Osteoporosis Donald Medical Dic

OSTEOPOROSIS Contents INTRODUCTION .................................................................................... 1 ETIOLOGY .............................................................................................. 2 Risk Factors for Osteoporosis .................................................................. 3 SYMPTOMS: ........................................................................................... 3 TREATMENT ....................................................................................... 4 PATIENT CARE ................................................................................... 4 DIAGNOSIS: ......................................................................................... 5 o. circumscripta cranii ........................................................................... 5 o. of disuse ............................................................................................. 5 glucocorticoid o. .................................................................................... 5 juvenile o., idiopathic juvenile o. .......................................................... 5 posttraumatic o....................................................................................... 5

INTRODUCTION osteoporosis (o˘s_te.-o.-por-o._sı˘s) [poros, a passage, _ osis, condition] Loss of bone mass that occurs throughout the skeleton, predisposing patients to fractures. Healthy bone constantly remodels itself by taking up structural elements from one area and patching others. In osteoporosis, more bone is resorbed than laid down, and the skeleton loses some of the strength that it derives from its intact trabeculation. Aging causes bone loss in both men and women, predisposing them to vertebral and hip fractures. This is called type II osteoporosis (formerly “senile” osteoporosis). Type I osteoporosis (also known as “involutional” bone loss) occurs as a result of the loss of the protective effects of estrogen on bone that takes place at menopause.

ETIOLOGY: Multiple modifiable factors contribute to bone mass and strength: increased body weight, higher levels of sex hormones, higher amounts of calcium and vitamin D in the diet, and frequent weight-bearing exercise all build up bone and prevent fractures. Bone loss and the risk of fractures increase with age, immobilization, thyroid hormone excess, the use of corticosteroids and some anticonvulsant drugs, the consumption of alcohol, tobacco, and caffeine, and after menopause. Genetics (a nonmodifiable risk factor) also contributes to osteoporosis. SEE: table.

Risk Factors for Osteoporosis Female Advanced age White or Asian Thin, smallsmall-framed body Positive family history Low calcium intake Early menopause menopause (before age 45) Sedentary lifestyle Nulliparity Smoking Excessive alcohol or caffeine intake High protein intake High phosphate intake Certain medications, when taken for a long time (high doses of glucocorticoid, phenytoin, thyroid medication) Endocrine Endocrine diseases (hyperthyroidism, Cushing’ Cushing’s disease, acromegaly, hypogonadism, hyperparathyroidism) SOURCE: Stanley, M and Beare, PG: Gerontological Nursing, FA Davis, Philadelphia,1995. Philadelphia,1995.

SYMPTOMS: Bone loss progresses for many years without causing symptoms. When it results in fractures, bone pain and loss of mobility may be disabling. Signs of osteoporosis include deformities of the skeleton, such as kyphosis (the so-called “dowager’s hump”), and loss of height, especially if vertebral compression fractures occur.

TREATMENT: Supplemental calcium and regular exercise help slow or prevent the rate of bone loss and are recommended for most men and women.

Bisphosphonate drugs (such as alendronate), calcitonin, sodium fluoride, and other agents are useful for patients of either gender. In menopausal women, estrogen supplementation or the selective estrogen receptor modulators help prevent bone loss and fractures.

PATIENT CARE: Protection against osteoporosis should begin in childhood and adolescence, focusing on building bone mass. Encourage children to eat calciumrich foods and teach parents to encourage regular exercise, including school gym classes and sports programs, to build strong bones and establish healthy lifestyle habits. Parents also should be informed about the effects eating disorders, excessive dieting, excessive exercise, alcohol consumption, and smoking have on bone density. From the mid-20s through age 35, focus continues to be placed on building and maintaining bone mass through a calcium- rich diet. After age 35, bone resorption exceeds bone formation. Emphasis is placed on preventing bone loss through a healthy diet, use of calcium (plus vitamin D) supplements (ensure an intake of at least 1000 mg of calcium per day), and weight-bearing exercises such as weight-lifting, walking, jogging, dancing, and climbing stairs. High-impact aerobics may create too much stress on the bones of older adults and should be avoided. After patients have been diagnosed with osteoporosis, time should be spent assessing their diets and activity levels. Although patients should engage in walking or other weight-bearing activity for 30 to 60 minutes three to four times a week, this goal may need to be approached slowly. Foods that are rich in calcium include dairy products, spinach, sardines, and nuts. Calcium supplements totaling 1000 to 1500 mg per day should be consumed. Supplements can prevent further bone loss. Based on bone density testing, alendronate or another drug that inhibits bone resorption may be prescribed in a daily or weekly formulation. Teach the patient to take this drug on an empty stomach with a full glass (8 oz) of water only, first thing in the

morning, and then to remain inan upright position for 30 minutes while refraining from eating or drinking.

DIAGNOSIS: Dual energy x-ray absorptiometry (DEXA scanning) is recommended by the World Health Organization for the early diagnosis of bone loss. Dual photon absorptiometry and quantitative computerized tomographic scanning of bone can also be used.

o. circumscripta cranii Localized osteoporosis of the skull associated with Paget’s disease.

o. of disuse Osteoporosis due to the lack of normal functional stress on the bones. It may occur during a prolonged period of bedrest or as the result of being exposed to periods of weightlessness (e.g., astronauts in outer space).

glucocorticoid o. Bone loss that results from prolonged treatment with oral or inhaled steroids, such as prednisone, beclomethasone, or triamcinolone.

juvenile o., idiopathic juvenile o. A rare childhood disease of inadequate bone mineral density, characterized by poor bone formation that usually improves spontaneously during puberty or young adulthood. Affected children often complain of bone or back pain, muscle weakness, or impaired gait. Fractures of long bones and vertebral compression fractures are common. Other diseases of bone formation, such as osteogenesis imperfecta, must be excluded before a diagnosis of juvenile osteoporosis is made. Affected children are usually asked to refrain from participation in sports to lessen the risk of fractures.

posttraumatic o. Loss of bone tissue following trauma, esp. when there is damage to a nerve supplying the injured area. The condition may also be caused by disuse secondary to pain.