OsteoporosisDone by:

Hani abu dieh

OUTLINE

Definition. Pathophysiology. Risk factor. Causes. Signs and symptoms. Diagnostic procedure. Prevention and medical management. Nursing process.

What is it?

• metabolic skeletal disease characterized by low bone density and microarchitectural

deterioration of bone tissue which results in increased bone fragility and susceptibility to fracture.

• The vertebrae ,wrists ,and hips are the most common sites of fractures.

Pathophysiology

•Result of prolonged imbalance of Bone Remodeling;

- Bone remodeling occurs throughout an individual’s lifetime. - In normal adults, the activity of osteoclasts (bone resorption) is

balanced by that of osteoblasts (bone formation). - normal bone remodeling in the adult result in gradually increase

bone mass until the early 30s.

* with ageing the peak bone mass is gradually decrease and

1.Calicitonin which inhibit bone resorption and promote bone formation. (decrease)

2.Estrogen which inhibit bone breakdown. (decrease)

3.PTH increase bone turnover and resorption. (increase)

Puberty

Peak Bone Mass

Menopause

Old age

0 40 50 60 7020 3010

Age in years

Bone Mineral Density

Bone Remodeling

Risk Factors

- female more than male.

- increase age.- inadequate intake of calcium and vit D.

- estrogen deficiency or menopause.

-family history. - Lack of physical activity . -Smoking , alcohol consumbtion -medication. (corticosteroids, antiseizure ) - low weight and body mass index.

- caucasian, asian.

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Causes of Osteoporosis:

(A ) - ( Idiopathic age related osteoporosis most)common:

(1 )Young adults

(2 )Postmenopausal (type I)

(3 )Senile (type II)

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)B ( Osteoporosis secondary to diseasestates:

1 .Metabolic conditions e.g calc. deficiency, vit. D deficiency, malnutrition, scurvy.

2 .Endocrine conditionse.g, Hyperparathyroidism.

3 .Renal disease.

4 .Gastrointestinal-liver disease.

5.Bone marrow infiltration e.g, leukemia.

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7 .Drugse.g Phenobarbital, Thyroid hormones, Corticosteroid.

8 .Life stylee.g Nutnition, alcohol, smoking, inactivity, immobilization, excessive caffeine

9 .Miscellaneouse.g Rh. arthritis..

Signs and symptoms

• Osteoporosis has been called “silent disease” because bone mass is lost over many years with no sings or symptoms.

•C\M:1.Loss of height.

2.Back pain.3 .vertebrae collapse. (dowager’s hump)

Diagnosing Osteoporosis

1.x-ray studies: determine bone density.2 .radiographic: bone mass. (osteopenia).

3.ultrasonography:determine bone density.4 .Dual-energy x-ray absorptiometry (DEXA) is

the preferred modality for measuring bone mineral density (BMD).

Prevention and medical managment

• The main goal of treatment is to prevent development of osteoporosis and to stabilize remaining bone mass.

(1) A calc. rich diet esp. in childhood.

• adolescents may need 1200mg and postmenopausal women may need 1500mg daily.

• Milk, cheese and yogurt are rich in calcium.

• Elderly should be advised to take 400-800 units of Vit. D daily Comes (from 2 sources : the sun and Fortified dairy products, egg yolks, saltwater fish, and

liver)

(2) Never Smoking

(3) Exercise• Exercising regularly in childhood and adolescence can

ensure that you will reach peak bone density.

(4) Alcohol , caffeine intake should be avoided.

(5) Women with low body w.t (those with eating disorders) should receive appropriate evaluation, Rx and dietary counseling.

DRUG THERAPY

1.calcitonin: a synthetic thyroid hormone usually prescribe as a daily nasal spray to reduce factors that cause loss of calcium and increase reabsorption of calcium in the gastrointestinal tract.

2 .Selective Estrogen Receptor Modulators.

3 .Hormone Replacement Therapy: to increase serum estrogen levels, which in turn decrease the rate of bone resorption.

Nursing process assessment

• Profile: Age & gender• Risk factor• Secondary causes• Symptoms related• Past medical Hx• Family Hx• Social Hx

History:

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Physical Exam:

• General: - decreasing height greater > 1.5inches - dorsal kyphosis - exaggerated cervical lordoisis - low body weight.

• Assessed for:- localized pain- muscle spasm- neurologic deficit (risk of spinal cord compression)

- loss of strength - range of motion in the affected area

• Fractures most commonly occur in the vertebral bodies, wrist, humerus, hip. rib and pelvis (in that order).

Nursing diagnosis:• acute pain • Impaired physical mobility • self-care deficit (Dressing or grooming) • Imbalanced nutrition: Less than body requi

rements

• Risk for impaired skin integrity • Risk for injury • Risk for constipation RT immobility• Deficient knowledge about the

osteoporosic process and treatment regimen.

Goals:

-relieving pain-improve self-care.-improve nutritional status.-improve physical mobility.-prevent injury. (no new fracture)-improving bowel elimination.-promoting understanding of osteoporosis and

the treatment regimen.

Intervention -consumes adequate dietary calcium and vit D.

-encourage to increase level of exercise.

-modify lifestyle choices: avoid smoking, alcohol, carbonated beverages.

-maintain optimal body wt.

-creates safe home environment.

-adheres to prescribe screening and monitoring prcedures.

-take prescribed medication as instruction.

Reference:

• Brunner & suddarth’s Textbook of medical-surgical nursing.11th edition.

• Web site:

-www.nursing4all.com

-www.nursingcaste.com

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