Osteoporosis: Clinical Guidelines for Prevention, Diagnosis, and Management » (New Edition)

Sarah Hall Gueldner, DSN, is Professor of Nursing and fellow in the Institute of Primary and Preventative Health Care at Binghamton University, in Binghamton, New York, and the Arline H. and Curtis F. Garvin Visiting Professor of Nursing at Case Western Reserve University (2006-2007). Dr. Gueldner earned a Bachelor of Science in Nursing degree from the University of Tennessee College of Nursing in Memphis, a Master of Nursing degree from Emory University, and a Doctor of Science in Nursing degree from the University of Alabama in Birmingham, where she was named Medical Center Graduate Fellow. She completed postdoctoral study in psychoneuroimmunology at Emory University. Dr. Gueldner held an appointment as Senior Research Scientist at the University of Georgia Gerontology Center from l988-l994 and is a Fellow in the American Academy of Nursing, the National Academies of Practice, the Gerontological Society of America, and the Association of Gerontology in Higher Education.

Dr. Gueldner's research centers on health promotion in elderly populations, with secondary work related to the development of a picture tool to measure personal sense of well-being in compromised populations. She served as the principal investigator of a federally funded study that examined the benefits of exercise in nursing home residents and community-dwelling elders and has published the findings of her five-year study profiling the prevalence of osteoporosis in rural women. She has also conducted lifestyle research testing a number of interventions, including exercise, environmental enrichment, mood, life satisfaction, and immunocompetence in elderly populations. Given that smoking places individuals at greater risk for developing osteoporosis, Dr. Gueldner is principal investigator for a randomized, double-blind clinical trial that tests a variety of interventions to support smoking cessation.

Theresa N. Grabo, PhD, ARNP, BC, is Associate Professor of Nursing and Director of the Graduate Program at Binghamton University, in Binghamton, New York. She is also a fellow in the Institute of Primary and Preventative Health Care at the University. Dr. Grabo practices at Valley Gyn Specialists in Luzerne, Pennsylvania. She earned a Bachelor of Science in nursing degree from the State University of New York at Buffalo, a Master of Nursing degree and Family Nurse Practitioner Certificate from Binghamton University, a Master of Public Administration from Marywood University in Scranton, Pennsylvania, and a PhD from the University of Pennsylvania. She served as a Fellow in the Summer Nursing Research Institute, International Center of Research for Women, Children and Families at the University of Pennsylvania School of Nursing.

Dr. Grabo has over 20 years experience as a Nurse Practitioner providing care to women and has focused her research activities on the health problems of midlife women including heart disease, osteoporosis, female sexual function, and hormone therapy. She is co-investigator on a National Institute of Nursing Research grant investigating ways to improve heart healthy behaviors among rural women.

Eric D. Newman, MD, received his Bachelor of Arts degree in Biology from The Johns Hopkins University, and his Medical Degree from The Pennsylvania State University College of Medicine, in Hershey, Pennsylvania. He completed an internal medicine residency at University of North Carolina (Chapel Hill) and a rheumatology fellowship at Geisinger Medical Center. During his medical school training, Dr. Newman was the recipient of a two-year NIH research grant. He has been on staff at Geisinger since 1988, and has been Director of Rheumatology since 1997. In 2002 he was appointed Vice-Chairman of the Division of Medicine. In 2006 Dr. Newman was named Director of the Clinical Trials Office for the Geisinger Health Care System. He is very active in clinical research, focusing on clinical trials and outcomes research in rheumatology. Dr. Newman developed and maintains the Rheumatology Diagnosis, Treatment, and Outcomes Database, which currently has information on 30,000 patients encompassing over 220,000 clinic visits.

