‘A STUDT TO ASSESS THE IMPACT OF HEALTH EDUCATION ON PREVENTION OF OSTEOPOROSIS AMONG PREMENOPAUSAL WOMEN’-IN DISTRICT HOSPITAL CHITRADURGA –KARNATAKA”
RAJIVGANDHIUNIVERSITY OF HEALTH SCEINCES
PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
Nilaben Hasmuklal Chuhan
VIVEKANANDA COLLEGE OFNURSING
CHITRADURGA, KARNATAKA.
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATEAND ADDRESS
/ Nilaben Hasmuklal Chuhan1ST YEAR, M.Sc. NURSING
VIVEKANANDACOLLEGE OF NURSING,
BASAPPAHOSPITAL, 5TH BLOCK,
B.L. GOWDA LAYOUT, TURUVANUR ROAD,
CHITRADURGA-577501, KARNATAKA.
2. / NAME OF THE INSTITUTION / VIVEKANANDACOLLEGE OF NURSING,
BASAPPAHOSPITAL, 5TH BLOCK,
B.L. GOWDA LAYOUT, TURUVANUR ROAD,
CHITRADURGA-577501, KARNATAKA.
A / COURSE OF STUDY AND SUBJECT / DEGREE OF MASTER OF SCIENCE IN NURSING.
MEDICAL SURGICAL NURSING
4. / DATE OF ADMISSION TO COURSE / 11th Jun 2009
5. / TITLE OF THE TOPIC / A STUDY TO ASSESS THE IMPACT OF HEALTHEDUCATION ON PREVENTION OF OSTEOPOROSIS AMONG PREMENOPAUSAL WOMEN - IN DISTRICTHOSPITAL CHITRADURGA-karnataka”
6.BRIEF RESUME OF INTENED OF WORK :
INTRODUCTION :
Osteoporosis is a progressive systemic skeletal disorder
characterized by low bone mineral density (BMD), deterioration of the
micro architecture of bone tissue, and susceptibility to fracture. A recent
consensus conference defined osteoporosis as "a skeletal disorder
characterized by compromised bone strength predisposing to an increased
risk of fracture."
In 1994 The World Health Organization (WHO) proposed a clinical
definition of osteoporosis based on measurements of BMD. According to the
WHO definition, a patient is osteoporotic based on a BMD measurement
that is 2.5 standard deviations (SDs) below typical peak bone mass of young
healthy white women. This measurement of standard deviation from peak
mass is called the T score.
Assigning the T score permits the early detection of osteoporosis, and thus,
lowers the risk of either hip or spine fractures. However, the use of T scores
at different sites and with different techniques has been controversial
because intersite and intermodality correlation has been poor. The WHO had
not established standards for osteoporosis in men, children, and persons of
ethnic groups.
Types of osteoporosis
Osteoporosis can be subdivided into 3 types: (1) involutional, or primary,
osteoporosis in which no underlying cause can be identified; (2) secondary
osteoporosis in which the underlying cause (eg, steroid use) is known; and
(3) rare forms of the disease, such as juvenile, pregnancy-related, and
postpartum osteoporosis.
Involutional osteoporosis develops from excessive age-related bone loss.
Most consider that this phenotype is an excessive expression of normal age-
related changes in bone.
Risk factors
Age and menopause are the 2 main determinants in osteoporosis. Other risk
factors include a family and/or personal history of fracture, estrogen
deficiency, alcoholism, and a sedentary lifestyle.
Complications and costs
Typically, osteoporotic fractures affect the vertebral body, distal radius, and
proximal femur. Osteoporotic fractures happen as a consequence of minimal
injury. A major complication is a fracture of the femoral neck. About 20-
30% of patients who have a femur neck fracture die in the year following the
fracture. Half of the survivors remain disabled to some degree.
Osteoporosis causes considerable economic and social costs and increased
morbidity and mortality rates as a result of bone fragility and fractures.
Direct financial expenditures for the management of osteoporotic fractures
are estimated to be $10-15 billion annually.
:
Need for the study :-
1. Osteoporosis is often known as “ The silent thief “ because
bone loss occur without symptoms and progressive loss and
thinning of bone tissues happens over many years. This disease
affects millions of people through out the world. Women are four
time more likely than men to develop this disease. The patient themselves
are some times unaware of their health problem like osteoporosis. The aging
process result in some changes which are normal in this age group and they
need to be treated actively. When osteoporosis occurs, the client is at risk for
pathological fracture.Immobilization and non weight Bering activities
increasing the rate of bone resorption. The bone resorption also cause alcium
to be released in the blood and hypercalcemia results.
