Osteoporosis is a serious health problem worldwide and most commonly affects postmenopausal women (World Health Organization, 1994). Of the variety of complications associated with osteoporosis in postmenopausal women, osteoporotic fracture is the most prevalent and serious one. It affects their quality of life and puts heavy burden on the healthcare system in Hong Kong. Since osteoporosis exercise program can help to reduce bone loss, it seems to be an effective strategy to prevent and manage osteoporosis in postmenopausal women. The purpose of this study is to develop an evidence-based osteoporosis exercise education program for postmenopausal women, based on the best available evidence, with an aim of helping them to prevent and manage osteoporosis through the prevention and reduction of bone loss and its related fractures. A search of literature from four databases, including Pubmed (1997 to August 2011), CINAHL Plus (1937 to August 2011), Cochrane Library (1996 to Issue 8 of 2011) and EMBASE Classic + EMBASE (1947 to August 2011), was done to identify relevant randomized controlled trials (RCTs). The methodology checklist for RCTs developed by the Scottish Intercollegiate Guidelines Network (SIGN, 2008) was used to evaluate the quality of the selected studies. A total of nine studies met the inclusion criteria and did not violate the exclusion criteria. The findings of these studies showed that exercise intervention or program significantly reduced postmenopausal women’s likelihood of having fracture and also improved their bone mass density slightly. Among the reviewed studies, programs were most commonly implemented within a 12-month period and two 60-minute supervised exercise sessions were delivered per week. The potential of implementing the proposed program, based on the evidence from the literature review, to local practice was assessed. Based on the assessment, the proposed program is necessary and beneficial for postmenopausal women. An evidence-based osteoporosis exercise education program is developed based on the best available evidence. The SIGN grading system was utilized to provide grades for the recommendations in the guideline. An effective and adequate communication with potential stakeholders to gain their support and cooperation for the proposed program is essential. In addition, a tailor-made pilot test is also crucial for ensuring the successful implementation of the proposed program. The pilot study will be conducted in a local practice and the targeted participants are 124 postmenopausal women. Data analysis will be done by the paired t-test. The proposed evidence-based osteoporosis exercise education program will be considered as effective if (1) there is a reduction of bone loss and an increase in physical activity level in postmenopausal women, and (2) there is an increase of confidence and self-perceived skill on the prevention of management of osteoporosis in nurses. / published_or_final_version / Nursing Studies / Master / Master of Nursing

The primary purpose of this research study was to cross-validate the risk factors in the Osteoporosis Risk Assessment by Composite Linear Estimate [ORACLE] as a screening tool in a population of healthy U.S. women at various menopausal stages. The secondary purpose of this study was to evaluate the potential use of physical activity history and relevant osteoporosis risk factors to effectively determine current bone status for a mixed menopausal population. Third, the purpose of this study was to compare Omnisense quantitative ultrasound [QUS] and dual-energy x-ray absorptiometry [DXA] diagnostic values of osteopenia/osteoporosis based upon T- and Z-scores. Methods: Fifty-six female subjects (46.1 ± 6.3 years) in pre-, peri-, and post-menopausal stages who volunteered to participate in this study. Subjects completed an osteoporosis risk factor and physical activity history questionnaire. Subjects underwent laboratory testing comprised of distal radius quantitative ultrasound scan, dual hip and spine DXA scans, and a one week physical activity assessment. Results: Logistic regression analysis was utilized to examine the ability of the ORACLE to predict low BMD at the femoral neck and lumbar spine. There were no significant relationships between the group of ORACLE variables and BMD status at either the femoral neck or lumbar spine. In addition, none of the individual variables (age, BMI, use of HRT therapy, previous fracture, speed of sound [SOS]) were found to be significant predictors of low BMD at the femoral neck or lumbar spine. Notably, SOS measures from the Omnisense QUS were not found to have a strong positive predictive ability, with sensitivity values between 0-20% and specificity values between 81-86% at the femoral neck and lumbar spine. When the cohort was divided into normal and overweight/obese groups, sensitivity and specificity of QUS measures was not improved in the normal BMI group compared to the overweight/obese group. The use of physical activity variables to predict low BMD revealed some relationships trending toward significance, supporting previous research. Linear regression analyses revealed that the individual accelerometry variable of moderate-vigorous non-bout activity counts at the lumbar spine approached significance as a predictor of low BMD (p = 0.081). A significant correlation (r = 0.31, p < 0.05) between steps/day and subjective measures of current weight-bearing activity support the validity of the physical activity recall method for current physical activity. Conclusions: This study found that the ORACLE risk factors were not a valid osteoporosis screening tool in a mixed menopausal population of U.S. women. Secondarily, subjective and objective physical activity measures were non-significant predictors of current low BMD, but greater levels of moderate to vigorous non-bout activity counts trend towards being a significant predictor of higher BMD at the lumbar spine. Finally, results showed that Omnisense QUS measures were not found to be significantly related to DXA measures. Key Words: bone mineral density, dual-energy x-ray absorptiometry, osteoporosis, physical activity, quantitative ultrasound. / School of Physical Education, Sport, and Exercise Science

