Previous studies of osteoporosis in women have focused on strategies to reduce bone loss or increase bone mass. Yet scant attention has been devoted to the problem of women with multiple vertebral fractures who have substantial pain, deformity, and disability. Although impairments caused by vertebral fractures cannot be completely corrected, it is possible to improve such disabilities with a targeted intervention. Life-care communities are an ideal setting for such an intervention because the prevalence of osteoporosis and vertebral fractures in these settings is high, and because women living there would have easy access to an intervention. We propose an intervention for 216 older women who have at least one vertebral compression fracture. Six life-care communities in North Carolina have agreed to permit us to recruit from their facilities for this intervention. Prior to the start of the intervention, all subjects will be assessed in three domains: the physical, the functional, and the psychosocial. We have design and tested the reliability of measures to do this. Half of the respondents in each home will participate in the osteoporosis-focused intervention with two components: a physical therapy component with exercises designed specifically to address the musculoskeletal problems caused by spinal fractures, and a social work component that will focus on teaching coping skills, maintaining self-esteem, and minimizing stress and psychiatric symptoms. The other women will participate in a placebo intervention that also has these two components but which is not directed at osteoporotic problems. After the placebo intervention is complete, all women in that arm of the study will be offered the opportunity to participate in the osteoporosis intervention while the first intervention group will practice self-maintenance skills. Measures will be repeated at three-month intervals.
Our specific aims are to improve quality of life of respondents in the areas of physical, functional, and psychosocial performance through the intervention and then to have those improvements maintained by continued individual exercise and ongoing use of positive coping strategies. This intervention should translate well into a low-cost way of helping women who-suffer from the functional limitations, psychosocial and physical impairments, and loss of independence that can result from spinal osteoporosis with vertebral compression.
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