Research progress on nursing intervention for primary osteoporosis

GUO Shanping,DUAN Gongxiang

(School of Nursing University of South China,Hengyang,Hunan,421000)

ABSTRACT: Osteoporosis is a common disease that frequently affects middle-aged and old people,and fracture caused by osteoporosis is the main cause of disability and death of those people. There is no effective way to cure osteoporosis so far,and healthy intervention is the most effective and economical means of prevention and treatment of osteoporosis. This article expounds the current status of interventions at home and abroad from the aspects of diet,lifestyle,exercise,pain care,fall prevention and psychological care for the management of osteoporosis to help medical workers to actively deal with new problems in the aging population.

KEY WORDS: osteoporosis; fracture; intervention; review

Introduction

Osteoporosis is a systemic metabolic skeletal disease characterized by low bone mineral density (BMD) and deterioration of bone microstructures resulting in reduced bone strength and,consequently,an increased susceptibility to fractures[1],also the risk increases with age. With the prolongation of human life and the arrival of an aging society,Osteoporosis has become one of the most common chronic diseases after diabetes and hypertension. According to the International Osteoporosis Foundation (IOF),about one third of women and one fifth of men over 50 will suffer from osteoporotic fractures in their lifetime[2]. Fractures can lead to a decrease in quality of life[3],an increase in premature mortality[4],disability and financial burden. According to statistics,the average hospitalization cost of osteoporotic fractures in China is 27561.27 Chinese Yuan (CNY)[5].In a survey based on the "small census" of 2015 to predict and analyze the changing trend of population size and structure in China from 2015 to 2100,it was found that in the first half of the 21st century,the population size of the elderly aged 60 years and over will climb to the peak of the whole century in about 253,reaching about 482 million people[6]. There is no effective way to cure osteoporosis so far,so healthy intervention is the most effective and economical means of prevention and treatment of osteoporosis. Therefore,this study reviews interventions at home and abroad in order to provide reference for the majority of medical workers.

Diet and lifestyle intervention

Malnutrition is very common in the elderly,especially in the middle and old age groups. So,a balanced diet with multiple nutrients assumption is of great importance to keep a healthy bone system. A study of elder people in American showed that higher intakes of milk and other dairy products can reduce the incidence of hip fractures[7]. Adequate calcium intake is beneficial for achieving ideal bone peak,reducing bone loss,improving bone mineralization and maintaining bone health. Moreover,adequate vitamin D can increase intestinal calcium absorption,promote bone mineralization,maintain muscle strength,improve balance ability and reduce the risk of falling[8]. A systematic review suggested that moderate vitamin K2 supplementation played a role in improving vertebral bone mineral density and reducing postmenopausal osteoporotic fracture in women,and vitamin K2 supplementation was also recommended in our country's guidelines[8-9].A Chinese researcher found that intestinal flora imbalance is a key factor in the occurrence of postmenopausal osteoporosis,so reducing the incidence of inflammatory bowel disease and maintaining intestinal health,such as diet,probiotics intake,can reduce the incidence of osteoporosis[10]. Chinese tea culture,which has a long history and contains many elements of Chinese civilization,is an important representative of the Chinese traditional culture. Tea contains a variety of vitamins and amino acids,which can promote the formation of new bone and inhibit bone resorption,protect the motor system,prevent and delay the occurrence and development of osteoporosis. A recent survey based on the middle-aged and elderly population in China suggests that long-term moderate tea intake can reduce the incidence of osteoporosis in women,but the role in men is not obvious,this maybe because the main status of smoking in Chinese male population is more severe than that of in female,which may counteract any potential protective effect of tea consumption on bone health[11]. In terms of alcohol intake,studies have shown that among men aged 30-59,14+gl/weekly (1 gl=118.29 ml)intake of alcohol has a higher risk of hip fracture than moderate intake,but not in men over 60 years old. Compared with women,non-drinkers have a higher incidence of hip fracture than moderate drinkers[12],so maybe,a little alcohol intake should be advocated in Chinese middle-aged and elderly women.

Exercise intervention

Physical exercise can not only increase bone mass but also improve bone mechanical properties[13]. Many studies have incorporated physical exercise into the prevention and treatment system of osteoporosis and achieved good results. The main forms of exercises are resistance exercises (vibration training,impact training); balance training; leisure exercises (dancing,Taijiquan,yoga,etc.); walking (fast walking,jogging,climbing,etc.),etc.

Resistance exercises

Whole body vibration training is a new and systematic training method,which stimulates neuromuscular reflex by controlling the frequency and amplitude of mechanical vibration,and repetitively stimulates skeletal stress to achieve resistance effect,thereby improving the nerve-muscle-skeletal system of the body. A study compared the effects of high,medium and low frequency vibration training on menopausal women,and confirmed that long-term high and medium frequency training can significantly increase the bone mineral density of lower limbs[14]. Ba et al.[15]also confirmed that high frequency whole body vibration training could improve proximal femoral BMD in women. A survey of pressure training combined with vibration training can indirectly stimulate the growth of bone tissue in aged 55-75 males,and there was a long maintenance period after stopping training[16]. Wang[17]compared vibration training with traditional training in the population aged 60-75,and concluded that the effect of vibration training on bone mineral density growth was better than that of traditional strength training. But whether vibration training can strictly improve bone mineral density remains controversial. A meta-analysis also showed that whole body vibration training could not improve BMD,but could alleviate pain[18]. Therefore,the actual effect of vibration training needs to be confirmed by further research.

