OSTEOPOROSIS

Contents
INTRODUCTION .................................................................................... 1
ETIOLOGY .............................................................................................. 2
Risk Factors for Osteoporosis .................................................................. 3
SYMPTOMS: ........................................................................................... 3
TREATMENT ....................................................................................... 4
PATIENT CARE ................................................................................... 4
DIAGNOSIS: ......................................................................................... 5
o. circumscripta cranii ........................................................................... 5
o. of disuse ............................................................................................. 5
glucocorticoid o. .................................................................................... 5
juvenile o., idiopathic juvenile o. .......................................................... 5
posttraumatic o....................................................................................... 5

INTRODUCTION
osteoporosis (o˘s_te.-o.-por-o._sı˘s) [poros, a passage, _ osis, condition]
Loss of bone mass that occurs throughout the skeleton, predisposing patients to
fractures. Healthy bone constantly remodels itself by taking up structural elements
from one area and patching others. In osteoporosis, more bone is resorbed than laid
down, and the skeleton loses some of the strength that it derives from its intact
trabeculation. Aging causes bone loss in both men and women, predisposing them
to vertebral and hip fractures. This is called type II osteoporosis (formerly “senile”
osteoporosis). Type I osteoporosis (also known as “involutional” bone loss) occurs
as a result of the loss of the protective effects of estrogen on bone that takes place
at menopause.
ETIOLOGY: Multiple modifiable factors contribute to bone mass and strength:
increased body weight, higher levels of sex hormones, higher amounts of calcium
and vitamin D in the diet, and frequent weight-bearing exercise all build up bone and
prevent fractures.
Bone loss and the risk of fractures increase with age, immobilization, thyroid
hormone excess, the use of corticosteroids and some anticonvulsant drugs, the
consumption of alcohol, tobacco, and caffeine, and after menopause. Genetics (a
nonmodifiable risk factor) also contributes to osteoporosis. SEE: table.
Risk Factors for Osteoporosis
Female
Advanced age
White or Asian
Thin, small-
small-framed body
Positive family history
Low calcium intake
Early menopause
menopause (before age 45)
Sedentary lifestyle
Nulliparity
Smoking
Excessive alcohol or caffeine intake
High protein intake
High phosphate intake
Certain medications, when taken for a long time (high doses of
glucocorticoid, phenytoin, thyroid medication)
Endocrine
Endocrine diseases (hyperthyroidism, Cushing’
Cushing’s disease, acromegaly,
hypogonadism, hyperparathyroidism)
SOURCE: Stanley, M and Beare, PG: Gerontological Nursing, FA Davis,
Philadelphia,1995.
Philadelphia,1995.

SYMPTOMS: Bone loss progresses for many years without causing

symptoms. When it results in fractures, bone pain and loss of mobility may be
disabling. Signs of osteoporosis include deformities of the skeleton, such as
kyphosis (the so-called “dowager’s hump”), and loss of height, especially if vertebral
compression fractures occur.
TREATMENT: Supplemental calcium and regular exercise help slow or prevent
the rate of bone loss and are recommended for most men and women.
Bisphosphonate drugs (such as alendronate), calcitonin, sodium fluoride, and other
agents are useful for patients of either gender. In menopausal women, estrogen
supplementation or the selective estrogen receptor modulators help prevent bone
loss and fractures.
PATIENT CARE: Protection against osteoporosis should begin in childhood and
adolescence, focusing on building bone mass. Encourage children to eat calcium-
rich foods and teach parents to encourage regular exercise, including school gym
classes and sports programs, to build strong bones and establish healthy lifestyle
habits. Parents also should be informed about the effects eating disorders,
excessive dieting, excessive exercise, alcohol consumption, and smoking have on
bone density. From the mid-20s through age 35, focus continues to be placed on
building and maintaining bone mass through a calcium- rich diet. After age 35, bone
resorption exceeds bone formation. Emphasis is placed on preventing bone loss
through a healthy diet, use of calcium (plus vitamin D) supplements (ensure an
intake of at least 1000 mg of calcium per day), and weight-bearing exercises such as
weight-lifting, walking, jogging, dancing, and climbing stairs. High-impact aerobics
may create too much stress on the bones of older adults and should be avoided.
After patients have been diagnosed with osteoporosis, time should be spent
assessing their diets and activity levels. Although patients should engage in walking
or other weight-bearing activity for 30 to 60 minutes three to four times a week, this
goal may need to be approached slowly. Foods that are rich in calcium include dairy
products, spinach, sardines, and nuts. Calcium supplements totaling 1000 to 1500
mg per day should be consumed. Supplements can prevent further bone loss. Based
on bone density testing, alendronate or another drug that inhibits bone resorption
may be prescribed in a daily or weekly formulation. Teach the patient to take this
drug on an empty stomach with a full glass (8 oz) of water only, first thing in the
morning, and then to remain inan upright position for 30 minutes while refraining
from eating or drinking.

DIAGNOSIS:
Dual energy x-ray absorptiometry (DEXA scanning) is recommended by the World
Health Organization for the early diagnosis of bone loss. Dual photon absorptiometry
and quantitative computerized tomographic scanning of bone can also be used.
o. circumscripta cranii Localized osteoporosis of the skull associated with
Paget’s disease.
o. of disuse Osteoporosis due to the lack of normal functional stress on the
bones. It may occur during a prolonged period of bedrest or as the result of being
exposed to periods of weightlessness (e.g., astronauts in outer space).
glucocorticoid o. Bone loss that results from prolonged treatment with oral or
inhaled steroids, such as prednisone, beclomethasone, or triamcinolone.
juvenile o., idiopathic juvenile o. A rare childhood disease of inadequate
bone mineral density, characterized by poor bone formation that usually improves
spontaneously during puberty or young adulthood. Affected children often complain
of bone or back pain, muscle weakness, or impaired gait. Fractures of long bones
and vertebral compression fractures are common. Other diseases of bone formation,
such as osteogenesis imperfecta, must be excluded before a diagnosis of juvenile
osteoporosis is made. Affected children are usually asked to refrain from
participation in sports to lessen the risk of fractures.
posttraumatic o. Loss of bone tissue following trauma, esp. when there is
damage to a nerve supplying the injured area. The condition may also be caused by
disuse secondary to pain.