OSTEOPOROSIS

Dr. Lubna Dwerij

OSTEOPOROSIS
 Osteoporosis is the most prevalent bone disease in the
world.
 The consequence of osteoporosis is bone fracture.
 Peak adult bone mass is achieved between the ages of 18
and 25 years in both females and males and is affected by
genetic factors.
 Bone mass during these years is affected by nutrition,
physical activity, medications, endocrine status, and
general health.
Risk factors for osteoporosis and their effects on bone
remodeling and maintenance
Prevention
 Primary osteoporosis occurs in women after menopause
(usually between the ages of 45 and 55 years) and in men
later in life, but it is not merely a consequence of aging.
 Failure to develop optimal peak bone mass during
childhood, adolescence, and young adulthood contributes
to the development of osteoporosis.
 Early identification of at-risk teenagers and young adults,
increased calcium intake, participation in regular weight-
bearing exercise, and modification of lifestyle (eg,
reduced use of caffeine, cigarettes, carbonated soft
drinks, and alcohol) are interventions that decrease the
risk of osteoporosis, fractures, and associated disability
later in life.
Prevention
 Secondary osteoporosis is the result of medications or
other conditions and diseases that affect bone
metabolism.
 The degree of osteoporosis is related to the duration of
medication therapy.
 When the therapy is discontinued or the metabolic
problem is corrected, the progression of osteoporosis is
halted, but restoration of lost bone mass usually does not
occur.
Pathophysiology
 Osteoporosis is characterized by reduced bone
mass, deterioration of bone matrix, and diminished
bone architectural strength.
 Normal homeostatic bone turnover is altered; 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.
 The bones become progressively porous, brittle,
and fragile; they fracture easily under stresses that
would not break normal bone.
Pathophysiology
 These increase susceptibility to fracture, which occur
most commonly as compression fractures of the thoracic
and lumbar spine, hip fractures, and Colles’ fractures of
the wrist.
 These fractures may be the first clinical manifestation of
osteoporosis
Pathophysiology
 The gradual collapse of a vertebra may be
asymptomatic; it is observed as progressive kyphosis.
With the development of kyphosis ,there is an
associated loss of height.
 Women develop osteoporosis more frequently and more
extensively than men because of lower peak bone mass
and the effect of estrogen loss during menopause.
 The withdrawal of estrogens at menopause or with
oophorectomy causes an accelerated bone resorption
Risk Factors
 Small-framed, nonobese Caucasian women are at greatest
risk for osteoporosis.
 Asian women of slight build are at risk for low peak BMD.
 African American women, who have a greater bone mass
than Caucasian women, are less susceptible to
osteoporosis.
 Men have a greater peak bone mass and do not experience
sudden estrogen reduction.
 As a result, osteoporosis occurs in men at a lower rate and
at an older age (about one decade later).
 It is believed that testosterone and estrogen are important
in achieving and maintaining bone mass in men.
Risk Factors
 Nutritional factors contribute to the development of
osteoporosis.
 A diet that includes adequate calories and nutrients
needed to maintain bone, calcium, and vitamin D must be
consumed.
 Vitamin D is necessary for calcium absorption and for
normal bone mineralization.
 Dietary calcium and vitamin D must be adequate to
maintain bone remodeling and body functions.
 The best source of calcium and vitamin D is fortified milk.
A cup of milk or calcium-fortified orange juice contains
about 300 mg of calcium.
Risk Factors
 The recommended adequate intake (RAI) level of calcium
for all individuals is 1000 to 1200 mg daily
 The recommended vitamin D intake for adults 50 years of
age and older is 800 to 1000 international units (IU) daily.
 Bone formation is enhanced by the stress of weight and
muscle activity. Resistance and impact exercises are most
beneficial in developing and maintaining bone mass.
 Immobility contributes to the development of
osteoporosis.
 When immobilized by casts, general inactivity, paralysis,
or other disability, the bone is resorbed faster than it is
formed, and osteoporosis results.
Assessment and Diagnostic Findings
 Osteoporosis may be undetectable on routine x-rays until
there has been 25% to 40% demineralization.
 Osteoporosis is diagnosed by dual-energy x-ray
absorptiometry (DXA), which provides information about
bone mineral density (BMD) at the spine and hip.
 BMD testing is recommended for:
 All women older than 65 years of age.
 For all men older than 70 years of age.
 For postmenopausal women and men older than 50 years
of age with osteoporosis risk factors, and
 For all people who have had a fracture thought to occur as
a consequence of osteoporosis
Assessment and Diagnostic Findings

