OSTEOPOROSIS

OSTEOPOROSIS
• Silent disorder because present long before symptoms occur
• A disease that threatens more than 28 million Americans
• Characterized by reduction of total bone mass and change in bone structure increase
susceptibility to fracture
• Rate of bone reabsorption > rate of bone formation = reduced total bone mass
• Bone becomes progressively porous, brittle, fragile
• Fracture easily under stresses that would not break normal bone
• Frequent results in compression fracture of thoracic and lumbar spine (skeletal deformity)
• Colles’ fracture of wrist
• Most costly $, in terms of human suffering, pain, disability, fracture, and death
• Gradual collapse of vertebra may be asymptomatic; observed as progressive kyphosis
• Kyphosis (dowager’s hump) associated with height loss – FIRST SIGN
• Frequent post menopausal women lose height form vertebral collapse – Back Pain
• Postural change result relaxation of abdominal muscles, protruding abdomen
• May produce pulmonary insufficiency – SOB, Dyspnea
• Many Complain of fatigue
• Increase Ca intake, participate regular weight bearing exercises, modification of lifestyle;
Decrease caffeine, cigs, alcohol these will decrease the risk for developing osteoporosis,
Fractures, and other disabilities later in life.

GERONTOLOGIC CONSIDERATIONS
• Prevalence in women older than 80 years 84%
• Back pain
• SOB, dyspnea – because of decrease expansion of lungs
• Aging population incidence of following rise
o Incidence of fracture
o Pain
o Disability
• Absorb dietary Ca less efficiently and excrete it more readily through kidneys
• Post menopausal women, elderly consume as much 1500mg/day
PATHOPHYSIOLOGY
• Normal bone remodeling adult result in increase bone mass until about 35 years
• Factors influence peak bone mass / development of osteoporosis
o Genetics – Aging
o Nutrition
o Lifestyle choices (smoking, caffeine, alcohol consumption)
• Bone loss universal phenomenon associated with aging
• Age related loss begins soon after peak bone mass achieved
• Calcitonin
o Inhibits bone reabsorption, promotes bone formation - decreases
• Estrogen
o Inhibits bone breakdown – decreases with aging
• Parathyroid
o Hormone increases with aging, increases bone reabsorption
• Withdrawal of estrogens and menopause and with Oophorectomy causes accelerated
bone reabsorption that continues during post menopausal years
• Women develop more frequent, more extensively than men because of lower peak bone
mass, effect of estrogen loss during menopause
• More than ½ all women older than 45 years of age show evidence of osteoporosis on X-
ray

RISK FACTORS
• Small, framed, nonobese white women and at increased risk
o Lack weight bearing, smoking, caffeine, alcohol
• African American because greater bone mass are less susceptible
• Men > peak bone mass, do not experience sudden hormonal changes occur lower rate,
at older age
• Nutritional factors
o Vitamin D – Ca absorption, normal bone mineralization
o Dietary Ca, vitamin D adequate to maintain bone remodeling, body functions
o Best source Ca / Vitamin D = fortified milk
• Bone formation enhanced by stress of weight, muscle activity
• Immobility contributes to development
• When immobilized by casts, paralysis, general inactivity, bone resorbed faster than
formed, osteoporosis occurs
• Coexisting medical conditions
o Malabsorption syndromes, Lactose intolerance
o Alcohol abuse, renal failure, liver failure
o Cushings Syndrome, Hyperthyroidism
o Hyperparathyroidism
• Medications – Can affect the bodys use and metabolism of Ca
o Corticosteriods, Isoniazid, heparin, tetracycline
o Aluminum containing antacids
o Furosemide, anticonvulsants, thyroid supplements
o Lithium – Long term
o Chemotherapy agents
• Degree osteoporosis Related to duration of medication therapy
 • Therapy d/c or metabolic problem corrected, progression halted but restoration lost bone
mass usually does not occur
ASSESSMENT AND DIAGNOSTIC FINDINGS
• Identified on routine x-rays when 25-40% demineralization
• DEXA – Dual Energy x-ray Absorptiometry
o Provides information about bone mass at spine and hip
• Ultrasonic Heel – Density bone sonometer
o Used to diagnose osteoporosis and predict risk of fracture

