Osteoporosis

Definition

is a progressive  bone  disease  that is characterized by

a decrease in bone mass and density which can lead to
an increased risk of  fracture .Typical fragility
 fractures occur in the vertebral column, rib, hip and
.wrist
 Pathophysiology
Reduced total bone mass. the rate of bone resorption that is maintained by
osteoclasts is greater than the rate of bone formation that is maintained by
osteoblasts, resulting in a reduced total bone mass.
Progression. The bones become brittle, fragile; they fracture easily under
stresses that would not break normal bone.
Age-related losses. Calcitonin and estrogen decrease with aging, while
parathyroid hormone increases, increasing bone turnover and resorption.
Consequence. The consequence of these changes is loss of bone mass over time.
 Classification

 Primary osteoporosis. Primary osteoporosis occurs in women after

menopause and in men later in life, but it is not merely a consequence of
aging but of failure to develop optimal peak bone mass during
childhood, adolescence, and young adulthood.
 Secondary osteoporosis. Secondary osteoporosis is the result of
medications or other conditions and diseases that affect bone metabolism.
 Causes and risk factor
1. Genetics . African American women low risk to osteoporosis than Asian.
2. Age. risk for osteoporosis increases with increasing age.
3. Nutrition. A low calcium intake, low vitamin D intake, high phosphate intake.
4. Physical exercise. A sedentary lifestyle increases the risk for osteoporosis .
5. Lifestyle . alcohol consumption, smoking, and lack of exposure to sunlight.
6. Medications. corticosteroids,anti seizure medications affect calcium
absorption.
 Clinical Manifestations

• Fractures. most commonly as compression fractures.

• Kyphosis. The gradual collapse of a vertebra result in loss of height.
• Decreased calcitonin. Calcitonin, promotes bone formation, is decreased.
• Decreased estrogen. which inhibits bone breakdown, decreases with
aging.
• Increased parathyroid hormone. Parathyroid hormone increases with
aging, increasing bone turnover and resorption.
• Pain, fatigue, depression, or anxiety from fear of breaking a bone.
 Assessment and Diagnostic Findings

 Dual-energy X-ray Absorptiometry (DXA). Osteoporosis is diagnosed

by DXA, which provides information about BMD at the spine and hip.
 BMD testing. BMD testing is useful in identifying osteopenic and
osteoporotic bone and in assessing response to therapy.
 Laboratory studies. Laboratory studies such serum calcium and Vitamin
D.
 Medical Management
Non Pharmacologic Therapy :-
 Diet. A diet rich in calcium and vitamin D .
 Exercise. Regular weight-bearing exercise promotes bone formation.
Pharmacologic Therapy:-
 Calcium supplements with vitamin D
 Calcitonin. reducing bone loss and increasing bone mineral density.
 Teriparatide. it stimulates osteoblasts to build bone matrix .
 Surgical Management
• Joint replacement. Joint replacement is a surgery to replace all or part of
a joint with a man-made joint called prosthesis.
• Closed or open reduction with internal fixation
 Nursing Management
Nursing Diagnosis :-
1. Acute pain related to fracture and muscle spasm.
2. Risk for constipation related to immobility or development of ileus.
3. Risk for injury: additional fractures related to osteoporosis.
Nursing Interventions :-
 Advise the patient to rest in bed in a supine or side-lying position
 knee flexion increases comfort.
 intermittent local heat and back rubs promote muscle relaxation.
 Administer analgesics as prescribed to relieve pain.
 encourage good posture and teach body mechanics.
 Early institution of high fiber diet, increased fluids intake .
 use of prescribed stool softeners help prevent or minimize constipation.
 The nurse encourages walking, good body mechanics. and good posture.
 avoid smoking, alcohol, and caffeine.