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Osteoporosis from the Patient’s Perspective

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Osteoporosis is a condition widely believed to affect the older members of the society. While both men and women aged over 75 years are at risk of experiencing osteoporosis, it is believed that women are generally more at risk than men to develop the condition due to postmenopausal problems associated with the hormone loss (Riggs & Melton, 2005). This paper presents a patient’s perspective of the osteoporosis condition, as it is important to have an understanding of the personal experience and impact of this condition as told by the patient. The patient’s perspective will provide a complete picture of osteoporosis and help healthcare providers understand the disease from the viewpoint of the patient. According to what we have been told about the disease including its risk factors, prevention, and treatment; less attention has been provided regarding what the patients undergo on a daily basis as they live with this disease. While the condition is manageable and treatable, some patients consider osteoporosis as a terminal illness, which every woman will have to live with for the rest of their lives after menopause. For these patients, having been diagnosed with osteoporosis marks the end of their normal lives as they consider themselves doomed. Perhaps, there is inadequate knowledge and increased lack of awareness among populations, on osteoporosis disease with regards to its causes, risk factors, prevention and treatment methods available to various bone fractures.    

The Problem

From an interview conducted with a 58-year old woman who had just suffered from a wrist fracture, a number of issues have emerged on how patients see the causes of osteoporosis as a disease. According to this patient, all women who have reached post-menopausal stage will develop the problem at some point in their lives. The patient sees osteoporosis more as women’s problem than a problem that affects the general well being of the older population in the society. While she acknowledges her lack of physical exercise during her younger years, she nevertheless attributes the problem to post-menopausal stage that every woman has to contend with. She strongly believes that she knew at some point after reaching post-menopausal stage, that she would develop the problem simply because she was a woman. In addition, the patient believes her sedentary lifestyle contributed greatly to her condition and regrets having failed to engage in physical activities early on in her life. Thus, the patient offers a word of caution to all women to engage in physical activities in order to reduce chances of developing the disease as she believes that the condition is a terminal one that restricts the life of patients and condemns them to all manner of physical and emotional miseries. 

The patient’s perception that osteoporosis is a condition affecting women after post-menopausal stage could have been informed by the fact that the condition is more prevalent in women than in men. According to Riggs & Melton (2005), two out of three women will develop osteoporosis after reaching post-menopausal stage. Conversely, only one out of eight men will develop the disease after 70 years of age. Thus, women are considered to be more at risk of developing the condition than men, due to their increased loss of hormone after reaching post-menopausal stage.  It is against this backdrop that this patient believes osteoporosis is a problem affecting women and not men. Having developed this disease, the patient believes life will not be normal as before. For her, the condition is terminal, since she would have to depend on drugs for the rest of her life besides being more cautious to avoid developing more complications as a result of the fall. Even as physicians would explain that osteoporosis is not a terminal illness, although it can be lethal, the patient’s perception is that the disease is life-threatening and will therefore condemn her to a miserable life for the remainder of her life.

A Lay Perspective

The overriding theme in the patient’s perspective of osteoporosis as a disease is fear. Having experienced wrist fracture as a result of osteoporosis, the patient fears that she may break her hip. Osteoporosis is a condition that does not present any form of symptoms and signs until when a patient experiences a fracture in the wrist, hip or spine (Riggs & Melton, 2005). It is also argued that even when one has developed a minor bone fracture, the onset of pain that would symbolize presence of osteoporosis may take longer, thus a patient may not be able to know whether or not he or she has the osteoporotic problem. However, once the symptoms and signs associated with severe pain as a result of fracture in the bone are identified, the patient would be at high risk of experiencing fractures in other bones of the body (Riggs & Melton, 2005). It is against this background that osteoporosis patients are advised to be more cautious with their movement in order to avoid fall that may result into more severe fractures of the bones.

While it is within the physicians’ professional mandate to offer such advice, it only serves to fuel anxiety and fear in the patient. According to the patient in this study, the fear of experiencing a fall that would result into hip fracture is quite eating into her mentally. In addition, the patient fears that the disease has condemned her to a miserable life by restricting her freedom to move about and perform certain tasks. Further, she fears her condition would be a burden to the entire family should it get serious to the point of not being able to move at all as a result of breaking a hip bone. The patient understands that hip fracture would condemn her to a life in bed for the rest of her life and this would inconvenience her family. She knows that after developing a hip fracture, she would be assisted and cared for by other members of the family. However, she is not happy at all about such an experience and fears that since she would need someone to stay at home and care for her hence being a bother to the rest of her family.