Balance training

The decline of the musculoskeletal system in the elderly will cause muscle atrophy,which will lead to muscle strength weakness,as well as exercise and balance ability and consequently,falls and fractures are prone to occur[19]. Therefore,effective balance training is also one of the effective measures to prevent osteoporotic fractures and falls[20]. Ibolya et al.[21]conducted a 12-month comprehensive balance training for osteoporotic women,confirming that the exercise significantly improved postural balance and aerobic capacity.

Leisure exercises

Leisure exercises such as square dancing,as one of the leisure programs for elderly women,have been very popular in recent years. Liu et al.[22]have proved its clinical validity,and thought that the effect of square dancing combined with supplementary of calcium will be better. Oksuz et al.[23]conducted a six-week Pilates exercise for women aged 50-75 in Turkey,found that this exercise could relieve pain and improve the quality of life,suggesting that Pilates be included in the exercise training for women with osteoporosis. As one of the quintessential leisure exercises in China,Wuqinxi exercise has attracted much attention. Studies have shown that although Wuqinxi exercise does not significantly improve BMD,it can significantly improve the balance ability of elderly women,thereby reducing the occurrence of falls[24]. Sun et al.[25]compared Taijiquan with fast walking exercise in elderly women,and found that although both improved BMD,the effect of fast walking could last longer. A recent study showed that 24-week Yijinjing exercise and Baduanjin exercise had better effects on increasing lumbar vertebral BMD in elderly women than in Five-bird Exercise,but the effects of three Qigong exercises on proximal femoral BMD were not significant[26]. Leisure exercises can achieve physical and mental balance with its soothing rhythm and gentle movements,so it is suitable for extensive development among the elderly.

Pain care intervention

Pain is the most common and main symptoms of osteoporosis which can affect the quality of sleep of patients,lead to various emotional problems,and further reduce the quality of life. Therefore,comprehensive intervention programs such as pain management combined with pulsed magnetic field treatment can effectively relieve pain and Anxiety and depression,enhance happiness[27]. Physical factors such as ultrashort-wave,microwave,transcutaneous electrical nerve stimulation,and intermediate frequency pulse therapy can not only relieve pain,but also promote the healing of osteoporotic fractures[28-29]. Before implementation of physical therapy,it is required to select the appropriate treatment dose and method under the guidance of a professional therapist.

Fall prevention intervention

Fall is an independent risk factor for osteoporotic fractures[30]. Studies have shown that the incidence of fractures in elderly people who underwent fall is about 5% -10%,and 90% who have fractures are due to falls[31],A multi-factor fall risk assessment and management project is the most effective strategy for preventing falls in the elderly in the community,which can reduce the incidence of falls by 18%[32]. Studies found that multi-level fall interventions are more effective than single interventions,which include health and fall risk,vision,home environment assessment,and health education,diet and exercise guidance for risk factors. Among them,exercise intervention plays an important role in reducing the incidence of falls,including muscle training,balance training and endurance training,while the duration should not be less than 12 weeks,and a combination of multiple sports will be better; and carrying out risk assessments of the home environment aims to propose targeted improvement measures. By strengthening safety awareness,their balance and coordination functions are improved,incidence and fear of falls therefore are reduced[33-35]. In western developed countries,active interventions have been made to prevent falls of the elderly,which has been of great significance to the reduced occurrence of falls. To be the same in China,the State issued the Technical Guidelines for the Intervention of the Falls in the Elderly in 2011,which summarizes the evidence and experience of prevention and control of elderly falls from the perspective of public health,proposes intervention measures and methods to provide technical support to the staff and departments engaged in this field,thus effectively reduce the incidence of falls in elderly people[36].

Psychological intervention

Depression can lead to a variety of physical diseases,and studies have shown that there is a correlation between bone loss and depressive symptoms[37]. The level of anxiety is closely related to the reduction of BMD,which increases the risk of fracture[38]. Therefore,the short-term treatment of depression in elderly patients with osteoporosis will also provide a new direction for clinical intervention[39]. A study based on health belief model pointed out that three months of osteoporosis prevention health education combined with rehabilitation exercise could significantly reduce anxiety and depression scores and enhance health belief[40]. The results were the same as those of focus nursing model used by Ren et al.[41]. In recent years,there are some studies on psychological intervention in elderly patients with osteoporosis,but still not enough,so paying attention to the mental health of osteoporosis patients would be the direction of further research.

Prospects

With the arrival of aging population and in response to the call “Preventive Treatment of Disease” of the National Health Care Commission,prevention of osteoporosis should also be urgently put on the agenda. Despite various interventions,there is still a lack of systematic and individualized intervention system and management,which would be an important key point for further study.