Dr. Newman has played an integral role in the design, implementation, and monitoring of the Geisinger Osteoporosis Disease Management Program since its inception in 1996. The program includes published guidelines, bone density testing, and outcomes analysis, and it has received 3 national awards and generated 12 peer reviewed publications. He developed the Geisinger Mobile DXA Program, which brings state-of-the-art osteoporosis risk assessment directly to the primary care site. Over 3,500 DXAs are performed yearly in the Mobile Program. In addition, he is a physician leader in the Advanced Access Program and is nationally recognized for his pioneering work in process redesign to improve access to care for patients with rheumatic diseases.

David R. Cooper, MD, is a graduate of Binghamton University in Binghamton, New York, with Bachelor of Arts degree, and a graduate of the Thomas Jefferson University Medical School with an orthopedic residency in Philadelphia. He is the director of The Knee Center in Wilkes-Barre, Pennsylvania, and his orthopedic practice specializes in the care and treatment of knees, including arthroscopic surgery and knee replacement. He has personally performed over 6,000 arthroscopies and 500 knee replacements in his career. He is an adjunct professor at Kings' University in Wilkes-Barre, and at the Decker School of Nursing at Binghamton University. He is also the attending orthopedic surgeon at the Pocono Raceway for the NASCAR events each year. In addition to his clinical practice, Dr. Cooper lectures and teaches nationwide. He has presented at the national conference of the American Bar Association, at the LRP Publications national workers' compensation program, and is the recipient of the Professional Education Seminars, Inc. Excellence in Teaching Award.

Osteoporosis is a preventable disease. But each year some 500,000 people are hospitalized from osteoporosis fractures, and another 180,000 people are placed into nursing homes from injuries due to osteoporosis.

What can nurses, clinicians, medical researchers, physiologists, health care policy experts, and other providers do to diminish, if not eradicate, the disease from local to global scales? What are the best methods for care and treatment? Osteoporosis addresses these questions, and more. Designed as a complete reference, Osteoporosis presents vivid explanations plus illustrations of specific surgical procedures to guide in the preparation and post-operative rehabilitation of the patient for surgical repairs of fractures. Chapters also discuss leading components of a patient's recovery, from dietary requirements and exercise, to fall prevention, quality of life and independence issues.

The authors highlight disease prevention strategies and various models of community outreach that have proven effective in educating target populations about osteoporosis, encouraging proper lifestyle choices, and helping children to achieve their maximum bone potential at a young age.

Osteoporosis can be prevented. Here is the book to help you, and your health care institution, do just that.

