OSTEOPOROSIS

Objective
• Review the functions of osteoclast and osteoblast in modelling of bones

• Define osteoporosis

• Explain the risk factors

• Describe the pathophysiology for osteoporosis

• Explain the assessment and diagnostic test for patients with osteoporosis

• Describe the medical management for osteoporosis

Functions of osteoclast
and osteoblast

• https://www.youtube.com/watch?v=78RBpWSOl08
 Peak Bone Mass
• Peak Bone Mass (PBM)is defined as the
amount of bony tissue present at the end of
the skeletal maturation.

• directly dependent upon both its volume

or size and the density of the mineralized
tissue contained within the periosteal
envelope
 Bone Mineral Density
• Bone Mineral Density (BMD) is
the amount of minerals (mostly
calcium and phosphorous)
contained in a certain volume of
bone
Osteoporosis
• Osteoporosis is a disease that is characterized by low bone mass, deterioration of
bone tissue, and disruption of bone microarchitecture

• It can lead to compromised bone strength and an increase in the risk of fractures

• Osteoporosis is a silent disease until the patient experiences a fracture

Osteoporosis (cont..)
• Osteoporosis has been mislabeled as a women’s disease by the public, but it
affects men too

• Young men are affected by it, which usually goes undiagnosed until a fracture

• Delayed interventions are usually unsuccessful

Osteoporosis (cont..)
• The diagnosis of osteoporosis is never
taken as primary osteoporosis without
ruling out the secondary causes.

• Primary osteoporosis occur in women after

menopause and in men later in life.

• Men are more likely to suffer from

secondary causes of osteoporosis
 Risk factors
Genetics
• Caucasians/Asians
Predisposes to
• Females
low bone mass
• Family history

Age
• Post menopause
Hormones • Advanced age
inhibits bone • Low testosterone
loss • Low calcitonin
Risk factors
Nutrition
• Low calcium intake
Reduced
nutrients needed • Low Vit D intake
for bone • High phosphate intake
remodeling • Inadequate calories

Physical exercise
Bones need • Post menopause
physical stress • Advanced age
for bone • Low testosterone
maintenance • Low calcitonin
 Risk factors
Lifestyle Choices

• Caffeine
Reduces osteogenesis
• Alcohol
in remodeling
• Smoking
• Lack of exposure to sunlight

Medications/ Comorbidity
• Corticosteroids/Antiseizure medications/
Affects calcium Heparin and thyroid hormone
absorption and • Anorexia nervosa/ hyperthyroidism/ renal
metabolism failure and malabsorption syndrome
 Pathophysiology
Hormone (estrogen, testosterone and growth hormone) keep the number and activity of
osteoblast than osteoclasts

Physical exercise and proper diet (Calcium & vitamin) help bone to get stronger and denser
to maintain the peak bone mass (infant to 30 years)

After this age osteoclast

gradually remove more
bone than osteoblasts
can make
 Normal bone

Signs and Symptoms

• Asymptotic

• Peripheral fractures
Deformity Radiolucency of the bones
• Localized pain

• Tenderness

• Deformity
Signs and Symptoms (cont..)

Compression Fractures

• Respiratory dysfunction
• Kyphosis
• Loss of height
• Vertebral
compression
fractures
• Paralytic Ileus (T10 – L2)
 Diagnostic Evaluation and Assessment

• Xray

• MRI

X ray
 Diagnostic Evaluation and Assessment (cont..)
Initial laboratory tests

• Renal profile (Urea, Creatinine)

• Calcium, phosphorus, magnesium

• Liver function tests

• Full blood count ( ESR, Hb, WBC, RBC and platelets )

• 25 Hydroxyvitamin D

• Thyroid stimulating hormone

• Parathyroid hormone
Medical Management
• Pharmacological management
• Calcium-recommended 1000 to 2000mg and Vitamin D supplements 800 to
1000mg.
• Anti- resorptive agents – Biphosphate and Calcitonin
• Hormone replacement therapy
• Fracture Management
• Fractures of hip- Joint replacement or ORIF
Percutaneous vertebroplasty
• Compression fractures –
• conservative management ( pain and dietary management)
• Percutaneous vertebroplasty
Medical Management (cont..)

Non Pharmacological Management

• Diet

• Vitamin C (citric food, cabbage family)

• Vitamin D (fortified milk, Oily fish such as salmon mackerel sardines)

• Reduce animal protein ( red meat)

• Intake of calcium ( milk, cheese, yogurt, soya beans)

Medical Management (cont..)
Non Pharmacological Management
• Weight bearing and resistance exercise

• Cessation of smoking and alcohol consumption

• Adequate sun exposure

Nursing Management
• Pain related to restricted movement

• Impaired physical mobility related to pain

• Altered nutritional balance less than body requirement

• Risk for fall related to pain, restricted movement

• Knowledge deficit related to complications, treatment and disease process