Handle with Care

“Sticks and stones may break my bones,” the familiar children’s rhyme goes. But if you are a nurse suffering from osteoporosis (porous bones), such routine on-the-job activities as lifting patients or carrying heavy medical equipment could put you at risk for a serious fracture of the hip, spine or wrist.

Osteoporosis is a metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue. It is often called the “silent disease,” because victims have no symptoms of how fragile their bones have become until a fracture occurs. According to the National Institutes of Health (NIH)’s Osteoporosis and Related Bone Diseases National Resource Center, osteoporosis is a major public health threat for 25 million Americans. Two key factors put today’s aging RN population at especially high risk: 80% of osteoporosis victims are women, and the risk increases after menopause.

Asian nurses, in particular, have strong reason to be concerned about developing this serious disease. The National Asian Women’s Health Organization (NAWHO) estimates that more than one-fifth of Asian American women currently suffer from osteoporosis. The NIH notes that Caucasian and Asian women are more predisposed to the condition than black or Hispanic women, due largely to differences in bone mass and density.

“Asian nurses typically have a shorter body stature than Caucasian nurses,” adds Alice Chan, RN, a Sacramento, Calif.-based public health nurse who serves on the national advisory board for NAWHO’s Living Healthy osteoporosis education program. “Even when a hospital bed is adjusted to the lowest level, there is still potential for us to strain our backs when leaning over to lift heavy patients. In many cases, hospitals’ physical standards do not accommodate nurses whose height is less than five foot two.”

But even though Asian nurses are at the top of the risk ladder, osteoporosis doesn’t discriminate. African-American and Hispanic nurses are threatened by the disease as well.

“All women are at risk,” maintains Dr. Felicia Cosman, associate professor of medicine at Columbia University and clinical director of the National Osteoporosis Foundation. “Even African-American women, who seem to have the lowest risk of all the racial and ethnic groups, have a one-in-eight chance of suffering a significant fracture due to osteoporosis, compared to one-in-two for a Caucasian or Asian woman. That’s still a fairly high risk, and it may increase substantially with age.”

Boning Up on Osteoporosis Prevention

Although a number of medications are available for treating osteoporosis, the disease has no cure—making prevention the best defense. The NIH offers these recommendations for keeping bones strong:



  • Eat a balanced diet rich in calcium. According to Cosman, 1,200 milligrams of calcium daily is advisable.


  • Exercise regularly, especially weight-bearing activities. Chan recommends swimming for 20-30 minutes a day.


  • Don’t smoke. “Too many nurses are still smoking,” Cosman cautions.


  • Limit alcohol and caffeine intake. “Many nurses drink a lot of cola and coffee at work,” Chan observes, “because nursing can be exhausting and we feel like we need a boost to keep us energized. But caffeine, like alcohol, is one of those agents that contributes to lower bone density.”

Women who have a family history of osteoporosis or are otherwise at high risk should see their physician for a bone density test in order to determine a further course of action. “When your periods start to become very irregular, that’s the time to get a bone density test—and push for it if your doctor says no,” advises Cosman. “Not everyone needs a bone density test at menopause, but if you have any of the clinical risk factors, you should strongly consider getting the test. If the results reveal that you fall into or close to the osteoporosis range, you will probably need to be treated with some medication.”

More information about osteoporosis risk factors and treatment, targeted to specific racial and ethnic minority groups, can be found online at www.osteo.org.

Taking Precautions at Work

If you are a nurse who has been diagnosed with osteoporosis, it doesn’t necessarily mean you’ll have to give up your physically strenuous career. But what will you have to do differently on the job to reduce your risk of suffering a debilitating fracture or other bone injury? Chan and Cosman have these suggestions:


  • “Generally, we recommend not lifting heavy things, such as patients,” says Cosman. “I would also really stress the use of good body mechanics in the workplace—e.g., taking most of the force in your legs rather than your back and no lifting while leaning forward.” She suggests consulting a physical therapist for more specific recommendations.


  • Take special care to avoid falls. “Even though hospitals take great pains to prevent this, I have seen incidents where nurses did slip and fall at work—it’s a hazard that can occur in a workplace where you’re often in a hurry,” Chan points out. “Even if you’ve only spilled a few drops of medicine or IV fluid on the floor, there’s always a chance you could slip on it.”


  • Above all, Chan emphasizes, don’t be afraid to ask for help if an activity proves too physically challenging. “Sometimes in an emergency, it’s easy to think only about the patient and forget about yourself,” she says. “But if the height or weight of the patient creates a situation you can’t handle physically, always ask for help. Sometimes even two nurses may not be able to lift a patient who weighs close to 300 pounds; you might have to wait for a third or fourth person to help you.” 

