Osteoporosis

Nachinab Gilbert
 Osteoporosis
• osteoporosis is defined as a skeletal disorder
characterized by compromised bone strength
that predisposes to an increased risk of fracture

• It results from an imbalance between calcium

resorption and bone formation resulting in an
overall loss of bone tissue and increases the risk
of fracture.

• Osteoporosis generally does not become clinically

apparent until a fracture occurs
Aetiology
• Postmenopausal osteoporosis (PMO) is primarily
due to estrogen deficiency

• Age associated or senile osteoporosis is primarily

due to an aging skeleton and calcium deficiency

• Idiopathic osteoporosis

• Juvenile osteoporosis ( onset is at age 8-14yrs)

Pathogenesis
• Normal bone remodelling in adults results in
increased bone mass until about age 35.
• Generally, between ages 30 and 40, the rate of
calcium reabsorption is about balance with bone
formation
• After age 50, there begins imbalance between
calcium reabsorption and bone formation referred
to as age – related loss.
• Osteoporosis may result from
 the withdrawal of oestrogen at menopause,
nutritional factors such as lack of vitamin D
and calcium for absorption and for normal
mineralisation
 lack of physical activity
 Clinical features
• Fracture of any bone most commonly of the wrist
(Colle’s Fracture), vertebral and hip
• Pain either localised or radiating
• Tenderness
• Muscle spasms
• Loss of normal lumbar curve
• Kyphosis
Diagnostic investigations
• History and physical examination
• Serum calcium, phosphorus and alkaline
phosphate
• Radiology (decreased bone density, wedging of
the vertebrae)
• Bone biopsy
Medical treatment
• Calcium supplement (e.g. calcium carbonate or
calcium citrate)
• Vitamin D supplements
• Diet high in calcium e.g. cup of milk, chocolate,
cheese, salmon
• Oestrogen replacement therapy
• Calcitonin
• Surgery for pathological fractures
 Nursing management
Treatment
• Serve drugs as prescribed for example, oestrogen
replacement of postmenopausal levels and
testosterone to increase bone mass

• Serve calcium gluconate plus vitamin D

 Diet
• Exposure to sunlight for vitamin D
• Give foods high in calcium and vitamin D (from
dairy products)
• Discourage patient from taking carbonated drinks
(thought to contain phosphorus which is linked to
bone reabsorption)
Exercise
• Ensure range of motion exercises for patient
hospitalised
• Recommended regular weight bearing exercise to
your patient (if indicated to prevent bone loss)
• Instruct patient to exercise within his/her
range/limit.
• Daily walking, jogging and stair climbing to
improve general wellbeing of client
 Observation
• Monitor for side effects of medications

• Check client’s skin for redness, warmth and

new sites for pain (possible indication of
fracture)
Safety and Injury Prevention
• Keep side rails up to prevent falling from bed

• Move patient gently and carefully at all times

• Explain to the family and other paramedics

how easily the patient’s bone can fracture

• Ensure dry and well mop floor to prevent

accidental falls especially in the elderly
 Prevention and health education
• Teach patient healthy habits related to
lifestyle example avoidance of alcohol,
caffeine and stress
• Encourage exercise for patients and other
persons
• Explain the value of walking daily to provide
for strong bone remodelling
• Encourage regular exercise for patient
(especially weight bearing exercise)
 Prevention and health education
cont.
• Advise patient to sleep on a firm mattress but
to avoid excessive rest
• Teach patient on body mechanics (that is
stoop before lifting object)
• For female patients on oestrogen, explain to
them to have regular gynaecological check –
ups and report any abnormal bleeding.
 Prevention and health education
cont.
• Encourage patient and family to adhere to
prescribed medication
• Provide information in relation to adequate
daily intake of 800mg or more calcium
• Participate in dietary education related to
vitamin D intake
• Thoroughly explain osteoporosis to patient
and family members.