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DEFINITION

Osteoporosis is the most common metabolic bone disorder. Osteoporosis causes decreased bone mass and an increased risk of fracture. The disease is a significant cause of morbidity in the older adult.

ETIOLOGY

A multifactorial disease Has two major causes; calcium deficiency and estrogen levels deficiency Decreased estrogen levels are secondary to menopause, and hypocalcemia is believed to be a result of chronic inadequate dietary calcium ingestion. Other causative factors include medications, (corticosteroid and heparin), cigarette smoking, excessive caffeine ingestion, endocrine disorder (hyperthyroidism, hyperparathyroidsm, diabetes mellitus, glucocorticoid excess) prolonged bed rest, liver disease alcoholism.

EPIDEMIOLOGY
Approximately 15 to 20 million Americans are thought to suffer from osteoporosis. Women are eight time more likely to suffer from osteoporosis than men. They are usually white, post menopausal ad underwight. 90 % of women will have the disorder by the age of 75

PATHOPHYSIOLOGY

Osteoporosis is a reduction in bone mass with bone resorption exceed bone formation. Bone mass peaks at approximately 35 years and then subsequently begins to decrease. In the perimenopausal period increased bone loss Bone remodeling or the process of bone breakdown and formation is a constant process Lack of stress to the bone causes demineralization of bone. With Hypocalcemia, calcium is released from bone to reestablish the normal serum level. After the age of 35 when the bone mass peaks and bones are strongest, bone resorption begins to exceed bone formation, resulting in decreased bone density. Women over 40 also absorb less calcium from food. Estrogen is though to decrease bone resorption, decrease renal calcium loss and increase calcium absorption in the GIT.

CLINICAL MANIFESTATION

Height loss Dorsal Khyposis Back pain Fractures, Bone most commonly affected: Wrist & Hip Vertebral crush fractures, most commonly of the twelfth thoracic and first lumbar vertebrae, may result from daily activity such as bending Women suffer from hip fractures two to three times more frequently than men. Diagnostic studies include: x ray, however the finding will not definitive until approximately 30 % of bone mass to loss.

THERAPEUTIC MANAGEMENT

Management is aimed to decrease the process of bone resorption, increasing bone formation, and preventing fractures. Treatment measure are postmenopausal estrogen replacement therapy and adequate dietray or supplemental calcium. Recommendation for calcium supplementation are 1000 mg, premenopausal and 1500 mg postmenopausal. Studies indicate that the average daily adult calcium intake is 450 to 550 mg. Calcium supplement and vitamin D supplement may be prescribed to increase calcium absorption.

NURSING MANAGEMENT
ASSESSMENT

Determinate of height loss dorsal khyposis presence of back pain, and occurrence of fractures or repeated fractures. Address psychosocial issues: change in body image and limitation in vocational and recreational activities.

NURSING MANAGEMENT (Cont)

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NURSING DIAGNOSES Chronic pain r/t decreased bone mass Impaired physical mobility r/t decreased bone mass and possible fractures Altered nutrition: less than body requirement r/t inadequate calcium and/or vitamin D intake Body fluid disturbance r/t body changes and disease process. Knowledge deficit regarding disease process and treatment regimen

NURSING MANAGEMENT (Cont)

PLANNING Nursing care is planned to attain the following patient outcomes: 1. Patient achieves management of pain 2. Patient functions within restricted mobility limitations 3. Patient attains and/or maintains optimal nutrition 4. Patient develop a more positive self concept 5. Patient can explain the disease process and treatment regimen

NURSING MANAGEMENT (Cont)

IMPLEMENTATION Administer prescribed medication to control pain and monitor possible side effect Back bracing or other supportive devices may be used to decrease pain. Apply warm compresses to control pain Promote body mechanic and ROM Promote adequate and well balanced diet high in calcium and vitamin D and wise selection of calcium supplement. Encourage to exposure to sunlight to optimize the bodys production of vitamin D. Provide much information about osteoporosis.