Contributors     xi
Foreword     xiii
Preface     xv
Acknowledgments     xvii
Introduction and Overview   Sarah H. Gueldner   Theresa N. Grabo   Eric D. Newman   David R. Cooper     1
The Problem     1
The Science     1
Transferring Knowledge to Practice     2
The Clinical Mandate     2
Children: An Overlooked At-Risk Group     2
The System Mandate     3
The Purpose of This Book     3
Summary     5
Prevalence, Risk Factors, and Pathogenesis
Demographic Perspectives: The Magnitude of Concern   Janice Penrod   Annabelle M. Smith   Susan Terwilliger   Sarah H. Gueldner     9
Introduction     9
Prevalence     10
Fractures     11
Lifetime Fracture Risks     11
Global Perspectives     12
Consequences of Osteoporosis     13
Future Projections     16
The Pathogenesis of Osteoporosis   Sheri A. Stucke   Bernadette M. Lombardi   Sarah H. Gueldner   Theresa N. Grabo     19
Introduction     19
Bone Physiology     20
Conclusion     28
Clinical Management
Diagnostic Tests and Interpretation   William T. Ayoub     33
Introduction     33
Bone Mineral Density Testing     33
Guidelines for Interpretation     35
Clinical Utility     38
Markers of Bone Turnover     39
Secondary Cause Evaluation     40
Pharmacological Management   Theresa N. Grabo   Daniel S. Longyhore     47
Bisphosphonate Therapy     48
Parathyroid Hormone Therapy (PTH)     52
Estrogen Therapy     53
Bioidentical Hormones     57
Selective Estrogen Receptor Modulators (SERMs)     59
Calcitonin (Salmon) Therapy     64
Combination Antiresorptive Therapy     66
Calcium and Vitamin D     67
Vitamin D     69
Integrative Therapies     72
Pain Management     73
Conclusion     76
Surgical Management of Fractures   Eric Seybold   Heather Hazlett   David R. Cooper     83
Complications of Osteoporosis     83
Hip Fractures     84
Vertebral Compression Fractures     88
Wrist Fractures     97
Prevention     99
Conclusion     99
Nonpharmacological Management
Diet and Bone Health   Helen Smiciklas-Wright   Catherine E. Wright     103
The Effect of Calcium on Peak Bone Mass     104
Does Calcium Intake Minimize Bone Loss and Reduce Fractures?     104
Recommended Calcium Intakes     105
The Calcium Paradox     106
Food Sources of Calcium     106
Vitamin D     107
Sources of Vitamin D     108
Recommended Vitamin D Intakes     109
How Much Calcium and Vitamin D Is Available in Foods and Supplements?     109
Is It Possible to Consume Too Much Calcium and Vitamin D?     109
Total Diet     110
Nutritional Recommendations     112
Summary     113
Exercise Mandate: Preventative and Restorative   Renee M. Hakim   Janet Ramus Grabo     117
Preventative     118
Restorative     127
General Considerations     132
Summary     133
Osteoporosis and Fall Prevention   Roberta A. Newton     141
Elements of a Fall Prevention Program     143
HEROS Fall Prevention Program for Community Dwelling Older Adults     148
Maintaining Independence and Quality of Life   Marlene Joy Morgan     153
Client-Centered Approach     154
Setting Goals for Lifestyle Redesign     155
Integrating Interdisciplinary Assessments     155
Common Problems Affecting Independence and Quality of Life     159
Lifestyle Redesign for Living With Osteoporosis     161
Successful Lifestyle Redesign-Outcomes and Prognosis     164
Summary     164
Prevention Strategies
Maximizing Peak Bone Mass in Children, Adolescents, and Young Adults: A Public Health Priority   Leann M. Lesperance     169
Nutrition     170
Physical Activity     173
Medications     174
Medical Conditions     175
Prevention Programs     177
A Model for Improving Access to Osteoporosis Care: The Geisinger Health System Mobile DXA Program   Eric D. Newman     181
Osteoporosis Testing     181
Heel Ultrasound-A Helpful but Incomplete Solution     182
Mobile DXA-Providing the Gold-Standard Test at the Convenience of the Patient's Primary Care Physician's Office     183
Mobile DXA-Conclusions and Future Directions     185
A Model for Community Outreach: Cooperative Extension Osteoporosis Prevention and Screening Programs   Marilyn A. Corbin   Jane Trainor   Chin-Fang Liu   Sarah H. Gueldner     187
Introduction     187
About cooperative Extension     188
Creating Health: Osteoporosis     190
Other Program Examples     192
Summary     198
Health Policy and Insurance Reimbursement   Geraldine R. Avidano Britton   Katherine Kaby Anselmi   Laura Pascucci     201
Policy Makers and Stakeholders     202
Reimbursement: Federal     208
Policy and Reimbursement: Individual States in the United States     209
Policy Development: Case Studies     214
Summary     216
Emerging Approaches in the Prevention of Osteoporosis   Carolyn S. Pierce   Guruprasad Madhavan   Kenneth J. McLeod     219
Introduction     219
Bone Adaptation and Fluid Flow     220
Fluid Flow in Humans     221
Skeletal Muscle Pump Stimulation and Bone Health     224
Concluding Remarks     228
Acknowledgments     229
Resources and Related Links     235
Federal Government     255
State Government     238
Nongovernment     239
Diagnoses That Support Medical Necessity for Bone Densitometry for Reimbursement     241
Index     247