New Evidence Confirms the Value of Routine Osteoporosis Screening

Is routine bone density testing for women age 65 and older really an effective tool for preventing osteoporosis, the bone-weakening disease that is especially common in women of Asian descent? Until recently, most bone health experts believed there was not enough hard evidence to support either a “yes” or “no” answer to that question.

Now, however, a newly issued recommendation from the U.S. Preventive Services Task Force, a federally appointed panel of medical experts that evaluates the effectiveness of clinical preventive services, has put an end to the debate. In a report published September 17, 2002 in the Annals of Internal Medicine, the task force recommended that women 65 years of age and older be screened routinely for osteoporosis. “[We] found good evidence that the risk for osteoporosis and fracture increases with age and other factors, that bone density measurements accurately predict the risk for fractures in the short term, and that treating asymptomatic women with osteoporosis reduces their risk for fracture,” the recommendation notes.

In its previous report on osteoporosis, issued in 1996, the task force found there was insufficient evidence to determine whether or not routine screening made a difference in preventing the disease. But in the years since then, an accumulation of new research data led the panel to update its position and conclude that “the benefits of screening…are of at least moderate magnitude for women at increased risk by virtue of age or presence of other risk factors.”

The task force recommends that women 65 and over with normal bone density should receive a routine osteoporosis test every five years. Women who are at particularly high risk for the disease, such as Asian women and those with a family history of osteoporosis, should begin screening earlier, at age 60, the panel adds.

Resources for Osteoporosis Prevention and Treatment

A landmark study published this past December in the Journal of the American Medical Association suggests that millions of American women age 50 and older who have not been tested for osteoporosis (porous bones) may be at an increased risk of suffering serious bone fractures. The National Osteoporosis Risk Assessment (NORA), the nation’s largest such study to date, tested more than 200,000 post-menopausal women over a one-year period and found a high incidence of undetected cases of either osteoporosis or pre-osteoporotic low bone mass.

According to the National Institutes of Health, Asian women are at particularly high risk of developing this disease; however, women of all races, including African Americans and Hispanics, are also at risk. Moreover, research studies recently published in the New England Journal of Medicine (NEJM) indicate that many patients being treated for asthma or prostate cancer—both diseases that disproportionately affect African Americans and other people of color—are also at increased risk for osteoporosis because their medications block calcium intake, which can lead to loss of bone density.

Here’s a look at some resources that are currently available, or are in the clinical trial stage, to help prevent and treat osteoporosis in minority patients:

• Detection: Quidel Corp., a provider of rapid point-of-care diagnostic technologies, offers two tests designed to help health care providers detect and treat low bone mass and osteoporosis in the disease’s early stages. The QUS-2 Calcaneal Ultrasonometer is a battery-operated, lightweight portable device that measures bone mass. It is used as an aid in diagnosing osteoporosis, identifying patients with low bone mass and predicting atraumatic fracture risk.

Metra DPD, a clinical laboratory test, is intended to identify elevated bone resorption that is associated with osteoporosis and other metabolic bone diseases, in both women and men. The U.S. Department of Health and Human Services recently established mandatory national Medicare coverage for Metra DPD for patients who are diagnosed with primary or secondary osteoporosis. This is a major step forward in making early detection of osteoporosis more accessible, because some Medicare carriers had previously refused to reimburse patients for the test. For more information, contact Quidel Corp. at (800) 524-6318 or visit www.quidel.com.

• Treatment: Novartis Pharmaceuticals Corp., maker of the cancer treatment drug zoledronic acid (marketed under the brand name Zometa), is currently testing the medicine’s effectiveness in a new application: treatment of osteoporosis. The results of Phase II clinical trials, published in the February 27 issue of NEJM, indicate that zoledronic acid significantly increases bone density in women with post-menopausal osteoporosis. Zoledronic acid, an intravenous bisphosphonate, was also found to cause less gastrointestinal side effects than traditional oral bisphosphonates.

In addition, says the study’s principal investigator, Dr. Ian Reid of the University of Auckland, New Zealand, “Oral bisphosphonates, although effective in treating osteoporosis, have complicated dosing requirements that can lead to [patient] compliance problems. An effective therapy that offers the convenience of once-yearly intravenous dosing would represent a major advance in osteoporosis treatment.” Novartis is now conducting an extensive Phase III study to determine zoledronic acid’s efficacy in reducing the risk of osteoporotic fractures in both men and women. More information is available from Novartis Corp. at (888) 669-6682 or www.novartis.com.