Thesis (M.S.)--University of Michigan, 1987.

Thesis (M.S.)--University of Michigan, 1987.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1971. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

The literature is replete with reports of osteoporosis in rheumatoid arthritis, but the mechanism of bone loss remains obscure. This is probably due to the overlap with bone loss of aging and the menopause, whose exact mechanisms are also poorly understood. Against this background, a study was designed to evaluate generalised bone loss in young, premenopausal (if female), patients with rheumatoid arthritis. The protocol was designed to record demographic data, as well as information pertaining to the disease. Cortical bone mass was measured at the metacarpals and left femur, using an automated, computer-controlled technique. Trabecular bone was evaluated at the left femur (Singh index) as well as at the 3rd lumbar vertebra (Saville index). Bone kinetics were studied by the measurement of urinary excretion of calcium, phosphate and hydroxy-praline (resorption) and serum alkaline phosphatase (formation). Disease activity was measured clinically and with laboratory indices. Physical activity was indirectly measured by quantitating the disability, using the Keitel function test as well as a modified health assessment questionnaire (HAQ). The radiograph of the right wrist was scored by the Larsen index. The carpometacarpal ratio was also calculated from the radiograph. Numerous statistical techniques were applied in the analysis of the data. Healthy volunteers were used as controls. Patients with SLE were also studied, in order to compare the 2 inflammatory diseases. Patients with RA had generalised cortical bone loss (metacarpal and femur) (p &lt; 0.001). Trabecular bone measurements were not significantly different from normals, using the crude radiographic techniques. Duration of disease was the most important clinical determinant of this bone loss. The relative contributions of disease activity and lack of physical activity to the loss of bone could not be adequately separated using conventional statistical techniques. Corticosteroid therapy did not promote metacarpal bone loss in these subjects, but may have contributed to thinning of the femoral cortex. Nonsteroidal anti-inflammatory drugs and disease modifying agents did not seem to influence the extent of the bone loss. Nutritional status and skinfold thickness did not correlate with bone mass. Dietary factors played no role in the genesis of bone loss, but may have had some effect on disease activity. Metacarpal measurements showed a sensitivity of 80% and specificity of 85% in discriminating between osteopaenic and normopaenic groups with RA. Osteopaenia could not be adequately predicted in the absence of metacarpal measurements. Metacarpal bone loss in RA was due to endosteal resorption, while in SLE it was due to periosteal resorption. The semi-automatic technique for measurement of metacarpal bone mass showed good reproducibility among 5 observers and at 2 different centres. The pathogenesis of bone loss in RA was multifactorial, the largest contribution probably coming from a humoral factor in the circulation, closely related to disease activity. Ionised calcium was elevated in 55% of RA patients, but only 5% of SLE patients. Serum PTH levels were normal in 99% of the RA subjects. Elevations in alkaline phosphatase. (25%) probably reflected disease activity rather than increased bone formation. Factor analysis of 27 variables showed that disease activity was central to the development of OP in RA. CS therapy tended to be used in the presence of active disease. Disability was not an important determinant of bone loss in RA, but may be a useful measure of activity of the disease. This study did not evaluate the relationships with sex hormonal status or vitamin D metabolism. Future research should aim at cohort analysis at 2 different periods, in order to improve our understanding of the pathogenesis of bone loss in RA.

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