Osteoporosis

Done by: dalal hussain alanazi

Is a condition in which the bone matrix is

lost, there by weakening the bones and
making them more susceptible to
fracture.

Osteoporosis

Pathophysilogy and etiology:

The rate of bone resorption increases over the rate of bone formation,
causing loss of bone mass.
Calcium and phosphate salts are lost, creating porous, brittle bones.
Occur most commonly in postmenopausal women, but may also occur
in men.
other factors include:
1.
Age.
2.
Inactivity.
3.
Chronic illness.

Osteoporosis

4.

5.
6.
7.
8.
9.
10.

Medication such as corticosteroids, excessive thyroid replacement,

cyclosporine.
Calcium and vitamin D deficiency.
Family history.
Smoking and alcohol use.
Diet - caffeine has been linked as risk factor.
Race whites and asians have higher risk incidence.
Body type small frame, short stature, low body fat.

Osteoporosis

Clinical manifestations:
Asymptomatic until later stages.
Fracture after minor trauma may be first indication.
Most frequent fracture associated with osteoporosis
include fractures of the distal radius, vertebral
bodies, proximal humerus, pelvis, and proximal
femur (hip).
May have vague complaints related to aging process
(stiffness, pain, weakness)
Estrogen deficiency may be noted.

Osteoporosis

Diagnostic evaluation:
X-ray show changes only after 30% to 60% loss of
bone.
Serum and urine calcium levels are normal.
Serum bone matrix Gla protein (a marker for bone
rurn over) is elevated.
Bone biopsy shows thin, porous, otherwise normal
bone.

Osteoporosis

Management:
Adequate intake of calcium 1.5 g per day may be
perventive.
Adequate intake of vitamin D.
Vitamin D plays a major role in calcium absorption and
bone health.
Major food sourcs are daily products, egg , fish and
liver.
Daily intake should be between 400 and 800
international units.
Weight-bearing exercise (walking) throughout life.

Osteoporosis

Hormone replacement therapy is no longer recommended for

osteoporosis prevention or treatment because the risks outweigh the
benefits.
Raloxifene (Evista), an estrogen receptor agonist, is an alternative to
estrogen. Not as effective as estrogen, but does show some benefit in
preserving bone density. No increase risk to breast cancer.
Calcitonin (Miacalcin) administered by nasal spray may
help prevent spinal fracture. Adverse effect is nasal burning and a runny
nose.
Bisphosphonates, such as risedronate (Actonel), alendronate
(Fosamax), and ibandronate (Boniva), bind to and inhibit
osteoclast action, remain active on bone resorptive surfaces
tor 3 weeks, and do not impede normal bone formation.

Osteoporosis

Associated with improved bone density and

decreased hip and spinal fracture rate.
They must be taken with fluid but not food, and
patient must remain upright for 30 minutes after
taking pill to prevent esophagitis.
Parathyroid hormone teriparatide (Forteo) use is
limited because it requires daily subcutaneous
injections.
Prevention of falls in elderly patients to prevent
fractures.

Osteoporosis

Nursing assessment:
Obtain history of risk factors for osteoporosis,
history of fractures, and other musculoskeletal
disease.
Assess risk for falls and fractures - sensory or motor
problems, improper footwear, lack of knowledge of
safety precautions, and so forth.

Osteoporosis

Nursing care:
Reducing pain
Administer opioid analgesics, as ordered, for acute exacerbations of
pain.
Encourage replacement with nonopioid pain relievers as soon as
possible to avoid drowsiness, possible addiction.
Assist with putting on back brace and ensure proper fit.
encourage use as much as possible, especially while
ambulatory.
Encourage compliance with physical therapy appointments
and practicing exercises at home to increase muscle strength
surrounding bones and to relieve pain.

Osteoporosis

Patient education and health maintenance:

Encourage exercise for all age-groups. Teach the value of
walking daily throughout life to provide stress required for
strong hone remodeling.
Provide dietary education in relation to adequate daily
intake of calcium (1,500 mg). Calcium can be obtained
through milk and dairy products, vegetables, and supplements.
Anyone with a history of urinary tract calculi should consult
with health care provider before increasing calcium intake.

Osteoporosis

Encourage use of combined calcium and vitamin D

replacement. Avoid massive doses of vitamin D, however,
because this may be harmful

Encourage young women at risk to maximize bone mass through

nutrition and exercise.
Suggest that perimenopausal women confer with their health care
provider about the need for calcium supplements and estrogen
therapy.
Alert patient to resources such as the national osteoporosis
foundation.

Osteoporosis

References:
Manual of nursing practice.
Picture from google.

Osteoporosis

Any Q