 Laboratory studies (eg, serum calcium, serum phosphate,

serum alkaline phosphatase, urine calcium excretion,
urinary hydroxyproline excretion, hematocrit, erythrocyte
sedimentation rate [ESR]) and x-ray studies are used to
exclude other possible disorders (eg, multiple myeloma,
osteomalacia, hyperparathyroidism, malignancy) that
contribute to bone loss.
Medical Management
 A diet rich in calcium and vitamin D throughout life, with
an increased calcium intake during adolescence, young
adulthood, and the middle years, protects against skeletal
demineralization.
 Regular weight-bearing exercise promotes bone formation.
From 20 to 30 minutes of aerobic exercise (eg, walking), 3
days or more a week, is recommended.
Medical Management
 Pharmacologic Therapy
 The first-line medications used to treat and prevent
osteoporosis include calcium and vitamin D supplements
and bisphosphonates.
 Common side effects of calcium supplements are
abdominal distention and constipation.
 Other medications that might be prescribed after these
medications are tried include calcitonin, selective
estrogen receptor modulators, and anabolic agents.
Medical Management
 Pharmacologic Therapy
 Bisphosphonates increase bone mass and decrease bone
loss by inhibiting osteoclast function.
 These medications have demonstrated cost-effectiveness
in preventing osteoporotic-related fractures.
 Adequate calcium and vitamin D intake is needed for
maximum effect, but these supplements should not be
taken at the same time of day as bisphosphonates.
 Side effects of bisphosphonates include gastrointestinal
symptoms (eg, dyspepsia, nausea, flatulence, diarrhea,
constipation).
Medical Management
 Pharmacologic Therapy
 Some patients may develop esophageal ulcers, gastric
ulcers, or osteonecrosis of the jaw related to
bisphosphonate use.
 Patients who take oral bisphosphonates must take these
medications on an empty stomach on arising in the
morning with a full glass of water and must sit upright for
30 to 60 minutes after their administration.
Medical Management
 Pharmacologic Therapy
 Calcitonin (Miacalcin) directly inhibits osteoclasts, thereby
reducing bone loss and increasing BMD.
 Calcitonin is administered by nasal spray or by
subcutaneous or intramuscular injection.
 It should not be prescribed for patients with seafood
allergies.
Medical Management
 Fracture Management
 Fractures of the hip that occur as a consequence of
osteoporosis are managed surgically by joint replacement
or by closed or open reduction with internal fixation.
 Patients need to be evaluated for osteoporosis and
treated, as indicated, in order to prevent additional
fractures.
 Pharmacologic and dietary treatments are aimed at
increasing vertebral bone density.
NURSING PROCESS
 Assessment
 Health promotion, identification of people at risk for
osteoporosis, and recognition of problems associated with
osteoporosis form the basis for nursing assessment.
 The health history includes questions focuses on:
 Family history, previous fractures, dietary consumption of
calcium.
 Exercise patterns, onset of menopause.
 Use of corticosteroids as well as alcohol, smoking, and
caffeine intake.
 Physical examination may disclose a fracture, kyphosis of
the thoracic spine, or shortened stature.
Nursing Diagnoses
 Deficient knowledge about the osteoporotic process and
treatment regimen
 Acute pain related to fracture and muscle spasm.
 Risk for constipation related to immobility or development
of ileus (intestinal obstruction).
 Risk for injury: additional fractures related to
osteoporosis.
Nursing Interventions
 Promoting Understanding of Osteoporosis and the
Treatment Regimen
 Patient teaching focuses on factors influencing the
development of osteoporosis, interventions to arrest or
slow the process, and measures to relieve symptoms.
 It is emphasized that all people continue to need
sufficient calcium, vitamin D, and weight-bearing exercise
to slow the progression of osteoporosis.
 Patient teaching related to medication therapy is
important.
Nursing Interventions
 Relieving Pain
 Relief of back pain resulting from compression fracture
may be accomplished by resting in bed in a supine or side-
lying position several times a day.
 The mattress should be firm.
 Knee flexion increases comfort by relaxing back muscles.
Intermittent local heat and back rubs promote muscle
relaxation.
 The nurse encourages good posture and teaches body
mechanics.
 When the patient is assisted out of bed, a trunk orthosis
(eg, lumbosacral corset) may be worn for temporary
support and immobilization.
Nursing Interventions

 Improving Bowel Elimination

 Constipation is a problem related to immobility and
medications. Early institution of a high-fiber diet,
increased fluids, and the use of prescribed stool softeners
help prevent or minimize constipation.
 If the vertebral collapse involves the T10–L2 vertebrae,
the patient may develop a paralytic ileus.
 The nurse therefore monitors the patient’s intake, bowel
sounds, and bowel activity.
Reference
 Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth's textbook of
medical-surgical nursing (Edition 13.). Wolters Kluwer Health/Lippincott
Williams & Wilkins.