Help Your Patients Prevent Osteoporosis

By Penelope Morrison Bosarge, RNC, CRNP, MSN

Providers should help female patients design a lifetime program to optimize bone mass and preserve skeletal integrity.1

Promote good nutrition and a diet with adequate calcium. Milk and other low-fat dairy products, leafy green vegetables, soybeans, and tofu are good calcium sources. Advocate regular weight-bearing exercise. Brisk walking, running, aerobics, weight training, cross-country skiing, dancing, and tennis can help the bones and improve the heart function, muscle tone, and balance.

Strongly discourage patients’ use of tobacco and intake of large amounts of alcohol. Both can interfere with bone health. Also, consider other preventive measures such as pharmacological therapy with bisphosphonates, calcitonin, or selective estrogen receptor modulators.2, 3, 4

An adequate calcium intake must be consumed to prevent further demineralization of bone, which may compromise the usefulness of any therapeutic or preventive plan. New national dietary guidelines specify 1000 mg daily for all women under 65 who are pre-menopausal or taking estrogen. Women who are menopausal and not on estrogen or above age 65 should take 1500 mg.5 Give careful instructions for choosing a calcium supplement and its proper administration. Ensure it provides adequate elemental calcium and is bioavailable.

(Editor’s note: Bosarge is a women’s health nurse practitioner and a member of the teaching faculty for graduation programs at the University of Alabama School of Nursing in Birmingham.)

References

1. Civitelli R. Osteoporosis: screening and treatment issues. Syllabus material for Advances in Health Care for Women over 40: Contemporary Forums Conference. Washington, DC: June 1998; pp. 24-30.

2. Liberman UA, Weiss SR, Broll J, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med 1995;333:1437-1443.

3. Civitelli R, Gonnelli S, Zacchei F, et al. Bone turnover in postmenopausal osteoporosis. Effect of calcitonin treatment. J Clin Invest 1988;82:1268-1274

4. Delmas PD, Bjarnason NH, Mitlak BH, et al. Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med 1997;337:1641-1647.

5. Consensus development conference: prophylaxis and treatment of osteoporosis. Am J Med 1991;90:107-110.