• Lab studies
o Serum Ca
o Serum Phosphate
o Serum Alkaline Phospatase
o Urine Ca excretion
o Urinary hydroxyproline excretion
o Hematocrit
o Erythocyle sedimentation rate

• Bone density
o Single photon
o Duel photon
• Thyroid function test
• Parathyroid

MEDICAL MANAGEMENT
• Strengthen bone to prevent patient from suffering fracture
• Adequate, balanced diet rich Ca, Vitamin D throughout life – (1000 – 1500mg)
o Increase Ca intake during adolescence, young adulthood, and middle age to
protect against skeletal demineralization
• Tums
o Cheapest Ca supplement

• 3 glasses skim or whole vitamin D milk or other food high in Ca (cheese, other dairy
products, steamed broccoli, canned salmon with bones) daily
o 1C Plain nonfat yogurt – 400mg; 1oz C. Cheese; 1oz M. Choc – 25mg; Collar
greens 1C 289mg
o Adults 1000mg/day
o Postmenopausal 1000-1500mg/day

• Ca supplement (Ca carbonate) taken with meals or beverage high in vitamin C to promote
absorption
o Take one hour before meals
o Common side effects Ca supplements
 Abdominal distention
 Constipation (teach to increase H20 and fiber)
 • Regular weight bearing exercise (20-30 minutes aerobic exercise) Walking 3 days or
more a week.
o Exercise improves balance, reducing falls, fractures
• Sunlight increases vitamin D absorption
PHARMACOLOGIC THERAPY
• HRT with Estrogen, Progesterone to retard bone loss, Prevents occurrence of Fracture
o Estrogen: Decreases bone reabsorption, Increases bone mass reducing incidence
of osteoporotic fractures
 Been associated with slightly increase incidence breast, endometrial cancer
 Using lowest effective dose decreases cancer risk
 Combined with progesterone diminish potential risk for endometrial cancer
o HRT contraindicated with pregnant or who have undiagnosed vaginal bleeding;
active thrombophlebitis; endometrial, breast cancer, Estrogen dependent tumors,
and acute liver disease
 Examine breast monthly
 Pelvic Exam with Pap smear, Endometrial bx – 1 to 2 times a year
Common Side effects of HRT
o Periodic bleeding or spotting
o GI upset
o Breast tenderness
o Mood swings
o Fluid retention
o Weight gain

• Designer Estrogens such as Raloxifene (Evista) decrease the risk for osteoporosis
without increasing the risk for breast cancer
• Fluorinated toothpaste / H20 increases bone formation
Pain Treatment
o Firm mattress, Back rubs
o Heat
o No twisting motion – move as one unit
• Home: Clutter free with grab bars / shower stool

• Alendronate (Fosamax)
o Alternative to HRT
o Produces increase in bone mass by inhibiting osteoclast function (Dec bone loss)
o Taken early AM with 8oz of water while sitting up. 30-60 minutes before food (must
be on empty stomach) or before other meds for maximum absorption
o Adequate Ca, Vitamin D needed for max effect
Common Side Effects of Fosamax
 Dyspepsia, Nausea, Flatulence
 Diarrhea, Constipation

• Calcitonin
o Suppresses bone loss through direct action on osteoclasts, decreasing bone
turnover
o Administer by nasal spray, SQ or IM
  Alternate nares
 SQ at HS cause flush of face
Common Side Effects of Calcitonin
o Nasal irritation
o Flushing, GI disturbances, Urinary frequency

NURSING DIAGNOSIS
• Knowledge deficit about osteoporotic process
• Pain R/T fracture / muscle spasms
• Constipation R/T immobility
• R/F injury related to Osteoporosis

NURSING CONSIDERATIONS
• Constipation
• Pain
• Bowel elimination
• Prevention of injury