Osteoporosis and osteopenia management in women: survey, case-referent study, and interventional exercise trial
Three studies are presented; the first epidemiological study was a survey of Baton Rouge/New Orleans physicians who manage osteoporosis. When the respondents’ answers were compared to selected guidelines, they displayed poor knowledge regarding osteoporosis prevention, diagnosis, and treatment (X2=39.88; P<0.0001). Rheumatologists and endocrinologists scored globally better on osteoporosis management when compared to ObGyn (OR= 6.98) (CI=2.4; 22.8). Physicians with more years of experience were more knowledgeable of osteoporosis care (OR=1.04) (CI=1.014; 1.071). The second epidemiological study was a case referent study looking at osteoporosis treatment and patient adherence of selected women in Baton Rouge. Results showed that osteoporosis management depended partly on patient adherence. Barriers to patient’s adherence varied from physiological to psychological reasons. Physicians need to provide more explanation and motivation to the patients. Spine was the area most affected and showed more improvement with treatment than the femur (P<0.01). Bisphosphonates were the most effective treatment for the spine (P<0.05). In patients with osteoporosis, being on just calcium and exercise is not enough to counteract bone resorption. They also need to be on an anti-resorptive therapy. Low body mass index, genetics, and history of fractures were negatively correlated to bone mineral density (BMD) increase (P<0.05). The third interventional pilot study was a non-randomized controlled study done on osteopenic postmenopausal women to examine the effect of calcium supplements and core/lower back strengthening exercises on lumbar density and muscle strength. Repeated measures analysis showed that both groups increased in isometric lumbar strength with time (P=0.02). When fosamax and exercise were taken as treatments, with baseline BMD as a covariable, the one-tailed P value of the two-way ANOVA showed a numerically positive but not significant increase in the exercise group (yearly change=2.373 ± 2.625; T value=0.9; P=0.21). Also, the exercise group showed increased feelings of well-being as opposed to the control group who showed no change or worsening. One woman in the control group fractured a bone. Ultimately, osteoporosis management relies on physicians’ knowledge, involvement, and patient adherence. Calcium, exercise and anti-resorptive treatments are needed in case of osteoporosis. Calcium supplements and site-specific strengthening exercises may be enough in case of osteopenia.
osteoporosis treatment, osteopenia, post-menopausal women, epidemiological study, physicians' survey, case-referent study, patient adherence, lower back and core strengthening exercises, osteoporosis management, bisphosphonate, lumbar mineral density, muscle strength
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