The role of nurses in osteoporosis

By the very nature and scope of the profession, nursing plays a significant role in the prevention, detection and management of osteoporosis

There is an increased awareness that osteoporosis is an international health care concern that affects millions of individuals worldwide. Injuries, and the resulting potential disabilities related to osteoporosis, admissions to hospitals, nursing homes and long-term care facilities are burdening the health care systems of nations due to the significant costs associated with care and treatment.

By the very nature and scope of the profession, nursing plays a significant role in the prevention and detection of osteoporosis, as well as in the management of this condition. The skills of critical thinking, effective communication and interacting with other members of the interdisciplinary team enable nurses to understand the needs of the patients and the goals of osteoporosis management.

In order to enable nurses to assume these key roles, enhanced knowledge of osteoporosis within the curriculum of nursing programs and ongoing professional development opportunities are essential. Osteoporosis has to assume its prominent place along with other key chronic illnesses, such as cardiovascular disease, diabetes, and others.

Various nursing roles avail themselves to the prevention of osteoporosis through the education of groups of individuals regarding bone health. In community settings and schools, depending upon the resources available, and the priorities of individual healthcare systems, nurses can play a key role in the education of children, youth and parents regarding healthy lifestyles to promote bone health for the future. A renewed emphasis on physical activity and calcium intake is important, as youth become more sedentary and dietary preferences tend to exclude sufficient amounts of calcium need to achieve optimal bone health.

In specialized roles, nurses have the opportunity to provide outreach education to various community and professional groups regarding bone health. These can include healthcare providers, employee health and wellness initiatives, community health forums, seniors’, women’s and cancer survivor groups, to name a few.

Nurses play an integral role in facilitating the detection of osteoporosis, through their involvement in the assessment of patients at various points of contact within the health care system – primary care settings, emergency departments, fracture clinics, and the admission of individuals to various levels of healthcare (acute, chronic, long-term care, community home care). Incorporating simple questions into standard patient assessments or admission processes can facilitate the earlier detection of potential osteoporosis, by including, for example, a history of height loss or a fragility fracture (a broken bone that occurs as a result of minimal trauma, such as a fall from a standing height or less), and other common risk factors for the development of osteoporosis.

Following the diagnosis of osteoporosis, nurses play a significant role in supporting individuals in the treatment and management of this condition through ongoing assessment, teaching and counseling. Where resources exist, an interdisciplinary approach to providing care is optimal, and may include a nurse, physical therapist (exercise), occupational therapist (fall and fracture prevention), dietitian (calcium and vitamin D intake) and pharmacist (medication), working with the physician. Where these other resources are not readily available, it is within the scope of practice for the nurse to initiate counseling and teaching regarding these issues and lifestyle factors, and to coordinate and refer to other healthcare providers and community services, as available.

Nurses are instrumental in providing psychosocial support for individuals with osteoporosis. For many, this is yet another chronic condition that they are faced with, leading to anxiety regarding the diagnosis, treatment and prognosis. Nursing assessment and support assists individuals in maintaining their commitment and compliance to lifestyle modifications and treatment over the course of their lives, and in the modification of approaches as other conditions emerge. Nurses play a role in enabling individuals to cope with chronic illness through the development of coping strategies and, as required, pain management. With the bone health of individuals being monitored over a longer period of time, as compared with other chronic illnesses, nurses often provide ongoing remote telephone counseling and support, which poses its own unique set of opportunities and challenges.

The interplay between various health conditions requires a coordinated approach to optimize the health and wellness of individuals. The above examples have highlighted some of the nursing roles in the clinical specialty of osteoporosis; however, the opportunities for new innovations are endless.

Contributed by Ina Radziunas RN, Clinical Nurse Specialist Multidisciplinary Osteoporosis Program, Women’s College Ambulatory Care Centre Sunnybrook & Women’s College Health Sciences Centre, Toronto, Canada