Through no confirmed statistics are available on the spread of osteoporosis
in India. Unofficial estimation says that more than 50 millions persons are
affected by the disease. This means that Indian problem is more serious than
US,which has only 15millions osteoporosis patients.
Study suggest that a fourth of all women over 60 have experienced spinal
compression fracture, the small vertebral breaks that gradually collapse the
spine in to dowager’shump.
2.Since osteoporosis is more common in post menopausal women.
Menopause occurs approximately at age 51-52 years (range, 42-60 y).
following menopause, levels of circulating estradiol and estrogen
significantly decrease by around 25% and 75%, respectively.
There is controversy regarding the basic mechanisms underlying the
induction of high bone turnover after menopause. Several theories stand out.
Direct action of estradiol on osteoclasts has been shown only for avian
osteoclasts, but this mechanism remains a clear favorite. Bone resorption is
the unique function of the osteoclasts. In the avian model, estradiol decreases
the development and activity of osteoclasts and increases the activity of
osteoblasts directly. Estrogen deficiency induces increased generation and
activity of osteoclasts, which perforate bone trabeculae, reducing their
strength and increasing fracture risk. The life span of functional osteoclasts
and thus the amount of bone that osteoclasts resorbed may also be enhanced
following estrogen deficiency.
Estrogen may affect osteoclast function by promoting apoptosis. It has been
shown that 17beta-estradiol promotes apoptosis of murine osteoclasts in
vitro and in vivo by 2-3 times. This suggests that estrogen may prevent
excessive bone loss before and after the menopause by limiting the life span
of osteoclasts.
Recently, estrogen has also been shown to regulate secretion of
osteoprotegerin, an inhibitor of osteoclast differentiation.
Most of the estriol present in the circulation after menopause represents the
extraendocrine conversion of androgen precursors in muscle and adipose
tissue to estriol. This conversion in adipose tissue may explain why obese
patients are relatively protected against osteoporosis and fractures compared
with asthenic individuals.
Women undergoing early menopause or oophorectomy have accelerated
bone loss and a higher incidence of fractures. Amenorrhea also predisposes
women to osteoporosis. Those experiencing early menopause usually have
prolonged periods of oligomenorrhea, a trait that has a strong genetic
predisposition. Thus, these patients have repeat periods of increased bone
loss and low bone mass.
Early and late estrogen deficiency probably affects bone mass by means of
different mechanisms. Early estrogen deficiency, ie, that occurring before
age 25 years when patients attain peak bone mass, probably affects bone
maturation and formation during bone modeling. This leads to a thinner and
a more slender skeleton. Early estrogen deficiency occurs in Turner
syndrome, hyperprolactinemic amenorrhea, and amenorrhea among athletes.
By contrast, normal menopause and late estrogen deficiency (eg, that
following oophorectomy) induces a state of accelerated bone loss from
increased osteon activation frequency. Recent work has also demonstrated
increased cellular sensitivity to parathormone (PTH) in patients with
osteoporosis.
According to India’s Nationals News paper 20th Oct 2004 Over 30
millions case of osteoporosis in India.The condition remains largely under
diagnosis. This is because most doctors attribute to old age fracture in those
over 50, according to osteoporosis society in India. Many people do not
realize that osteoporosis is major problem that increases a person’s risk of
life, and can result in loss of productivity and mobility.
.4 TNational largest study of osteoporosis , National Osteoporosis Risk
Assessment[NORA ]found that almost half of the more than 200 000
postmenopausal women assess in the study had low bone mass, putting them
at risk of a breaking a bone seven percent of women in study were found to
have osteoporosis, in addition nearly 40 percent of women were found to
have low bone mass but were not osteoporosis.During the one year follow
up period, the rate of bone fracture was four time higher of women with
osteoporosis and twice as high for women with low bone mass compared to
women with normal bone density.
S Teotia SP, Teotia M.
SriSathyaSaiGeneralHospital & Institute of Higher
Medical Sciences, Bangalore, India.