Osteoporosis being a painless disease is hard to detect until when pain is experienced due to fracture of the bone. Due to this, the patient was unaware of her condition until when she experienced a fracture on her wrist bone. According to her, life was normal until she felt a fracture and severe pain on her wrist. A first visit to the doctor did not reveal the actual problem as the X-ray test showed she had a minor facture on her wrist and therefore the wrist was put on a cast which lasted for two week before another test. The patient had no knowledge of her condition and expected the fracture to heal within the two weeks that the wrist was placed in a cast. After expert diagnosis on her bone density, the patient learnt that she had an osteoporosis due to her post-menopausal stage. While the patient claims that post-menopausal osteoporosis can have debilitating effects on the general well being of a patient, she did not understand why the fracture on her wrist did not heal and was upset that the experience would totally change her life.

 Ideally, the patient had no knowledge of the disease and thus from the opinions and advices of the doctors, she has came to terms with her condition which she believes affects every woman at some particular point during post-menopausal period. The final diagnosis on the bone density was particularly important in informing the patient about her condition which she was not aware about. This is confirmed by her assertion that she was not going to find out about her condition had she not experienced the wrist fracture. However, based on doctors’ advice, she now understands that the disease can be prevented through regular check ups and appropriate exercise.

After discovering her condition, the patient identifies lack of active lifestyle in her past to have contributed to her condition. She concurs with the doctors’ opinion that her sedentary lifestyle in her early years mainly contributed to her condition and she advices all women to engage in physical activities. While she regrets about her indifference to physical activities in the past, the patient is more concerned about her present condition than any other thing, an experience which is causing her numerous mental problems. She attributes her condition to post-menopausal stage. The patient believes that every woman would develop the condition at some point during post-menopausal period. She therefore contends that while physical exercise during her younger years would have delayed the onset of the condition, she would nevertheless have developed osteoporosis just like any other woman who has reached menopause. However, according to the patient, the main concern now is how to be cautious all the time so as to avoid any fall that would cause hip fracture. She asserts that before the fracture on her wrist, life was normal and she felt completely healthy; however, the experience of being diagnosed with osteoporosis has totally changed her life. She feels that she can never have a full range of motion and hence will not be able to do anything anymore. In other words, the patient feels she is no longer healthy and consider her condition as a terminal one that would condemn her to physical and mental torture for the rest of her life.   

The patient feels that her condition has affected her identity as person. She no longer moves freely for fear of experiencing a more serious fracture especially on her hip which would not only affect her own mobility but also the freedom of other family members. According to the patient, the condition has changed the way she does her daily chores and how she moves. As a result, this has affected her self-esteem due to how she sees herself. She does not consider herself healthy anymore. Nevertheless, she has accepted her condition and understands that she would have to cope with it for the remainder of her life. The patient asserts that every member of her family is busy and thus may be inconvenienced by her condition should it get worse. For her, the disease is a burden to the family members as it would force her to have other family members to provide, when she is unable to move about. However, she thanks her husband’s health cover for the success in managing her condition. She argues that medical costs are extremely high in the country that without proper medical cover, she would have been unable to receive proper treatment for her condition.   

Solutions/ Activism

While biomedical explanations argue that osteoporosis is preventable through physical exercise, studies on the effectiveness of physical exercise on preventing the disease have produced varied outcomes. For instance, the project at the University of Arizona dubbed Bone-Estrogen Strength Training (BEST) identified only six physical exercises that can produce the greatest yield in BMD, these include squat, leg press, seated row, back extension, lat pull-down and military press (Houtkooper, Stanford, Metcalfe, Lohman, & Going, 2007).Other studies suggest that a whole year of frequent jumping exercises would improve the BMD of an individual. In general, aerobics, resistance and weight bearing exercises are known to maintain or improve the BMD especially in post-menopausal women (Cheng, Sipilä, Taaffe, Puolakka, & Suominen, 2002). The lack of a clear recommendation for exercises has produced highest yield in BMD development, hence reduced risk in developing osteoporosis.  Consequently, this could be the reason for the increased lack of awareness about the condition. According to our patient, had she engaged in physical activities early on in her life, she could have delayed the onset of osteoporosis in her life. It is also worth noting that it was until after the second diagnosis that the patient realized that she had suffered osteoporosis. Before the expert opinion and advice of the doctor, the patient had little or no knowledge in relation to the risk causes and how the disease could be prevented. 

