Prevention program targets osteoporosis

Education, screening, and phone counseling

A wellness consulting firm that specializes in telephone counseling and a pharmaceutical firm with expertise in worksite seminars have joined forces to target what many consider one of the most under-recognized and serious threats to women’s health: osteoporosis.

Osteoporosis is the loss of bone mass, most often seen in mid-life, that causes bones to become gradually weaker, thinner, and more brittle. It is an insidious disease in which the first symptom is often a broken bone, and it mainly targets women.

"Among the most eye-opening data is that osteoporosis is more costly and more common than cardiovascular disease," says Robin Foust, director of program development at Health Management Corporation (HMC), a Richmond, VA-based wellness consulting firm. (See the statistical data on osteoporosis, p. 30.) "It’s a very preventable condition many women don’t know about and very manageable if diagnosed early."

HMC specializes in health management by phone and has developed a phone-based osteoporosis program primarily for managed care organizations under its "women’s health" umbrella. "But we started to get inquiries [about a worksite program] and were aware of the work [Merck & Company] was doing with osteoporosis identification and management, such as on-site bone-mass loss screenings," she recalls.

West Point, PA-based Merck agreed to partner with HMC.

"There’s a lack of awareness, or underawareness, of what can be done to treat this disease," says Anne Clothier, director of health management services at Merck. "We worked closely with HMC, sponsoring and helping coordinate the program, taking more of a lead on the educational programs and working jointly on follow-ups. It’s been a tremendous partnership."

A multi-phase program

The Merck/HMC program is divided into several phases. The first is an awareness seminar that describes osteoporosis and its attendant risk factors. "Young women can be affected by this disease, and we want to prevent that," explains Foust. (At Sara Lee Corp., screenings turned up bone loss in some surprisingly young women. See the story, below.) "In addition, younger individuals [especially women in their teens and twenties] can in most cases increase their bone mass through a change in diet and lifestyle," Foust says.

Following the seminar, women interested in the program can call HMC’s toll-free phone line and participate in a risk assessment process. Based on their answers, if they are considered at risk, they become eligible for a free on-site screening, which is scheduled while they are still on the phone.

The screening itself is a noninvasive, painless procedure conducted on a portable piece of equipment called the P-Dexa. You sit, fully clothed, and basically put your arm in an armrest.

Individual action plans

The results are produced immediately, reviewed with the participant and forwarded to the employee’s primary care physician. Those identified either with osteopenia (a precursor of osteoporosis that involves some bone loss) or osteoporosis are told a nurse from HMC will contact them by phone.

In the final phase of the process, the HMC nurse reviews the therapy recommended by the physician, helps the patient set individually tailored goals to help them reduce risk factors and improve their health status, and monitors their progress. The nurse consultants are available 24 hours a day.

Detailed follow-up is key

The follow-up period is probably the most critical because it is here that the employee takes steps to either reverse or manage her bone loss. Therefore, HMC provides comprehensive case management.

"We start off by reviewing the test results with the employee, and what their numbers mean," says Cindy Uzcategui, RN, an HMC nurse consultant. "Then, we identify the major risk factors." These factors, she says, include:

• low-calcium diet;

• no hormone replacement after menopause;

• family history;

• being a small-framed, white female (the group most susceptible to osteoporosis);

• smoking;

• past history of steroid use — usually for asthma, or rheumatoid arthritis.

The nurse will tell the employee how to follow the therapy recommended by the primary care physician, but the nurse will not recommend specific products; instead he or she will refer them back to their physicians.

In terms of diet, Uzcategui notes, it’s important to get enough vitamin D, which helps with the absorption of calcium. What you don’t eat, she says, can be as important as what you do eat, and she urges them to stay away from caffeine, sodium, carbonated soft drinks, and high-protein foods.

The primary care physician may also recommend medication, either hormone replacement therapy or, depending on risk factors, the non-hormone drug Fosamax, which is manufactured by Merck and is also designed to help prevent fractures. (Hormone replacement therapy can increase the risk of breast cancer in some women. See this month’s Health & Well-Being supplement.)

Finally, says Uzcategui, she will review other risk-reduction strategies such as how to prevent falls, general safety tips, and strengthening or weight-bearing exercises.

[Editor’s Note: For more information on the HMC/Merck osteoporosis program, contact: Robin Foust, Health Management Corporation, 2235 Staples Mill Road, Richmond, VA 23230. Telephone: (804) 289-5020.]