“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.”