Osteoporosisand Fractures Clinical Guide
Therehave been fundamental changes in the underlying assumption about thetreatment and prevention of fractures and osteoporosis in Canada(Papaioannou et al., 2010).The attention is currently directed towards averting fragility offractures and the resulting side effects instead of curing theproblem that is now seen as one of the various threats that causeosteoporosis (DiCensoet al., 2005).Osteoporosis is a health condition where bones become weak andfragile due to lack of hormones and substantial minerals such ascalcium and vitamin D(DiCenso, Guyatt, & Ciliska, 2005).It has become necessary, due to various clinical factors thatescalate the possibility of fracture irrespective of mineral density,to adopt a holistic approach and to make a treatment decision basedon the utter possibility of a fracture (Papaioannouet al., 2010).
Researchsuggests that a lot of osteoporosis patients do not undergoappropriate treatment or assessment(Papaioannou et al., 2010).It was thus crucial for the Canada 2010 guidelines to deal with theissue of care gap for osteoporosis patients, to concentrate on theevaluation and supervision of men and women who are above 50 yearsand also, to incorporate fresh methods for evaluating the 10-yearrisk of osteoporosis into the treatment process (Papaioannouet al., 2010).Having such knowledge will help in predicting future fractures andprovide men and women with relevant therapies to prevent furtherfractures. It is thus mandatory for BSN-nurses to equip themselveswith the current knowledge regarding the clinical guidance practiceof handling osteoporosis issues and patients.
Theclinical practice recommends that people above 50 years need to beevaluated for risks factor for fracture and osteoporosis to pinpointrisk levels (Papaioannouet al., 2010).The physician should carry out detailed physical and historicalexamination of the patient to ascertain potential risk factors forfalls, fractures, undiagnosed vertebral fractures and minimal bonemass. To measure the mineral density you can use Dual-energy x-ray,and biochemical tests should be recommended for the patient beingassessed for osteoporosis (Papaioannouet al., 2010).For patients with a bone mineral of the density of 2.5, only littlelaboratory investigations are needed(Papaioannou et al., 2010).
Thepractice recommends that you assess 10-year risk with necessarytools. These can be with the Fracture Risk Assessment Tool (FRAX) or10-year Fracture Risk Calculator (FRC) or Canadian Association ofRadiologist and Canada (CAROC) or any assessment tool that has beenrecommended depending on a country (DiCensoet al., 2005).After assessing the patient, the physician should examine thetherapeutic options available (DiCensoet al., 2005).
Exerciseand prevention of falls is one option patients with osteoporosiswhen they exercise especially moderately, they reduce the risk of hipfracture. Also, the physician can reconsider recommending the intakeof calcium and vitamin supplements, prohibition of smoking, orpharmacological therapy (Papaioannouet al., 2010).For patients with high probability for a great osteoporotic fractureover ten years, it is recommended that they are offered pharmacologictherapy, as well as those patients who are over 50 years and have hadnumerous fragile fractures and still show signs of possibleadditional fractures , but the grades of therapy do differ(Papaioannouet al., 2010).
Thosepatients with moderate risk, various medical evaluations should berecommended to find out additional risks that were not reflected inthe risk evaluation system, and because more osteoporotic fracturesoccur in this stage pharmacologic therapy should be considered(Papaioannouet al., 2010).On the other hand, it is not required to offer pharmacologic therapyto people with minimal possibilities of fracture. In this stage, anecessary measure such as smoking cessation, prevention of falls,exercise and intake of vitamin D and calcium supplements arerecommended (Papaioannouet al., 2010).
Itis also recommended that physicians measure, again, the bone mineraldensity for about a period of one to three years for patients withmoderate risk undergoing osteoporosis and fracture treatment (DiCensoet al., 2005).If there are positive effects of therapy, then the testing intervalcan be increased, and this shows positive response to therapy, whileif there is a continued fracture or loss of bone density, the resultreflects negative adherence to therapy (DiCensoet al., 2005).Less frequently monitoring is recommended for patients with a stablebone mineral density (DiCensoet al., 2005).
Itis important that the physician refers patients to a specialist thatexhibit the following characteristics: Have extremely low bonemineral density, have secondary cause of osteoporosis that is outsidehis/her know-how, poor response to the first and second line oftherapies.
Theclinical guideline has been helpful in detecting, minimizing andpreventing future fractures (DiCensoet al., 2005).Also, through fall interventions, pharmacologic therapy and vitamin Dand calcium diet supplements, patients can eliminate associated riskfactors(DiCenso et al., 2005).Thus, saving the communities and country’s health economic costs,deaths and pain suffered by individuals.
Accordingto Blume and Curtis (2010), found that of the 30.2 million elderlypeople that were beneficiaries of Medicare in 2002 5% (1.6million)received medical attention for fractures as well as 7.2 millionosteoporosis patients. The mean projected health cost of fractures ina year was $8600 95% confidence interval, $10800 to $6400, thus,implying a cost of $14billion national wide. In addition, $2 billiondollars were spent on a half of osteoporosis patients, withoutfractures. Projection in 2008 showed a cost of $22 billion. Inanother study, in the UK, the number of people that will haveosteoporotic fractures in 2020 is projected to be 230,000 per yearwith a cost of 2.1 billion euros (Burge, Worley, Johansen & Bose,2008).
Treatmentof osteoporosis is now a holistic approach. Studies have proved that,enhancing patients’ knowledge, strengthening their health beliefsand promoting behavior change improves the quality of life andsatisfaction in osteoporosis patients (DiCensoet al., 2005).Also, the attention is currently directed towards averting fragilityfractures and the resulting side effects instead of curing theproblem that is now seen as one of the various threats that causeosteoporosis (DiCensoet al., 2005).
References
Blume, S. W.,& Curtis, J. R. (2010). Medical costs of osteoporosisin the elderly Medicare population. OsteoporosisInternational,22(6),1835-1844. doi:10.1007/s00198-010-1419-7
Burge, R.,Worley, D., Johansen, A., & Bose, U. (2008). Thecost of osteoporotic fractures in the UK: Projections for 2000-2020.Journalof Medical Economics,4(1-4),51-62. doi:10.3111/200104051062
DiCenso, A.,Guyatt, G., & Ciliska, D. (2005). Evidence-basednursing: A guide to clinical practice.St. Louis, MO: Elsevier Mosby.
Papaioannou, A.,Morin, S., Cheung, A. M., Atkinson, S.,Brown, J. P., Feldman, S., … Leslie, W. D.(2010). 2010 clinical practice guidelines for the diagnosis andmanagement of osteoporosis in Canada: summary. CanadianMedical Association Journal,182(17),1864-1873. doi:10.1503/cmaj.100771