The patient perceives that her life and her daily activities will be regulated by her condition for the rest of her life. While she is accepting her condition, she can neither understand nor forecast what the future would be like for her. For instance, she believes that medication will be part of her life now, but she has to be more careful with what she does and how she moves so as to avoid any fall. The patient has no idea about the treatment available for osteoporosis as she asserts that once she experiences hip fracture, it will be all over for her. While healthcare providers would like every patient to know that osteoporosis is treatable including the hip fracture through surgery, the patient seems to have no idea about this.         

Despite the availability of treatment for osteoporosis, the patient’s main concern is how to avoid developing hip fracture. While she understands and advices other women to change their lifestyle and participate in physical activities more often, she does not adopt physical exercise as a preventive measure for developing serious osteoporotic conditions such as hip or vertebrae fracture. For the patient, the most important issue now since she has been diagnosed with osteoporosis is to be more careful in order to avoid any fall. The fear of what life would be with a hip fracture seems to be the issue that is preoccupying the patient’s mind.

 The patient also talks about risk factors, appropriate preventive measures, as well as the role of doctors in helping individuals to overcome problems associated with osteoporosis. She identifies lack of exercise and post-menopausal stage as the key factors that have played a key role to the development of the disease in women. As for the remedies, the patient advices other women who have attained menopause to engage in regular physical exercises and to see their doctors more often so as to test for the development of osteoporosis from an early stage.  

Undoubtedly, the patient was shocked by the discovery of the condition in her. She singled out the change in her lifestyle to her knowledge of the disease after being informed by the doctor. The information from the doctor totally changed how she sees her body and her sense of identity. She no longer sees herself as a healthy person but a person walking around with a disease. The discovery also affected how she relates with others, especially members of her family. The patient feels she should not be tended by other members of the family as such a demand would prevent others from going about their business. With the information of the physician on the risk factors, the patient sees into the future and considers herself a burden to the rest of the family members who would have to forego their affairs in order to care and provide for her. This feeling alone is the most important issue that preoccupies the mind of the patient and saddens her each day.    

The knowledge of the physician was critical in informing the patient about the risk factors, prevention, and treatment methods of osteoporosis. The patient’s experience of osteoporosis is informed by the knowledge sought from the doctor. For the patient, a woman cannot escape osteoporosis but can only delay it. In other words, the physician’s explanation of women being at high risk of experiencing osteoporosis after reaching menopause was critical in the patient’s blanket belief that all women must go through the experience. However, the patient understands the importance of the doctors’ advice and care for her condition. For instance, she advices other women who do not know whether or not they are on the verge of experiencing osteoporosis to have their doctors screen them regularly for low bone density and other risk factors.

It is also important to point out that for the patient; osteoporosis is a big social issue that the society must give special attention. She is concerned about the high cost of medication not only for this particular condition but also for all other diseases. She argues that without proper medical cover, she would not have been able to find suitable treatment for her condition and possibly she could have experienced more serious conditions like hip fracture. The patient sees access to better medical services as the preserve of the rich and those who can afford better medical cover. For her, the high cost of treating osteoporosis is a big social issue that may be restraining the number of women seeking for screening and treatment of osteoporosis in the country. In addition to cost, the patient sees osteoporosis as a gender issue. According to the patient, women will develop the disease no matter their lifestyles. She believes that the best that women can do to delay the problem is to engage in physical activities. Thus, to the patient, osteoporosis is more of a woman problem than it is for men.

Conclusion

Osteoporosis can be a debilitating disease and is found to be common in aged men and women. However, the disease is found to be highly prevalent among women who have attained menopause. From the patient’s perspective, women should engage more in physical exercises and adopt active lifestyles, if they would have any chance of delaying the onset of osteoporosis. According to the patient, women have no escape route at all when it comes to osteoporosis. The only thing women would do is to delay the time when they would develop osteoporosis. Drawing from her own experience, the patient believes that lack of exercise and regular screening was the main factors behind her experience, which she believes started early than ‘normal’. Thus, the patient is passing a strong message that lifestyle and early screening could be vital in preventing the high prevalence of the disease among women and the elderly in general. In addition, the patient is telling us that while the disease is highly prevalent among women after menopause, there is a general lack of awareness across the population most at risk. Most women do not know about the risk factors and prevention methods of osteoporosis. To the healthcare providers, the patient is communicating a simple but powerful message that osteoporosis is a debilitating condition that not only burdens the patient but also the entire family. While healthcare providers understand that osteoporosis is a condition that can be prevented, managed, and treated, to the patient, the disease marks the end of life. 

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