OSTEOPORSIS                                                        

Overview    

u      Age related bone disease

u      Severe general reduction in the skeletal bone mass

u      Increased susceptibility to fractures

u Wrist, hip, vertebral column

u      Bone resorption occurs faster than bone formation

u      At the time of menopause, women experience a marked acceleration in bone loss.

u      Peak bone mass and the subsequent rate and duration of bone loss determines whether bones will be compromised and result in fragility fractures.

 

Classifications

u      Primary

u occurrence among older persons in whom no secondary predisposing condition exists

u    this includes postmenopausal osteoporosis and the osteoporosis of aging.

u      Secondary

u results from an associated condition such as hyperparathyroidism, long-term corticosteroid or heparin usage.

 

Risk Factors

u      Female gender

u In postmenopausal women, estrogen production and bone calcium storage decrease

u    Estrogen appears to protect against bone loss.

u      Advanced age

u      Family history

u      Sedentary lifestyle

u      Small framed body build

u      Inadequate dietary intake of calcium

u      Excessive alcohol consumption

u      Long term use of corticosteroids, anticonvulsants, furosemide

u      Heavy cigarette smoking

 

Clinical Manifestations

u      Often not dx until the client presents with a fracture

u shortened stature

u marked kyphosis of thoracic spine

u impaired breathing

u pain at fracture site

 

Diagnosis

u      X-ray shows degeneration in the lower vertebrae

u      Loss of bone mineral appears in later disease

u      Serum calcium, phosphorus, and alkaline phosphatase remain WNL

u      PTH may be elevated

u      Bone biopsy detects changes in bone cells

u      CT scan allows accurate assessment of spinal bone loss

u      Radionuclide bone scans display injured or diseased areas as darker portions.

u      Dual photon or dual energy x-ray can detect bone loss in a safe noninvasive test.

 

Acute and Subacute Care

u      Medical Management

u management of fractures if present

u physical therapy

u medication to inhibit bone loss and rebuild

u corseting to relieve back pain

u pain management

u dietary modification - high calcium                 

u      Medications

u Estrogen replacement after menopause to prevent osteo

u    inhibits osteoclast activity - decreased bone resorption

u    most effective when combined with calcium

u    Calcitonin (Cibacalcin, Calcimar)

uinhibits osteoclastic bone absorption

ucan be given IM, SC, intranasally

uneeds adequate amounts of calcium and vitamin D to work well

u      Biphosphonate

u    inhibit osteoclast mediated bone resportion

u    increases bone mass density

uFosamax  (alendronate)

u      Selective estrogen receptor modulators

u Evista (raloxifene)

u Mimics the effect of estrogen on bone by reducing bone resorption without stimulating breast or uterine tissues

u Increases bone mass density

u Does not relieve menopausal symptoms

 

u      Sodium Fluoride

u Appears to decrease the solubility of bone mineral and stimulates bone formation

u      Dietary Modifications

u Calcium intake:

u1200 mg/day for adolescents, pregnant or lactating women, all adults through mid 30s.

uPost menopausal women need 1500 mg/day if not taking estrogen.

 

 

u Eat milk, and other diary products

u Oysters

u Sardines with bones !

u Beans

u Cauliflower

u Greens

u Some nuts

 

Nursing Interventions

u      Teaching patient and family factors influencing the development, interventions to slow the process, and measures to relieve sx.

u      Inform re: adequate dietary or supplemental calcium, regular wt. bearing exercise.

u      Modification of life style—reduced caffeine, smoking, alcohol cessation.

u      Need for exercise and physical activity to maintain high-density bones.

u      Inform re:  foods high in calcium.

u      Encourage calcium supplements with meals and adequate fluids.

u      Inform pts that at menopause, HRT may be prescribed

u      Aldendronate should be taken on an empty stomach

u      Inform patient that HRT has been associated with a slightly increased incidence of breast and endometrial CA

u Pt must do monthly breast exams and have regular pelvic examinations.

u      Teach pain relief of back pain through bed rest, knee flexion, firm mattress, local heat and back rubs

u      Apply lumbosacral corset for immobilization and support

u      Instruct pt to move trunk as a unit and avoid twisting, maintain good body mechanics

u      Improving Bowel Elimination

u Encourage high fiber diet

u Increase fluids

u Use stool softeners

u Monitor intake, bowel sounds, bowel activity

u    Ileus may develop if vertebral collapse involved T10-L2 vertebrae