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 180 older women who have two or more vertebral compression fractures. Six life-care communities in North Carolina have agreed to permit us to recruit from their populations and to use 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 designed 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 easily translate into a low-cost way of helping women who suffer from the pain, functional limitations, and psychosocial impairments that often result from spinal osteoporosis with vertebral compression fractures.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD030442-03
Application #
2202761
Study Section
Behavioral Medicine Study Section (BEM)
Project Start
1992-09-01
Project End
1996-08-31
Budget Start
1994-09-01
Budget End
1995-08-31
Support Year
3
Fiscal Year
1994
Total Cost
Indirect Cost
Name
Duke University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
071723621
City
Durham
State
NC
Country
United States
Zip Code
27705
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Benjamins, Maureen Reindl; Musick, Marc A; Gold, Deborah T et al. (2003) Age-related declines in activity level: the relationship between chronic illness and religious activities. J Gerontol B Psychol Sci Soc Sci 58:S377-85
Gold, Deborah T (2003) Osteoporosis and quality of life psychosocial outcomes and interventions for individual patients. Clin Geriatr Med 19:271-80, vi
Roberto, Karen A; Gold, Deborah T (2002) Chronic pain in later life women: issues and challenges from the research literature. J Am Med Womens Assoc 57:97-9
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Bohannon, A D; Hanlon, J T; Landerman, R et al. (1999) Association of race and other potential risk factors with nonvertebral fractures in community-dwelling elderly women. Am J Epidemiol 149:1002-9
Purser, J L; Pieper, C F; Branch, L G et al. (1999) Spinal deformity and mobility self-confidence among women with osteoporosis and vertebral fractures. Aging (Milano) 11:235-45
Lewis, T; Tesh, A S; Lyles, K W (1999) Caring for the patient with Paget's disease of the bone. Nurse Pract 24:50, 53, 57-8 passim

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