of sun exposure, smoking, exces- and assist clinicians in deciding when to
sive alcohol intake, and sedentary lifestyle implement therapies. Waugh et al. (2009)
are some of the modifiable risk factors long completed a systematic review to determine
identified with osteoporosis (NIH, 2010). major risk factors for BMD in healthy women
Although osteoporosis most commonly aged 40 to 60 years, which could help to iden-
occurs in elderly men and women, it can tify those in need of screening to decrease
also develop because of secondary causes unnecessary testing. They found that only
(Knudtson, 2009). Medications such as glu- two of the commonly identified risk factors
cocorticoids and medical conditions such were significant in this age group, low body
as Cushing’s disease, anorexia nervosa, and weight and years since menopause.
malabsorption can contribute to osteoporosis. To prevent osteoporosis, the NOF (2010)
Pregnancy-associated osteoporosis is a rare recommends that everyone should have an
and temporary condition that occurs during adequate intake of calcium and vitamin D,
the third trimester or postpartum period of avoid tobacco, identify and treat alcohol-
a first pregnancy. Symptoms include back ism, and participate in exercise. The recom-
pain, loss of height, and vertebral fractures. mended total daily calcium intake is 1200
In certain cases, pregnancy-associated osteo- mg/day, including supplements. Calcium
porosis can contribute to pelvic pain and hip intake that exceeds that amount may put the
or pelvic fracture (Spinarelli et al., 2009). individual at risk for kidney stones or cardio-
The NOF (2010) recommends dual-energy vascular disease. A calcium intake calculator
x-ray absorptiometry (DeXA) to measure is available in their document.