Osteoporosis Quick Notes

OSTEOPOROSIS OSTEOPOROSIS •

Silent disorder because present long before symptoms occur

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A disease that threatens more than 28 million Americans

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Characterized by reduction of total bone mass and change in bone structure increase susceptibility to fracture

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Rate of bone reabsorption > rate of bone formation = reduced total bone mass

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Bone becomes progressively porous, brittle, fragile

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Fracture easily under stresses that would not break normal bone

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Frequent results in compression fracture of thoracic and lumbar spine (skeletal deformity)

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Colles’ fracture of wrist

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Most costly $, in terms of human suffering, pain, disability, fracture, and death

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Gradual collapse of vertebra may be asymptomatic; observed as progressive kyphosis

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Kyphosis (dowager’s hump) associated with height loss – FIRST SIGN

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Frequent post menopausal women lose height form vertebral collapse – Back Pain

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Postural change result relaxation of abdominal muscles, protruding abdomen

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May produce pulmonary insufficiency – SOB, Dyspnea

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Many Complain of fatigue

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Increase Ca intake, participate regular weight bearing exercises, modification of lifestyle; Decrease caffeine, cigs, alcohol these will decrease the risk for developing osteoporosis, Fractures, and other disabilities later in life.

GERONTOLOGIC CONSIDERATIONS • • • •

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Prevalence in women older than 80 years 84% Back pain SOB, dyspnea – because of decrease expansion of lungs Aging population incidence of following rise o Incidence of fracture o Pain o Disability Absorb dietary Ca less efficiently and excrete it more readily through kidneys Post menopausal women, elderly consume as much 1500mg/day

PATHOPHYSIOLOGY • •

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Normal bone remodeling adult result in increase bone mass until about 35 years Factors influence peak bone mass / development of osteoporosis o Genetics – Aging o Nutrition o Lifestyle choices (smoking, caffeine, alcohol consumption) Bone loss universal phenomenon associated with aging Age related loss begins soon after peak bone mass achieved Calcitonin o Inhibits bone reabsorption, promotes bone formation - decreases Estrogen o Inhibits bone breakdown – decreases with aging Parathyroid o Hormone increases with aging, increases bone reabsorption Withdrawal of estrogens and menopause and with Oophorectomy causes accelerated bone reabsorption that continues during post menopausal years Women develop more frequent, more extensively than men because of lower peak bone mass, effect of estrogen loss during menopause More than ½ all women older than 45 years of age show evidence of osteoporosis on Xray

RISK FACTORS • • • •

Small, framed, nonobese white women and at increased risk o Lack weight bearing, smoking, caffeine, alcohol African American because greater bone mass are less susceptible Men > peak bone mass, do not experience sudden hormonal changes occur lower rate, at older age Nutritional factors o o o

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Bone formation enhanced by stress of weight, muscle activity Immobility contributes to development When immobilized by casts, paralysis, general inactivity, bone resorbed faster than formed, osteoporosis occurs Coexisting medical conditions o o o o

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Malabsorption syndromes, Lactose intolerance Alcohol abuse, renal failure, liver failure Cushings Syndrome, Hyperthyroidism Hyperparathyroidism

Medications – Can affect the bodys use and metabolism of Ca o o o o o

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Vitamin D – Ca absorption, normal bone mineralization Dietary Ca, vitamin D adequate to maintain bone remodeling, body functions Best source Ca / Vitamin D = fortified milk

Corticosteriods, Isoniazid, heparin, tetracycline Aluminum containing antacids Furosemide, anticonvulsants, thyroid supplements Lithium – Long term Chemotherapy agents

Degree osteoporosis Related to duration of medication therapy

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Therapy d/c or metabolic problem corrected, progression halted but restoration lost bone mass usually does not occur

ASSESSMENT AND DIAGNOSTIC FINDINGS • • •

Identified on routine x-rays when 25-40% demineralization DEXA – Dual Energy x-ray Absorptiometry o Provides information about bone mass at spine and hip Ultrasonic Heel – Density bone sonometer o Used to diagnose osteoporosis and predict risk of fracture

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Lab studies o Serum Ca o Serum Phosphate o Serum Alkaline Phospatase o Urine Ca excretion o Urinary hydroxyproline excretion o Hematocrit o Erythocyle sedimentation rate

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Bone density o Single photon o Duel photon Thyroid function test Parathyroid

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MEDICAL MANAGEMENT • • •

Strengthen bone to prevent patient from suffering fracture Adequate, balanced diet rich Ca, Vitamin D throughout life – (1000 – 1500mg) o Increase Ca intake during adolescence, young adulthood, and middle age to protect against skeletal demineralization Tums o Cheapest Ca supplement

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3 glasses skim or whole vitamin D milk or other food high in Ca (cheese, other dairy products, steamed broccoli, canned salmon with bones) daily o 1C Plain nonfat yogurt – 400mg; 1oz C. Cheese; 1oz M. Choc – 25mg; Collar greens 1C 289mg o Adults 1000mg/day o Postmenopausal 1000-1500mg/day

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Ca supplement (Ca carbonate) taken with meals or beverage high in vitamin C to promote absorption o Take one hour before meals o Common side effects Ca supplements  Abdominal distention  Constipation (teach to increase H20 and fiber)

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Regular weight bearing exercise (20-30 minutes aerobic exercise) Walking 3 days or more a week. o Exercise improves balance, reducing falls, fractures Sunlight increases vitamin D absorption

PHARMACOLOGIC THERAPY •

HRT with Estrogen, Progesterone to retard bone loss, Prevents occurrence of Fracture o Estrogen: Decreases bone reabsorption, Increases bone mass reducing incidence of osteoporotic fractures  Been associated with slightly increase incidence breast, endometrial cancer  Using lowest effective dose decreases cancer risk  Combined with progesterone diminish potential risk for endometrial cancer o HRT contraindicated with pregnant or who have undiagnosed vaginal bleeding; active thrombophlebitis; endometrial, breast cancer, Estrogen dependent tumors, and acute liver disease  Examine breast monthly  Pelvic Exam with Pap smear, Endometrial bx – 1 to 2 times a year Common Side effects of HRT o Periodic bleeding or spotting o GI upset o Breast tenderness o Mood swings o Fluid retention o Weight gain

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Designer Estrogens such as Raloxifene (Evista) decrease the risk for osteoporosis without increasing the risk for breast cancer Fluorinated toothpaste / H20 increases bone formation

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Pain Treatment o Firm mattress, Back rubs o Heat o No twisting motion – move as one unit Home: Clutter free with grab bars / shower stool

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Alendronate (Fosamax) o Alternative to HRT o Produces increase in bone mass by inhibiting osteoclast function (Dec bone loss) o Taken early AM with 8oz of water while sitting up. 30-60 minutes before food (must be on empty stomach) or before other meds for maximum absorption o Adequate Ca, Vitamin D needed for max effect Common Side Effects of Fosamax  Dyspepsia, Nausea, Flatulence  Diarrhea, Constipation

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Calcitonin o Suppresses bone loss through direct action on osteoclasts, decreasing bone turnover o Administer by nasal spray, SQ or IM

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Alternate nares SQ at HS cause flush of face

Common Side Effects of Calcitonin o Nasal irritation o Flushing, GI disturbances, Urinary frequency

NURSING DIAGNOSIS • • • •

Knowledge deficit about osteoporotic process Pain R/T fracture / muscle spasms Constipation R/T immobility R/F injury related to Osteoporosis

NURSING CONSIDERATIONS • • • •

Constipation Pain Bowel elimination Prevention of injury