Osteoporosis

What is Osteoporosis?

- systemic skeletal disease characterized by low bone mass and deterioration of bone
tissue, leading to enhanced bone fragility and a consequent increase in fracture risk
- bone with lower density and higher fracture risk
- Loss in total mineralized bone
- Disruption of normal balance of bone breakdown and build up
- Osteoclasts: bone resorption, stimulated by PTH
- Calcitonin: inhibits osteoclastic bone resorption
Major mechanisms:
- Slow down of bone build up: osteoporosis seen in older women and men (men after
age 70)
- Accelerated bone breakdown: postmenopausal
- Normal loss .5% per year after peak in 20s
- Up to 5% loss/year during first 5 years after menopause

S/s

There typically are no symptoms in the early stages of bone loss. But once your bones have
been weakened by osteoporosis, you may have signs and symptoms that include:
- Back pain, caused by a fractured or collapsed vertebra

-Loss of height over time

-A stooped posture

-A bone fracture that occurs much more easily than expected

Labs/Diagnostics

- Osteoporosis may be undetectable on routine x-rays until there has been 25% to 40%
demineralization, resulting inradiolucency of the bones.

-Osteoporosis is diagnosed by dual-energy x-ray absorptiometry (DXA)

- BMD testing is recommended for all women older than 65 years of age, for all men older
than 70 years of age,

-for postmenopausal women and men older than 50 years of age with osteoporosis risk
factors, and for all people who have had a fracture thought to occur as a consequence of
osteoporosis
- Laboratory studies (serum calcium, serum phosphate, serum alkaline phosphatase, urine
calcium excretion, urinary hydroxyproline excretion, hematocrit, erythrocyte
sedimentation rate [ESR])
 - x-ray studies are used to exclude
other possible disorders (multiple myeloma, osteomalacia,
hyperparathyroidism, malignancy) that contribute to
bone loss.

Medical management

-Diet rich in calcium and vitamin D

-Diet that includes three glasses of skim or whole vitamin D-enriched milk
-Foods high in calcium
-Regular weight bearing exercise- promotes bone formation

Fracture management

- Fractures of the hip that occur as a consequence of osteoporosis

are managed surgically by joint replacement or by
closed or open reduction with internal fixation.

- Osteoporotic compression fractures of the vertebrae are

managed conservatively.

-Pharmacologic and dietary

treatments are aimed at increasing vertebral bone density.
-Percutaneous vertebroplasty or kyphoplasty
can provide rapid relief of acute pain and improve quality of life

Nursing Diagnosis/ Intervention

-Acute pain related to fracture and muscle spasm.

-Deficient Knowledge about osteoporosis and treatment regimen.
-Risk for Constipation related to immobility or development of ileus.
-Risk for injury related to osteoporosis.

Intervention:
- Advise the patient to rest in bed in a supine or side lying position several times a day.
Rationale: knee flexion increase comfort.
- Intermittent local heat and back rubs.
Rationale: promotes muscle relaxation
- Improving bowel movements.
Rationale: early institution of high fiber diet, increased fluids, helps prevent or minimize
constipation.
-Preventing Injury
Rationale: Good posture, good body mechanics and daily weight-bearing activity outdoors to
enhance production of vitamin D.

-
 Menopause
PTH Estrogen Loss of bones Calcitonin
Cause an
PATHOPHYSIOLOGY Fortified accelerated
Occurs in woman bone resorption
Milk
Inhibits bone Age
Aging
breakdown Calcium Body Functioning

Changes in net loss of Nutrition Adequate Vit Maintain bone

bone mass overtime D remodeling

Regular weight bearing Physical Exercise Necessary for

Bone
exercise calcium
mineralization
absorption
Bone formation Lifestyle
First- line calcium
medication is used
Medication Vit D.
caltrate
biphospherate
Reduce bone mass

Detoriation of bone matrix

Diminished bone architectural strength

Bone resorption that maintained by Reduced total

osteoclast is greater than the formation of bone mass
osteoblast

Fractured easily Bone becomes progressively

poor, brittle and fragile

Increase Susceptibility
to fracture Gradual collapse of a vertebrae

Thoracic and lumbar Postural changes result Protruding abdomen

spine in relaxation of muscle

Hip fracture May produce pulmonary

insufficiency
Development of khyposis
Associated loss of weight