Lifestyle risk factors for osteoporosis

MedSurg Nursing, Oct, 1997 by Terry N. Thomas

Hormone Replacement Therapy

Estrogen replacement therapy (ERT) continues to be controversial even though research supports its benefits. Risks associated with ERT include breast cancer, hypertension, clotting disorders, continuation of monthly bleeding (when progesterone is combined with estrogen), and migraine headaches (Ali & Twibell, 1994; McKeon, 1994). Many women are unaware that decreased estrogen may lead to osteoporosis and that ERT could help. Women are also concerned about taking a medication for a long period of time. All the above information has implications for education of women in mid-life and older. All postmenopausal women should be counseled about decreased estrogen and loss of bone mass and how ERT could help prevent osteoporosis. They should also be assisted to evaluate their risk for developing osteoporosis in order to make an informed decision about ERT.

Summary and Recommendations

Lifestyle factors can affect women's risk for developing osteoporosis. All have physiologic mechanisms which, if occur in combination, can produce a cumulative increase in risk. Lifestyle factors are only one aspect of the whole picture of osteoporosis, but lifestyle factors are something about which nurses can counsel their patients.

Preventing osteoporosis should start during adolescence and progress throughout a woman's lifetime. Assessing lifestyle risk factors should be an important part of the whole picture of osteoporosis prevention. Adolescent women should be assessed for dietary intake of calcium. Often, in this age group, the image of the slender woman as the ideal interferes with proper nutrition (Woods, 1995). Dairy products are viewed as fattening and are often avoided. Also, high-protein diets often used for weight loss increase calcium excretion in the urine, further leading to possible bone loss (Lappe, 1994).

Young women should be counseled to maintain a well-balanced diet, and an active lifestyle with weight-bearing exercise. Regular menstruation is also important for bone health, therefore women who have irregular periods should be advised to see a physician (Wardlaw & Weese, 1995).

Women approaching menopause or showing symptoms of menopause should be educated regarding ERT. Nurses are available in acute care or clinic settings to educate women on the benefits, risks, and side effects of ERT and discuss women's concerns. Moore and Noonan (1996) suggest booklets, books, and handouts as adjuncts to teaching about ERT and osteoporosis. They also recommend that when women seek information about ERT in various settings, that nurses use this as an opportunity to teach about other osteoporosis prevention skills such as weight-bearing exercise, adequate calcium intake, and the risks of smoking and high caffeine intake.

Erickson and Jones (1992) suggest using the workplace as a site for primary prevention programs for osteoporosis. At the worksite, teaching plans should include pathophysiology of osteoporosis, benefits and limits of screening, and treatment modalities, nutrition, and lifestyle modification. Educational pamphlets and audiovisual programs are available from the National Dairy Council and the National Osteoporosis Foundation.