As a nurse practitioner working in orthopedic surgery, I’ve noticed a disturbing trend: Many people I see who have fractures and are over the age of 50 have not been evaluated or treated for osteoporosis, and most aren’t on a regimen to prevent it. I decided to look further into the matter by conducting a literature review so I could be a better advocate for these patients.

About osteoporosis

I read about the increased concerns with the health of the aging population, especially with Baby Boomers who are advancing in age. Among those health concerns is osteoporosis, a skeletal disease that’s most commonly seen in older people and in postmenopausal women. It causes a decrease in the density of the outside layer and inside contents of bones, triggering aging bones to become more fragile, increasing the risk for fractures. Osteoporosis is a major threat to the aging population, so early detection is crucial.

Lack of awareness

The United States has multiple services and public health programs to help prevent, screen, and treat osteoporosis. For example, the United States Preventive Services Task Force recommends osteoporosis screening every 2 years for women of 65 and for individuals at high risk. Medicare beneficiaries don’t have to pay for osteoporosis screening, and the Affordable Care Act eliminated the cost of screening for eligible individuals with private insurance. Yet, I learned from my literature review that most people who are eligible for screening don’t obtain it. I also learned that a main cause for the numbers of patients with osteoporosis is suboptimal diagnosis and treatment, despite advances in technology and treatments. 

The consequences of these screening, prevention, diagnosis, and treatment issues are millions of possibly fractures a year. These fractures frequently lead to people never regaining their normal function, being permanent residents at nursing homes, and even death from complications. Furthermore, fractures place a major burden on individuals over the age of 50, their families, primary care providers, hospitals, operating rooms, and nursing homes.

Why is this happening? Osteoporosis isn’t a new disease; all medical providers likely have had some sort of education about it. I found that there are multiple factors, including the following:

• Many individuals over the age of 50 tend to view osteoporosis as a natural occurrence of aging. They think fractures related to osteoporosis are a part of life, and nothing can be done to avoid them.
• Some people don’t understand the results when they are tested and are unclear as to what osteoporosis is.
• The side effects of certain osteoporosis medications have had negative public exposure, leading some people too fearful of the side effects to take.
• Some physicians are uncertain as to whether the benefits of osteoporosis medications outweigh the risks.

What nurses can do

Nurses can play a role in increasing awareness of osteoporosis. For example, nurse leaders can implement an awareness program using Patricia Spath’s five key factors to implement change: expectations, feedback, physical environment, motivation, and required skills.

• Expectations is easy, we just let everyone know what they should be doing —promoting osteoporosis evaluations to all patients over 50 years of age.
• For feedback, simply let others know how they are doing; praise them when you see them promoting osteoporosis awareness and educate others on missed opportunities.
• Physical environment is the work area for nurses, such as physician office or hospital. Maintaining a positive environment fosters the ability of nurses to advocate for patients.
• Motivation is where we use data and statistics to explain the benefits of osteoporosis screening and treatment to patients and staff.
• We need to ensure that everyone who talks to patients about osteoporosis have the required skills and knowledge to correctly present the facts.

We also can improve our ability to implement change by applying techniques from leadership literature outside of healthcare, such as Leadership Is Language by L. David Marquet and Business Made by Donald Miller.

Using ideas from Marquet’s book will build bonds with our team and result in a larger diversity of thinking to enhance quality improvement. A main concept of the book is the importance of decreasing the power gradient between the leader and follower. Reducing the gradient allows the follower to feel more comfortable to intervene in the leader’s plan by, for example, sharing thoughts that the leader may not have considered. Team members who feel they’re a meaningful part of the team usually feel more committed to their work, rather than simply being compliant to their assigned task.

Implementing ideas from Miller’s book, which focuses on advertising a new product, can lead to better strategies for advertising osteoporosis awareness and building relationships with other healthcare organizations.

Act now

By improving awareness of osteoporosis screening, diagnosis, and treatment, we can reduce osteoporotic fractures and help patients, their families, and the healthcare system. Spath, Marquet, and Miller all provide strategies we can use to bolster the success of our efforts.  It’s our duty as nurses to improve our knowledge and be advocates for patients to improve their health. May is National Osteoporosis Awareness month, but let’s be advocates year round.

Mark Roark is a nurse practitioner at CHI St. Joseph London Orthopedics in London, Kentucky, and a DNP student at Eastern Kentucky University in Richmond, Kentucky.