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 Factors-

Predisposing 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 Predisposes to low
-Females bone mass
-Family history
-Small frame
Age
-Post-menopause Hormones (estrogen,
-Advance age
calcitonin, and
-Low testosterone in
men testosterone) inhibit
-Decreased bone loss.
calcitonin
Nutrition Diagnostics Studies
-Low calcium intake Reduces nutrients 1.Dual-energy X-ray
-Low vitamin D needed for the bone
-High phosphate Absorptiometry (DEXA)-
remodeling analyzed and reported as
intake
-Inadequate calories T-scores ( the number of
Physical Exercise standard deviations above or below the average
-Sedentary BMD value for young, healthy woman. A normal
-Lack of weight- BMD is less than 1 SD below
Reduces
bearing exercise
-Low weight and osteogenesis in the young adult mean value.
body mass index bone remodeling The WHO defines the
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
Lifestyle Choices below the young adult mean value.
-Caffeine
-Alcohol Affects calcium 2.Quantitative ultrasound
-Smoking absorption and studies (QUS)-use to diagnose
-Lack of exposure to
metabolism osteoporosis and to predict the
sunlight
Medications risk of hip and nonvertebral
-Corticosteroids fracture
-Antiseizure Bones needed stress
medications for bone maintenance.
-Heparin
-Thyroid Hormone
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 Understanding of Osteoporosis and the Treatment
Regimen
 Adequate dietary or supplemental calcium (1200-1500 mg/day) and
vitamin D
 Regular weight-bearing exercise

 Modification of lifestyle like cessation of smoking, reduce the use of

caffeine and alcohol

 Help to maintain bone mass

 Instruct to take the calcium supplements with meals

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

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

 Intermittent local heat and back rubs promote muscle tension

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

Illustration
Reference:
Textbook of Medical-Surgical Nursing
11th Edition

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

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