Osteoporosis

Osteoporosis

®  A disease of the bone characterized by a decrease in the bone mass and density with a change in bone structure

®  METABOLIC BONE DISORDERS

Pathophysiology

®  Normal homeostatic bone turnover is alteredà rate of bone RESORPTION is greater than bone FORMATIONà reduction in total bone massà reduction in bone mineral densityà prone to FRACTURE

TYPES

1. Primary Osteoporosis- advanced age, post-menopausal

2. Secondary osteoporosis- Steroid overuse, Renal failure

RISK factors for the development of Osteoporosis

1. Sedentary lifestyle

2. Age

3. Diet- caffeine, alcohol, low Ca and Vit D

4. Post-menopausal

5. Genetics- caucasian and asian

6. Immobility

ASSESSMENT FINDINGS

1. Low stature

2. Fracture (Femur)

3. Bone pain

LABORATORY FINDINGS

1. DEXA-scan

Provides information about bone mineral density

T-score is at least 2.5 SD below the young adult mean value

2. X-ray studies

Medical management of Osteoporosis

1. Diet therapy with calcium and Vitamin D

2. Hormone replacement therapy

3. Biphosphonates- Alendronate, risedronate produce increased bone mass by inhibiting the OSTEOCLAST

4. Moderate weight bearing exercises

5. Management of fractures

Osteoporosis Nursing Interventions

1. Promote understanding of osteoporosis and the treatment regimen

®  Provide adequate dietary supplement of calcium and vitamin D

®  Instruct to employ a regular program of moderate exercises and physical activity

®  Manage the constipating side-effect of calcium supplements

®  Take calcium supplements with meals

®  Take alendronate with an EMPTY stomach with water

®  Instruct on intake of Hormonal replacement

2. Relieve the pain

®  Instruct the patient to rest on a firm mattress

®  Suggest that knee flexion will cause relaxation of back muscles

®  Heat application may provide comfort

®  Encourage good posture and body mechanics

®  Instruct to avoid twisting and heavy lifting

3. Improve bowel elimination

®  Constipation is a problem of calcium supplements and immobility

®  Advise intake of HIGH fiber diet and increased fluids

4. Prevent injury

®  Instruct to use isometric exercise to strengthen the trunk muscles

®  AVOID sudden jarring, bending and strenuous lifting

®  Provide a safe environment