Osteoporosis

4-01-08

Osteoporosis By: Sue Renfrow, RN, BSN

Osteomalatia-causes pathological fractures, has bow legs, waddling gait (soft bones, like rubber) Pagent’s disease-rapid bone turnover due to osteoclasts (they build it faster than they can use it, bones build on top of bones, stiff bones) 2063

Osteoporosis A Metabolic Bone Disorder *A reduction in bone mass thereby increasing the risk for fractures. Brittle bones * A demineralizaton of bone making the bone more porous and brittle. * Bone resorption exceeds bone formation (calcium goes out of the bone into blood stream and is excreted) *Two main causes: - Calcium deficiency as result of chronic inadequate dietary calcium ingestion, endocrine disorders, excessive corticosteroids, eating disorders and excessive phosphorus. -Estrogen deficiency secondary to menopause Healthy People 2010 * Objectives to reduce the number of adults with osteoporosis * Develop guidelines to modify the effects of osteoporosis through prevention * Identify modifiable risk factors * Control of Medical conditions

Causative Factors *Medications: corticosteroids and heparin (effects metabolism of calcium) *Cigarette smoking *Excessive caffeine ingestion *Prolonged bed rest (bones not being used) *Alcoholism *Soft drink consumption (increased phosphorus = decreased calcium) *Normal aging process *Withdrawal of estrogen at menopause *Endocrine disorders (hyperthyroidism, hyperparathyroidism), eating disorders, GI surgery *Lack of weight bearing exercise *Family history of osteoporosis *Low calcium diet (high calcium food: broccoli, turnip greens, salmons, almonds, figs, dairy products)

Unmodifiable Risk Factors * A family history of osteoporosis. *Sex: Female *Ancestors from the British Isles, northern Europe, China, or Japan. *Being very fair skinned.

*Being small-boned. *Over the age of 35 start losing bone (start exercise to increase bone strength) *Ovaries removed. *Allergies to milk and milk products

Modifiable Risk Factors *Stress *Smoking *Alcohol consumption *Avoiding milk and cheese in your diet *Not exercising enough *Consumption of too many soft drinks *Not enough protein in your diet help to absorb calcium

Risk Lowering Strategies *Increase dietary Calcium and Vitamin D intake *Calcium Carbonate (TUMS) *Calcium Citrate *Stop Smoking *Moderate consumption of alcohol and caffeine *Weight bearing activity 30 min/day

Assessment & Diagnosis * X-rays identify osteoporosis when there is a 25% to 40% demineralization. * Lab studies including serum calcium, phosphorous levels and alkaline phosphatase, urine calcium, PTH, and hydroxyproline. * Dual-energy x-ray absorptiometry (DEXA) *“bone density scan” *Takes 5-15 minutes *provides information about spine and hip bone mass and bone mineral density (BMD) *Analyzed and reported by T-scores – the number of standard deviations (SD) above or below the average BMD.

Clinical Manifestations *Height loss *Dorsal Kyphosis or “Dowager’s Hump” *Cervical Lordosis (look like pregnant women) *Fractures (wrist fractures common) *Bone pain

Managing Osteoporosis aimed at decreasing bone resorption, resorption, maintaining bone, and preventing fractures Pharmacologic Therapy * Hormone Replacement Therapy (HRT) decrease bone reabsorption increases bone mass *estrogen and progesterone

- worry about cancer

* Calcitonin (Calcimar) started 5 years after menopause

4-01-08

* Inhibits bone resorption *Raloxifene (Evista)

*Selective receptor modulators (SERMs) *Estrogen receptor modulator, increases BMD without stimulating endometrium, indicated both for prevention and treatment of osteoporosis. (safer than HRT’s)

*Biphosphonates: alendronate (Fosomax), risedronate (Actonel), ibandronate (Boniva)

*Slows normal and abnormal bone resorption without inhibiting bone formation and mineralization.

Pharmacologic Therapy *“B” for bone mass rebuilding *“O” for only take with full glass of water *“N” for nausea - do not lie down *“E” for esophageal irritation

Goes towards biphosphonates (must use “BONE” therapy)

Nursing Implications in Pharmacological Therapy

*HRT: *caution pt. of risk involved in estrogen use

*Calcimar *Assess for allergy to salmon or fish products. May give SC, IM, or intranasally.

*Evista *Monitor for possible long term effects including cancer and thrombosis. Arrange for periodic blood counts. Safer than HRT’s

*Fosomax, Actonel, and Boniva (most commonly used) *Stay upright for 30 minutes.

Nursing Diagnoses *Knowledge deficit regarding disease process and treatment regimen *Chronic pain related to decreased bone mass and/or fractures *High risk for injury related to lack of awareness of environmental hazards *Altered mobility related to decreased bone mass and possible fractures *Altered nutrition related to inadequate calcium and vitamin D intake *Body image disturbance related to body changes and disease process “Bone” up on these facts: *Brimming with 302 mg of calcium an 8 ounce glass of milk can save your body from nibbling away at its own framework to satisfy its need for this mineral. *A slice of Swiss cheese layered in a ham sandwich racks up 272 mg *A cup of nonfat cottage cheese with your salad contains 150 mg *Two tbsp of parmesan cheese dusted on your pasta brings in 138 mg *One cup of nonfat yogurt packs around 400 mg *Broccoli at 178 mg a cup is and tofu at 260 mg *Collards 148 mg and turnip greens at 198 mg per cup *Every ounce of protein that you take in over four ounces, you need an extra 100 mg of calcium to stay even (calcium 1000mg) Osteoporosis-pale, thin, female. Exercise, take calcium, take vitamin D Take biphosphates at least 30 minutes before meals