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Tackling the problem of fragile and thinning bones

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Poor compliance among patients with osteoporosis makes the educational role of specialist nurses vital.

During the past decade the role of the osteoporosis nurse specialist has become increasingly established in primary and secondary care.

In the early 1990s, when Anne Sutcliffe developed an interest in the disease, the role was virtually unknown. She was one of the pioneers and believes there are still opportunities for nurses to help mould the role.

'There is a more structured approach now, with some nurses starting off within a rheumatology or orthopaedic department and then developing an interest in osteoporosis. The role is very autonomous and involves the complete clinical management of patients, many of whom will be seen by the specialist nurse and not a doctor. The job also focuses on education of different groups of healthcare professionals, at both formal and informal levels.'

Anne first came across the specialism almost by accident. Having worked in a number of roles - including practice nurse, district nurse and health visitor - she grabbed the opportunity to take a short-term contract researching bone disease. Thus began her interest in osteoporosis and, in 1992, Anne became an osteoporosis nurse specialist at the Freeman Hospital, Newcastle, where she still works today.

'The director of nursing at that time was very forward-thinking and the post was specifically created. I developed a template for my job based on the very few other nurse specialist roles at that time, and I instigated a number of nurse-led initiatives and nurse-led clinics,' she enthuses.

Over the years Anne has watched her role expand from one that was focused at a very local level to one that now extends into the regional and national arenas, and across primary and secondary care. This is one of the perks of the job, she believes. 'There are now a number of nurses throughout the UK who are based in primary care who have a remit to link with secondary care.'

Patients are referred to Anne's clinic after a DXA (dual energy X-ray absorptiometry) measurement. Looking at individual risk assessment, fracture history, the scan results and relevant history, she recommends treatment options and provides advice on diet, exercise and pain management.

Explaining the way in which osteoporosis treatments work and how they must be taken is an important aspect of Anne's role. As with other chronic diseases, compliance can be poor. Up to two-thirds of patients stop taking their medicine within a year. There are a number of reasons for this. Patients cannot notice the difference that their treatments are making and they do not experience symptom relief. They may also have difficulty taking the main class of drug treatments - bisphosphonates - as these need to be ingested on an empty stomach and can cause gastrointestinal side-effects.

Nevertheless, an increasing number of new options for patients should improve adherence. The first licensed IV bisphosphonate for the treatment of postmenopausal osteoporosis was launched in the UK in April as a quarterly pre-filled injection. It was shown to be effective and well tolerated over two years. Last September, Bonviva 150mg (ibandronic acid) was launched as the first and only once-monthly tablet for the treatment of postmenopausal osteoporosis.

'For those patients who cannot tolerate the oral preparations, or those who forget to take them, the new IV therapy is very rapid and does not involve staying in hospital for hours,' says Anne. 'It is always helpful to have more options of giving any drug that is going to improve bone density and reduce fracture incidence.'

But she stresses that the increasing choice must be coupled with education. 'It's important to keep reinforcing the messages about how the drugs work, how they must be taken and the need for long-term adherence. 'Despite our explanations, patients can still come back after six months and tell us that they have stopped taking the drug because it has not helped their pain. So we need to keep reinforcing and repeating those messages,' she says.

The overall understanding and awareness of osteoporosis among patients and the general public is low compared with many other diseases. Recent research from the YouGov and the Social Issues Research Centre shows that many women are completely unaware of the risk factors associated with the disease - even though the risk of developing the disease is higher than that of breast cancer. Few are aware of the consequences: the overall mortality rate is up to 24 per cent in the first year after a hip fracture.

So it is not surprising that patients who are diagnosed with osteoporosis sometimes have no idea what to expect. 'Sometimes new patients can be very frightened because they have heard a number of inaccurate horror stories about osteoporosis,' Anne explains. 'My job is to give them as much support as possible to enable them to continue to lead a normal life.'

How do I become... an osteoporosis nurse specialist?

This could be for you if: you are interested in a broad-based role that includes clinical work as well as patient and healthcare professional education. You should also like working autonomously.

You need to be good at: communication, patient education and being adaptable.

You need to have: at least two to three years? experience in any role following qualification. There is now a modular course run by the University of Derby for a diploma in osteoporosis.

You don't need to have: highly tuned practical skills.

Other similar jobs you could consider: a role in rheumatology or orthopaedics.

Where to find more information on similar roles: The National Osteoporosis Society has an allied health professionals forum ( and the RCN has a specialist group in falls and osteoporosis.
VOL: 102, ISSUE: 23, PAGE NO: 36

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