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