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Respond and provide additional insight that might be useful and appropriate for the issue addressed. Use your learning resources and/or evidence from the literature to support your position. Osteoporosis and Common Symptoms Osteoporosis can be defined as a skeletal disease characterized by low bone density resulting in increased bone fragility and an increased risk of fracture. According to Akkawi and Zmerly (2018), osteoporosis can be subdivided into primary osteoporosis, which includes postmenopausal osteoporosis (type I) and senile osteoporosis (type II), and secondary osteoporosis, which has a definable etiologic mechanism such as malabsorption, medications such as glucocorticoids, and some diseases such as hyperparathyroidism. Osteoporosis symptoms can include stooped posture, lower back pain, or loss of height from osteoporotic vertebral fractures and compression. Usually, there are no common symptoms of osteoporosis present until a fracture occurs. Recommended Diagnostic Tests The recommended diagnostic test for osteoporosis is a bone mineral density (BMD) test. According to Sözen et al. (2017), the diagnosis of osteoporosis is established by the measurement of BMD or by the occurrence of a fragility fracture of the hip or vertebra or in the absence of major trauma. According to Akkawi and Zmerly (2018), osteoporosis is defined as a BMD that lies 2.5 standard deviations or more below the average value for young healthy women, as measured with dual-energy X-ray absorptiometry (DEXA scan). In other words, osteoporosis is a T-score at or below 2.5. According to Sözen et al. (2017), the difference between the patient’s BMD and the mean BMD of young females aged in the range of 20–29 years (divided by the standard deviation of the reference population) yields the T-score. Common Treatments The common treatments of osteoporosis are all used to prevent fractures. According to Akkawi and Zmerly (2018), treatment and prevention strategies for osteoporosis and osteoporotic fractures include fall avoidance by correcting decreased visual acuity, reducing consumption of medication that alters alertness and balance, reducing fall hazards in the home, practicing physical activity to improve muscle strength, balance, and maintaining bone mass, the avoidance of cigarette smoking and excessive alcohol intake, and adequate dietary intake of protein, calcium, and vitamin D. Education about fall prevention and lifestyle modifications to promote bone health are ways to prevent fractures from osteoporosis. The recommended daily allowance and intake of calcium and vitamin D are also ways to help promote bone health and treat osteoporosis. There are also pharmacologic treatments for osteoporosis. According to Tu et al. (2018), medications to treat osteoporosis are categorized as either antiresorptive (i.e., bisphosphonates, estrogen agonist/ antagonists [EAAs], estrogens, calcitonin, and denosumab) or anabolic (i.e., teriparatide). References Akkawi, I., & Zmerly, H. (2018). Osteoporosis: current concepts. Joints, 6(2), 122–127. doi: 10.1055/s-0038-1660790 Sözen, T., Özisik, L., & Basaran, N. Ç. (2017). An overview and management of osteoporosis. European Journal of Rheumatology, 4(1), 46–56. doi: 10.5152/eurjrheum.2016.048 Tu, K. N., Lie, J. D., Wan, C., Cameron, M., Austel, A. G., Nguyen, J. K., Van, K., & Hyun, D. (2018). Osteoporosis: a review of treatment options. P & T: A Peer-Reviewed Journal for Formulary Management, 43(2), 92–104. Options for Primary Prevention The goal of the primary prevention of osteoporosis is to prevent bone loss. This occurs through lifestyle factors. According to Pai (2017), the primary prevention of osteoporosis are lifestyle changes that include exercise, adequate intake of calcium and vitamin D, avoiding alcohol, avoiding smoking, and avoiding excessive intake of salt. According to Benedetti et al. (2018), physical exercise is considered an effective means to stimulate bone osteogenesis in osteoporotic patients. Those at risk of fracture should avoid falls, glucocorticoids, heparin, and anti-epileptic drugs that reduce bone mineral density. According to Pai (2017), the daily calcium and vitamin D requirements include the following: – Premenopausal—calcium 1000 mg/day (includes calcium in food and beverages + supplements). It could be calcium carbonate or calcium citrate. Vitamin D 600 IU/day – Postmenopausal—calcium 1200 mg/day, vitamin D 800 IU/day Treatment Education Education on how to promote bone health and prevent osteoporosis is important early in life when the bone is being built and calcium deposits are made. Education on healthy diet and lifestyle is important to preventing osteoporosis. According to Pai (2017), dietary sources of calcium to promote bone health are milk, cottage cheese, yogurt, hard cheese, and green vegetables. Smoking and alcohol cessation education can help prevent bone loss. Education on exercise to increase bone density and increase strength and endurance (isometric, isotonic, and stretching) is needed and exercise should be performed at least 30 min a day, three times a week. Education on the importance of vitamin D and calcium are also important aspects of preventing and treating osteoporosis. Fall prevention education is important to those who have osteoporosis to prevent fractures. Fall prevention education includes ensuring there is good lighting at home, a clear floor without things that can trip a patient like throw rugs or floor clutter, utilizing grab bars or grab rails on stairs or in bathrooms, and the use of assistive devices like canes and walkers can help prevent falls. According to Jo et al. (2018), Most educational programs contain information on risk factors for osteoporotic fracture such as low bone mass, lifestyle, family history, comorbid medical conditions, medication use, and falls. In addition to education, awareness of the individual risk for a fracture may help to motivate behavioral improvements regarding bone health. Educating patients about bone mineral density screenings can also help prevent and treat osteoporosis. References Benedetti, M. G., Furlini, G., Zati, A., & Letizia Mauro, G. (2018). The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. BioMed Research International, 2018, 4840531. doi: 10.1155/2018/4840531 Jo, W. S., Cho, E. H., Kang, B. J., Kwon, G. D., Ha, Y. C., Jang, S., & Kim, H. Y. (2018). The impact of educational interventions on osteoporosis knowledge among Korean osteoporosis patients. Journal of Bone Metabolism, 25(2), 115–121. doi: 10.11005/jbm.2018.25.2.115 Pai M. V. (2017). Osteoporosis prevention and management. Journal of Obstetrics and Gynaecology of India, 67(4), 237–242. doi: 10.1007/s13224-017-0994-3