Syndromes of bone disease and deformities consequent to disorders of
nutrition, bone and mineral metabolism constitute a serious national health
problem. The studies on this subject are scanty. Data on nutritional bone
disease are described and discussed. We had surveyed 337.68 million
population residing in 0.39 million villages in 22 States of India
during the period 1963 to 2005. Of the 4,11,744patients identified with the
disorders of bone and mineral metabolism, 2,13,760 (52%) had nutritional
bone disease, 1,77,200 (43%) had endemic skeletalfluorosis and 20,784
(5%) had metabolic bone disease and in 41 patients (0.19%) the bone disease
was rare, mixed or unidentified. Vitamin D deficiency osteomalacia and
rickets caused by inadequate exposure to sunlight (290-315 nm), dietary
calciumdeficiency (<300 mg/day) and fluoride interaction syndromes,
calcium deficiency induced osteoporosis and calcium and vitamin D
deficiency induced osteoporosis in the elderly, were the commonest
disorders responsible for bone disease and deformities, besides caused by
endemic skeletal fluorosis as a single entity in endemic fluorosis villages.
Calcium deficiency per se dose not cause rickets, as revealed in
our long-term follow up study on 47,500 calcium deficient children. Only
mothers with severely depleted bone mineral and vitamin D stores gave birth
to their babies with congenital rickets. Vitamin D deficiency rickets in
children and osteomalacia in the mothers are the commonest disorders
prevalent in the rural population of India. These disorders and the
syndromes of calcium deficiency and fluoride interactions are largely
responsible for the morbidity and mortality in the young and promising
individuals,with economic consequences.
PMID: 18497435 [PubMed - indexed for MEDLINE]
Investigator found that osteoporosis is major problem in ageing people
specially for postmenopausal women .The problem can be enhance by
giving health education on preventive aspect of osteoporosis .so investigator
select perimenopausal group and give health education to achieve healthy
aging.
6.3 REVIEW OF LITERATURE:
Abdella and Livine stated that review of literature provides a basis for further investigation, justify the need for replication, practicability and feasibility of the study, indicates constraints of data collection and help to relate the finding from one study to another.
Physical activity is essential for bone remodeling. The skeleton needs
continuous physical stimulation to maintain healthy bones, otherwise bone
loss ensues. Osteoblast activity is sensitive to mechanical stresses.
Experiments of repetitive physical stress on bone have shown profound
increases in bone formation in stressed bone. Significant bone loss occurs
from immobilization or during space flight. Studies have shown that
physically active women have a higher bone mineral content than women
who are less active. Antigravity exercises, such as dancing or running, seem
to be more effective than swimming in maintaining BMD. In vertebrae, the
preferential loss of horizontal trabeculae leads to compensatory thickening
of vertical trabeculae. The correction of tooth alignment exploits physical
stress to create changes in bone remodeling in the jaw.
The steady decrease in general physical activity in the population is probably
one of the factors responsible for the increasing prevalence of osteoporosis
over the last 10 years. Several studies in perimenopausal women have shown
increases in bone mass between 5-7% over a 3-year period following the
institution of an exercise regimen compared with sedentary controls.
Therefore, a reasonable amount of physical activity throughout life may
protect individuals against bone loss.
It is unlikely that physical activity alone can offset the 30-40% loss of bone
occurring after menopause. In fact, a meta-analysis of all controlled clinical
trials showed no significant effects of physical activity on bone mass.
Further, long-term clinical trials have shown no fracture protection from
exercise. To the contrary, one study showed an increased fracture risk in a
population of older women who walked for exercise.
Prolonged heavy exercise may have deleterious effects on bone mass.
Extremely high levels of physical activity in young women may produce
hypothalamic amenorrhea and hence estrogen deficiency.
Exercise as a treatment (postmenopausal studies)[According to NORA]
Weight bearing exercise like jogging walking, dancing can help to prevent osteoporosis.
DHARWAD : Orthopedic surgen and sport medicine specialist Kiran
Kulkarni has said that osteoporosis or porus bone was becoming the leading
cause of physical disability in adults, especially the aged person .
DR.Kulkarni said that lack of regular exercise, eating junk food , low
calcium diet, excessive alcohol conception , morden working environment
were the risk factors for osteoporosis.
