Local programs target osteoporosis

Tall and broad-shouldered, Brent Lake has long worked hard to keep fit.

He competed in masters swimming events. He logged hours biking.

Then three years ago on New Year’s Eve, Lake, now 74, fell and fractured his back. The injury required surgery, including a metal tube in his back.

It was then the Bend resident learned he has osteoporosis.

“You see some people who fall like that,” he said, “and they don’t get up again.”

Osteoporosis, the deterioration of bone strength and density, is often called the “silent disease,” affecting at least 10 million Americans. And like Lake, many people don’t know they have it until a bone breaks.

Bone fractures can be one of the most significant health game-changers, physicians said. They can result in surgeries, weeks to months in rehabilitation and sometimes the inability to live independently.

“When patients are admitted for hip fractures, it is a big blow to their overall quality of life,” said Dr. John Zachem, an internist at St. Charles Bend.

And they happen regularly. According to the National Osteoporosis Foundation, roughly half of women older than 50 will break a bone due to the condition. For men, it’s about 1 in 4.

Now, a new program supported by St. Charles Bend and insurer PacificSource is working to better manage fracture patients.

St. Charles Bend has started the Orthopedic Nurse Navigator Program to interact with and track patients who are admitted to the hospital with bone fractures.

The nurses hope to convey to patients that osteoporosis is quite likely the reason behind the injuries and to link them with tools to manage the disease.

The health care system hasn’t always been effective in sharing information about osteoporosis, said Karin Thompson and Brandi Bliss, the two nurse navigators for the St. Charles program. Fracture patients can potentially go through hospitals and never be told that their bone break was connected to osteoporosis.

The Bend hospital sees plenty of fracture patients. The nurses said they recently started tracking fractures; the record number of patients admitted in one day is 17.

“These patients have their first fracture, and they go home and in another year they are back with another fracture,” Bliss said.

“Working at the bedside for eight years,” she added, “we know how impactful these fractures are to families.”

For Lake, the fall changed how he manages his health.

He is conscious now about getting calcium and vitamin D in his diet. He also regularly attends a St. Charles Bend exercise class called Preventing Osteoporosis. Although active before, he hadn’t incorporated the weight-bearing and core exercises that build the strength and balance to combat osteoporosis.

“You’re maintaining,” he said. “That’s what you want to do at this age. And that’s progress.”

A common disease

Osteoporosis and its less severe precursor, osteopenia, arise when bone mass starts to decrease. The interior of the bones begin to appear more porous as the deterioration progresses.

The two diagnoses are often thought of as women’s health issues, said Dr. Molly Omizo, an internal medicine physician in Bend who specializes in osteoporosis and bone health. While most everyone starts losing more bone than they build starting around age 40, women experience a significant drop after menopause.

“When we lose our estrogen we have a rather dramatic decrease in bone mass,” Omizo said.

Men fare better because they go through a gradual, rather than steep, hormonal decline as they age. They also tend to have more bone mass than women to begin with, Omizo said.

Yet men still develop osteoporosis at a significant rate. The National Osteoporosis Foundation says men older than 50 are more likely to break a bone due to osteoporosis than they are to get prostate cancer.

While osteoporosis is common, it’s not so pervasive that screening is recommended for everyone, Omizo said.

The most common screening for osteoporosis is called dual energy X-ray absorptiometry, called a DEXA scan. Presently, there aren’t across-the-board screening recommendations for normal-risk individuals, such as exists with mammograms to screen for breast cancer. Medicare starts reimbursing for DEXA scans at age 65 for women and 75 for men.

But the scans are recommended for people with certain risk factors. The U.S. Preventive Services Task Force issued a report in 2011 urging that postmenopausal women with risk factors including petite frames, family medical history, a history of smoking or above-average alcohol intake get a scan.

The good news, Omizo said, is it’s sometimes possible to prevent osteoporosis from developing and, later, good health choices can manage it. Patients just need to hear the message.

“You can help reduce the loss,” she said. “If you do exercise and have a good diet, you can probably maintain your bone mass pretty decently over the years.”

Reducing fractures

There are a number of efforts in the region to get that word out.

One happens in the St. Charles hospitals in Bend and Redmond every week. On a recent weekday, St. Charles Bend physical therapist Megan Ledyard led seven students through core exercises, lunges and weights in the Preventing Osteoporosis class.

The students, all older than 50, held plank positions seemingly effortlessly. Many have attended the classes for years.

Research shows balance work, strength training and weight-bearing exercise help ward off bone fractures. Ledyard said she also talks regularly in the class about simple body mechanics, from how to lift wet towels out of the washer to how to shovel snow. She does a whole day on gardening.

“We really try to get them to apply what they learn to everyday life,” Ledyard said. “For someone with osteoporosis, something as simple as putting your plates away could cause a fracture.”

After the class, nearly all the students said they had been diagnosed with at least osteopenia. Several had experienced a fracture. But they said they hope to be stronger than their parents’ generation. They recounted parents who struggled to get out of a chair in their later years.

Another program, the new Orthopedic Nurse Navigator Program, focuses on reaching fracture patients while they’re still in the hospital.

Nurses Bliss and Thompson said they make sure to visit with fracture patients to learn more about their history and to share what information and resources are available for dealing with osteoporosis. They also follow up with the patients and their primary care physicians 90 days after the hospitalization to make sure they’re on the right track.

If a person breaks a bone after the age of 50, Omizo said, chances are it’s related to osteoporosis.

Bliss said national estimates show that only 20 percent of those who have osteoporosis are being treated for it.

“We want to arm them with tools so they can take care of themselves after they leave here,” Thompson said.

The effort launched in January, and by the end of February the two nurses had already seen 100 patients. They hope to eventually expand it beyond those admitted to a hospital to include fracture patients who are treated in the emergency room and then released.

“We’re hoping to prevent them from ever coming back with a fracture,” Bliss said.

Welcomed intervention

The nurse navigators’ work isn’t always straightforward.

Phyllis Lewis, 73, felt like she had been doing everything right to prevent osteoporosis over the years. She was screened for the disease, took supplements and kept up a vigorous exercise routine.

Then the fractures started happening. First, the Sisters resident slipped on the ice and broke her pelvis. Next, a fall while hiking fractured her tailbone. In total, Lewis has experienced four fractures over the last five years.

“It’s been confusing as to what’s going on,” she said recently, when she was about to check out of St. Charles Bend after breaking her ankle. “Why am I breaking things?”

Thompson visited Lewis in her hospital room. They talked about other factors that could be influencing her bone health. Her medication for high blood pressure, Thompson noted, could possibly make her dizzy and affect her balance. And the nurse recommended Lewis engage in strength and balance training in addition to cardio exercise to make her stronger.

“I said, ‘Let’s step back. Why are you falling?’ ” Thompson said.

Lewis said she appreciates Thompson’s advice and is interested in joining an osteoporosis support group. She wants to do whatever she can to get back on her feet, as she and her husband are avid hikers and bikers.

“I’m willing to do anything,” she said. “I don’t want to break another bone. We’ve developed a lifestyle here that I love.”