Osteoporosis: Diagnosis and Managements _ _____________________________________________________
The good news is that osteoporosis can be detected before significant symptoms occur. A complete history and physical examination, followed by BMD testing, such as DXA or other modality, can identify the majority of patients with osteoporosis. For patients who are diagnosed with osteoporosis or who are determined to be at risk, a plan of diet supplementation and frequent weight-bearing exercises may significantly improve bone structure. Numerous medications useful in the treatment of the condition exist, including the bisphosphonates, SERMs, and recombinant PTH. In addition, several new therapies are on the horizon. Estrogen replacement, which had in the past been recommended fairly universally to postmenopausal women, is now reserved for use in only very limited circumstances, based on studies that have demonstrated increases in certain cancers, stroke, and coronary artery disease [13; 76]. Prevention is critical, and patients should learn about diet, exercise, and medication use. Finally, physicians and other providers should develop a greater understanding of osteoporosis and be more aggressive in addressing this topic. It is a disease that is increasing in prevalence and has significant morbidity, but also may often be treated with some success. Preventive measures should be discussed with patients earlier in life and not delayed until a patient is elderly.
DIAGNOSING AND TREATING OSTEOPOROSIS PATIENTS WITH THE ASSISTANCE OF AN INTERPRETER
As a result of the evolving racial and immigration demographics in the United States, interaction with patients for whom English is not a native language is inevitable. Because patient education is such a vital aspect of the treatment and management of osteoporosis, it is each practitioner’s responsibility to ensure that information and instructions are explained in such a way that allows for patient understanding. When there is an obvious disconnect in the communication process between the practitioner and patient due to the patient’s lack of proficiency in the English language, an interpreter is required. (In many cases, the terms “interpreting” and “translating” are used interchangeably, but interpreting is specifically associated with oral communication while translating refers to written text.) While this may be easier said than done, due to institutional and/or patient barriers, the U.S. Department of Health and Human Services Office for Civil Rights has stated that denying adequate interpreter services to patients with limited English proficiency is a form of discrimination and that insufficient use of professional interpreters and inappropriate reliance on ad hoc interpreters may compromise patient care [138]. In this multicultural landscape, interpreters are a valuable resource to help bridge the communication and cultural gap between clients/patients and practitioners. Interpreters are more than passive agents who translate and transmit information back and forth from party to party. When they are enlisted and treated as part of the interdisciplinary clinical team, they serve as cultural brokers, who ultimately enhance the clinical encounter. In any case in which information regarding diagnostic procedures, treatment options, and medication/treatment measures are being provided, the use of an interpreter should be considered. CONCLUSION Osteoporosis is a significant health problem. Along with osteopenia, it affects a very large portion of the population. Unfortunately, it is often a silent disease, because patients typically do not present with signs and symptoms until they actually experience an untoward event, such as a fracture. Clinicians and patients should understand the factors that heighten the risk for developing osteoporosis, including advanced age, certain ethnicities, family history, and female gender. Particular attention should be directed to modifiable risk factors, such as tobacco use, physical inactivity, nutritional deficiencies, and medication usage.
RESOURCES
American Bone Health https://americanbonehealth.org
International Osteoporosis Foundation https://www.osteoporosis.foundation Bone Health and Osteoporosis Foundation https://www.bonehealthandosteoporosis.org Osteoporosis Canada https://osteoporosis.ca The NIH Osteoporosis and Related Bone Diseases National Resource Center https://www.niams.nih.gov/health-topics/ bone-health-and-osteoporosis
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