Osteoporosis

Osteoporosis Definition 

a reduction in bone density and a change in bone structures



the rate of bone resorption is greater than the rate on bone formation



bones become previously porous, brittle and fragile



bones fracture easily under stresses that would not break in normal bone

A. K. A. Thin Bones

Incidence- The prevalence of osteoporosis in women older than 80 years old of age is 84%. The average 75 years-old woman has lost 25% of her cortical bone and 40% of her trabecular bone.

Predisposing and Risk FactorsPredisposing Factors 

Caucasian or Asian



Females



Family history



Small frame

Risk Factors Age •

Post-menopause

•

Advance age

•

Low testosterone in men

•

Decreased calcitonin

Nutrition •

Low calcium intake

•

Low vitamin D

•

High phosphate intake

•

Inadequate calories

Physical exercise •

Sedentary

•

Lack of weight-bearing exercise

•

Low weight and body mass index

Lifestyle choices •

Caffeine

•

Alcohol

•

Smoking

•

Lack of exposure to sunlight

Medications •

Corticosteroids

•

Antiseizure medications

•

Heparin

•

Thyroid Hormone

Manifestation—

In the early stages of osteoporosis, you probably will not have symptoms. As the disease progresses, you may have symptoms related to weakened bones, including: •

Back pain.

•

Loss of height and stooped posture.

•

A curved upper back (dowager's hump).

•

Broken bones (fractures) that might occur with a minor injury, especially in the hip, spine, and wrist.

•

Compression fractures in the spine that may cause severe back pain. But sometimes these fractures cause only minor symptoms or no symptoms at all.

Types of Osteoporosis Primary Osteoporosis- Occurs in women after menopause (usually after 45 and 55 years) and later in life in men, but it is not merely a consequence of aging. Failure to develop optimal one peak bone mass during childhood, adolescence, and young adult contributes to the development of osteoporosis without resultant bone loss. Secondary Osteoporosis- result of medications or other conditions and disease that affect bone metabolism. Specific disease states (eg. Celiac disease, hypogonadism) and medications (eg. Corticosteroids, antiseizure medications) that place patients at risk need to be identified and therapies instituted to reverse the development of osteoporosis.

Pathophysiology-

Genetics -Caucasian or Asian -Females -Family history -Small frame Age -Post-menopause -Advance age -Low testosterone in men -Decreased calcitonin Nutrition -Low calcium intake -Low vitamin D -High phosphate intake -Inadequate calories Physical Exercise -Sedentary -Lack of weightbearing exercise -Low weight and body mass index

Lifestyle Choices -Caffeine -Alcohol -Smoking -Lack of exposure to sunlight Medications -Corticosteroids -Antiseizure medications -Heparin -Thyroid Hormone

Predisposes to low bone mass

Hormones (estrogen, calcitonin, and testosterone) inhibit bone loss. Diagnostics Studies Reduces nutrients needed for the bone remodeling

X-ray Absorptiometry (DEXA)analyzed and reported as T-scores ( the number of standard deviations above or below the average BMD value for young, healthy woman. A normal BMD is less than 1 SD below Reduces osteogenesis in the young adult mean value. The WHO defines the bone remodeling osteoporosis as being present when the T-score is at least 2.5 SD below the young adult mean value. Ostopenia is diagnosed when the BMD T-score is between 1 and 2.5 SD below the young adult mean value.

Affects calcium absorption and metabolism

1.Dual-energy

2.Quantitative

ultrasound studies (QUS)-use to diagnose osteoporosis and to predict the risk of hip and nonvertebral

fracture Bones needed stress for bone maintenance. Management

Medical Management 1. Hormone replacement therapy (HRT) - the mainstay of therapy to retard

bone loss and prevent occurrence of fractures. Estrogen replacement

decreases bone resorption and increases bone mass, reducing the incidence of osteoporotic fractures. 2. raloxifene (Evista)- reduce the risk for osteoporosis by preserving bone

mineral density without estrogenic effects on the uterus. They are indicated for both prevention and treatment of osteoporosis. 3. Bishosphonates-reduce

spine

and hip fractures associated with

osteoporosis 4. Alendronate- offers an alternative to HRT and produces increase bone

mass y inhibiting osteoclast function and decrease bone loss. 5. Calcitonin- primarily suppresses bone loss through direct action on

osteoclast and reduced one turnover. It is effective in increasing BMD. It is administered by nasal spray or by subcutaneous or intramuscular injections Nursing Diagnosis 1. Deficient knowledge about the osteoporotic process and treatment regimen 2. Acute pain related to fracture and muscle spasm 3. Risk for constipation related to immobility or development of ileus 4. Risk for injury:additional fractures related to osteoporosis Nursing Inteventions 1. Promoting and Regimen

Understanding of Osteoporosis and the Treatment



Adequate dietary or supplemental calcium (1200-1500 mg/day) and vitamin D

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Regular weight-bearing exercise

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Modification of lifestyle like cessation of smoking, reduce the use of caffeine and alcohol



Help to maintain bone mass

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Instruct to take the calcium supplements with meals

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Teach patient to drink adequate fluids to reduce the risk of renal calculi

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For Alendronate users, it must be taken on an empty stomach with water and the patient must not consume foods or liquids for 30-60 minutes.

2. Relieving Pain

Illustration



Rest in bed in a supine position or side-lying position several times a day. The mattress should be firm and non-sagging.

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Intermittent local heat and back rubs promote muscle tension

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Instruct to move the trunk as a unit and avoid twisting.

Reference: Textbook of Medical-Surgical Nursing 11th Edition

Suzanne C. Smeltzer Brenda G. Bare Janice L. Hinkle Kerry H. Cheever

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