Objective: Providing information about health issues is important but may not be sufficient to motivate individuals to take action regarding their health. This study was conducted to determine what actions, if any, women with disabilities took after low bone mass was detected on bone mineral density (BMD) screening.
Design: A descriptive design was employed using a telephone survey. Six to 8 months after undergoing screening and learning that their values indicated that they had osteopenia or osteoporosis, women with a variety of disabilities were contacted by telephone to determine: 1) what they did with their results, 2) what actions their primary health care providers took if informed by the women about screening results, 3) women's compliance with recommendations for testing or for treatment, and 4) their reasons for not following up if they took no action.
Sample: The predominantly Caucasian sample of 114 women from a larger study had been informed that the results of BMD screening indicated osteopenia (n=47) or osteoporosis (n=67) using criteria of the World Health Organization. Their mean age was 51.3 + 12.1; they were well educated and had a variety of physically disabling disorders, such as multiple sclerosis, spinal cord injury, post polio syndrome, and cerebral palsy. Two-thirds of the women used a wheelchair some or all of the time; 4.5% were unable to transfer independently. Over 70% of them had never had previous BMD screening or testing; 60% of the women were menopausal.
Variable: The variable examined in this study was the reported action taken by women with disabilities following learning that they had osteopenia or osteoporosis.
Findings: About 70% of the women shared the results of screening with their physicians. Eight-five percent of those who shared their results reported that their physicians responded by recommending further BMD testing (60%), increasing their calcium intake (20%), or increasing their weight-bearing exercise (2.5%). A combination of further testing, use of medication to treat osteoporosis, and increased intake of calcium was prescribed for 12.3% of the sample. Of those who received recommendations for further testing, 17% had not yet had the testing by 6-8 months after initial screening. A small number of women indicated that their physicians told them not to worry about their decreased bone density or that nothing could be done about it.
Of those 30% of the women who did not share the results of BMD screening with their physicians, many were unable to give a reason for not doing so. Others reported that they forgot to do so, could not remember if they had done so, or indicated that they had many other concerns of higher priority to them and did not consider osteoporosis to be a major issue to them.
Conclusions: Low bone mass was not of high concern for a number of women in this study of women with disabilities with osteopenia or osteoporosis demonstrated on BMD screening. Further, few of the women's health care providers provided recommendations identified in the NIH Consensus Statement on Osteoporosis as important for women with low bone mass. Although a number of women reported the results of screening to their health care providers, most women received inadequate treatment.
Implications: Clinicians, including nurses, need to address osteoporosis risk in women in general and specifically women with disabilities. Further research is needed to 1) explore the reasons that health care providers fail to recognize the importance of osteopenia and osteoporosis in women with disabilities, a population vulnerable to falls and fractures, and 2) identify strategies effective in increasing women's knowledge about the issues and those of their health care providers.
This study was conducted as part of the Health Promotion for Women with Disabilities Project of Villanova University College of Nursing, funded by a grant from Bristol-Myers Squibb Foundation
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