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PART 4

Nutrition for Health and Fitness

Height

BOX 24-2
Common Medications
That Increase Calcium Loss and
Promote Risk of Osteoporosis
Phenytoin (Dilantin)
Phenobarbital
Thyroid hormone
Corticosteroids
Lasix and thiazide diuretics
Methotrexate
Cyclosporine
Lithium
Tetracycline
Aluminum-containing antacids
Heparin
Phenothiazine derivatives

40

60

70

BOX 24-3

Age

FIGURE 24-9 Normal spine at age 40 and osteoporotic

changes at ages 60 and 70. These changes can cause a loss
of as much as 6 to 9 in in height and result in the so-called
dowager's hump (far right) in the upper thoracic vertebrae.
(From Ignatavicius D, Workman M: Medical-surgical nursing:
critical thinking for collaborative care, ed 5, Philadelphia,
2006, Saunders).

Etiology
Osteoporosis is a complex heterogeneous
disorder of unknown etiology, but many risk factors contribute to this
condition over a lifetime. Although the fracture-precipitating condition of low BMD is common to all types of osteoporosis, an imbalance between bone resorption and formation results from an array of etiologic factors characteristic
of each form of this disease.
Loss of bone mass to a degree that produces fractures can
result from: (1) an excessive acceleration of resorption, especially after the menopause; or (2) a suboptimal peak bone
mass that results in bone after the menopause (or later in life
in males) that becomes fragile and susceptible to fracture.
The Pathophysiohgy and Care Management Algorithm, Parathyroid Hormone-Mediated
Post-Menopausal
Bone Osteoporosis, lists several risk factors and illustrates different scenarios
of older or younger postmenopausal women that lead to osteoporotic fractures. Risk factors for osteoporosis include
age, race, gender, and factors noted in Box 24-4.

Race and Ethnicity

Whites and Asians suffer more osteoporotic fractures than
blacks and Hispanics, who have a greater bone density (Siris
et al, 2001). Hypovitaminosis D with secondary hyperparathyroidism occur more often in the black population. Thin
women, particularly of northern European extraction, are
more at risk of osteoporosis than heavier women.

Medical Conditions That Deplete

Calcium and Promote Risk of Osteoporosis
Hyperthyroidism
Diabetes
Chronic renal failure
Scurvy
Chronic diarrhea or intestinal malabsorption
Hyperparathyroid disease
Chronic obstructive lung disease
Subtotal gastrectomy
Hemiplegia

Menstrual

Status

Loss of menses at any age is a major determinant

of osteoporosis risk in women. Acceleration
of bone loss coincides
with the menopause,
either natural or surgical, at which
time the ovaries stop producing estrogen. Estrogen replacement therapies have been shown to conserve BMD
and reduce fracture risk within the first few years following the menopause, at least in short-term studies.
Any interruption
of menstruation
for an extended period results in bone loss. The amenorrhea that accompanies excessive weight loss seen in patients with anorexia
nervosa or in individuals who participate in high-intensity
sports, dance, or other forms of exercise has the same
adverse effect on bones as the menopause. BMD in amenorrheic athletes has been measured at levels 25% to 40%
below control levels. When menses were resumed in these
athletes, bone mass increased, but eventually plateaued at
a level lower than that of sedentary women. Young women
with the "female athlete triad" of disordered
eating,
amenorrhea,
and low BMD are at increased risk for hav-