BY Roberto A Miki: Hip fracture occurs most often from fallow or
structurally compromised bone secondary to osteoporosis. Hip, wrist and
vertebral fracture in the elderly from low energy mechanism are often
termed fragility A.. The ignition of antiresorptive pharmacological theraphy
for osteoporosis arter a fragility fracture has been shown to significantly
decrease risk of subsequent fracture.
In onr resent study, mortality after a hip fracture was decrease with the I/V
administration of bisphosphonate studies that investigated the treatment of
osteoporosis following hip fracture found that osteoporosis treatment rates
ranged from 5% to30%.
.
.
Miura S, Nakamori M, Yagi M, Saavedra OL, Ikemoto S, Yamamoto S.
International Nutrition, GraduateSchool of Humanities and Sciences,
OchanomizuUniversity, Ochanomizu , Japan. Low calcium intake
and physical inactivity are modifiable risk factors of osteoporosis;
The present study, therefore, investigated daily calcium intake, main
calcium sources, and physical activity status in this population. The
study group comprised healthy women aged in their 30 s who had
participated in our previous survey using heel speed of sound (SOS)
measurement in Davao,Philippines. The women were stratified into three
groups based on SOS score and 20 were randomly selected from each, giving
60 in total. Calcium intake was measured by direct analysis of the food
samples collected from 3-days 24 hour-food duplicate method. Physical
activity was estimated based on edometer determined walking steps over 5
days. The median [25%, 75%]
calcium intake per day was 289 [225, 434] mg. Traditional foods derived
from local small fish and plants were the main calcium sources. The median
walking steps per day was 8750 [6920, 10836]. Although three groups did
not show significantly different calcium intakes and walking steps,
consumption of low-cost small fish and plant foods could be encouraged
along with walking in urban Filipino women living on low-incomes.
Remedies for osteoporosis:
Simple tips to tackle osteoporosis:
If osteoporosis has been diagnosed in the early stage one can fallow a simple
routine to regain health naturally.
Exercise to built strong bones: exercise for at least thirty minutes
comprising
of weight –bearing exercise such as walking or jogging, three times a week.
This regim has been proven to increase bone mineral density, and reduce the
risk of falls by strengthening the major muscle groups in the legs and back.
Water walking: is another suggested exercise to combat osteoporosis.
Walking in chest deep water for about 30 minutes atleast three times a week
is a suggested remedy as water helps supports the body weight and take
stress off bones and joints.
Sesame seeds : A handful of sesame seeds had every morning may also help
osteoporosis.
Almond Milk : Another home remedy for osteoporosis is a calcium rich
almond milk. One can have the Almond milk by soaking the almonds in
warm water , peeling it and blending it with either cow milk, goat milk or
soya milk.
:
Some diet tips to keep osteoporosis at bay:
One needs to brings a few changes to life style factors and diet to overcome
the effect of osteoporosis.
Here are some diet tips one can adhere to and keep osteoporosis bay:
It recommended that one should include 1500 mg of calcium daily either via
dietary means or via supplementation. For measurement purposes , it is
important to note that an 8 oz glasses of milk contains approximately 300
mg of calcium. Calcium supplements are an effective alternative option.
These comes in a variety of forms . The body can absorb only about 500mg
of calcium at one time and so intake should be spread throughout the day.
Bones need nourishment from calcium ,vitamin D , and phosphorous. A
poor diet lacking this essential vitamins and minerals contributes to
osteoporosis. Food rich in calcium especially necessary to maintain healthy
bones. Dairy products (milk, cheese, and yogurt) salmon ,sardines, almonds,
dark green leafy vegetables and broccoli are good sources of calcium.
.6.4 STATEMENTS OF THE PROBLEM;
“A study to assess the impact of health education on prevention of
osteoporosis among perimenopausal women – in district hospital
chitradurga-KANATAKA”
6.5 objectives of the study :
6.5.1To identify the level of knowledge of women about osteoporosis.
6.5.2To enhance knowledge on prevention of osteoporosis in
perimenopausal women through health education.
.
6.5.3To identify the association between knowledge and prevention of
osteoporosis among perimenopausal women.
6.6 operational definitions:
6.6.1 Osteoporosis : Loss of bone mass that occurs through out the
skeleton, predisposing patient to fracture. Healthy bone constantly
remodels it self by taking up structural elements from one area and
patchin others. In osteoporosis more bone is resorben than laid
down, and the skeleton from its intact trabeculation. Aging cause bone
loss in both man and women, predisposing them to vertebral and