Osteoporosis
Metabolic Bone Disease
Osteoporosis
Characterized by low bone mass and structural deterioration
Normal homeostatic bone remodeling is altered – the rate of bone
resorption is greater than the rate of bone formation.
Osteoporosis
Chronic, progressive metabolic bone
disease characterized by
– Porous bone
– ___ ____ ____
– Structural deterioration of bone tissue
– Increased bone fragility
Osteoporosis
Eight times more common in women
than men for several reasons
1.
2.
3.
4.
5.
Lower calcium intake than men
Less bone mass because of smaller frame
Bone resorption begins earlier and
accelerates after menopause
Pregnancy and breastfeeding deplete
woman’s skeletal reserve of calcium
Longevity increases likelihood of
osteoporosis; women live longer than men
Etiology
Risk factors (non-modifiable)
– Female gender
– Increasing age
– Family history
– White or Asian ethnicity
– Small stature
– Early menopause
Etiology
Risk factors (cont’d)
– Excess alcohol intake
– Cigarette smoking
– Anorexia
– Oophorectomy
– Sedentary lifestyle
– Insufficient calcium intake
– Low testosterone levels (hypogonadism
in men)
Etiology and Pathophysiology
Peak bone mass is achieved before age 20
–
Bone loss after midlife is inevitable but
rate of loss is variable
Bone resorption exceeds bone deposition
Bones become weakened and prone to
fracture, loss of height, and kyphosis.
Etiology and Pathophysiology
Diseases associated with
osteoporosis
Intestinal malabsorption
Kidney disease
Rheumatoid arthritis
Hyperthyroidism
Chronic alcoholism
Cirrhosis of the liver
Hypergonadism
Diabetes mellitus
Osteoporosis
Diagnostic Studies
Clinical Manifestations
– Known as silent disease
Diagnosis
– Bone Mineral Density (BMD)
– Dual-energy x-ray absorptiometry
(DEXA)
– History and physical
– Quantitative ultrasound
Osteoporosis
Can the disease be
prevented?
Treatment and Nursing Care
Diet Therapy
–
Weight bearing Exercises
–
Decrease Risk Factors
– Quit smoking and decrease consumption of alcohol
Drug Treatment of Osteoporosis
Estrogen Replacement Therapy
Calcium & Vitamin D supplements
Calcitonin
Biphosphonates (Fosamax, Didronel,
Actonel, Boniva, Aredia, Bonefos, Skelid)
Selective Estrogen receptor modulator –
Evista
Teriparatide (Forteo)
– Portion of parathyroid hormone
First drug to stimulate new bone formation
Medications Used in Treatment
of Osteoporosis
Hormone Replacement Therapy – Estrogen
– Controversy over use. Should discuss with health care
provider
Calcium
– There are a variety of calcium supplements
available (See Table 64-16, p. 1689).
They should be taken with _______ _ to aid in
absorption.
Also if taking large doses i.e. 1000 mg. / day – take
in divided doses of 500mg BID for better absorption
Medications Used in Treatment
of Osteoporosis
Calcitonin
– If calcitonin inhibits bone resorption by
opposing the effects of parathyroid
hormone, how does that affect serum
calcium levels?
– What is needed to counter that effect?
Medications Used in Treatment
of Osteoporosis
Bisphosphenates – (Fosamax)
– Inhibit osteoclast-mediated bone resorption thereby
increasing BMD and total bone mass.
– Side effects – anorexia, weight loss, gastritis
– Patient Teaching
Medications Used in Treatment
of Osteoporosis
Selective Estrogen Receptor
Modulators
– Mimic effect of estrogen on bone by
reducing bone resorption without
stimulating the breasts or uterus.
– Side effects
Leg cramps
Hot flashes
Osteomalacia
Metabolic Bone Disease
Osteomalacia
Decalcification and softening of the bone
Caused mainly by: vitamin D deficiency
**Vitamin D is required for the absorption of
calcium from the intestine and calcium is
responsible for mineralization of bone
Etiology
– Lack of exposure to __________ ____
– GI malabsorption, extensive burns, chronic diarrhea,
pregnancy, drugs such as Dilantin.
Osteomalacia
Signs & Symptoms
Most Common
– ____ ____
– Difficulty rising from a chair
– Difficulty walking
Additional Signs and Symptoms
– Low back pain, muscle weakness
– Weight loss, progressive deformities
Diagnosis
Blood work
– Decreased serum calcium or phosphorus
– Decreased serum 25-hydroxyvitamin D
– Elevated alkaline phosphatase
X-Rays
– Show loose’rs transformation zone –
– ribbons of decalcification in bone
Osteomalacia
Treatment and Nursing Care
Drug Therapy
–
–
Diet Therapy
– Milk, yogurt, cheese
– Dark green leafy vegetables, okra, broccoli
– Fish and seafood
– Almonds
Paget’s Disease
Paget’s Disease
Excessive bone resorption followed by
replacement of normal marrow by
vascular, fibrous connective tissue.
The new bone is ______, ____________,
___ ______
Most often affect the pelvis,
long bones, spine,
ribs, sternum, and cranium
Clinical Manifestations
In milder form, none
Common early symptom-Fatigue
Waddling gait
Loss of height
Increased head size
Complications
Pathological fractures (may be a first
sign of disease)
Bone tumors
Paget’s Disease
Diagnosis
– Elevated serum alkaline phosphatase
– X-ray will show increase in bone size
– Bone scan shows increased uptake in
affected bones
Drug Treatment for Paget’s
Drug Therapy
Calcitonin-salmon (Miacalcin)
– Bone is in a constant state of remodeling,
whereby old bone is removed by osteoclasts,
and new bone is laid down by osteoblasts.
Calcitonin inhibits bone removal by
osteoclasts, and promotes bone formation by
osteoblasts.
NSAIDS
Bisphosphonates
Paget’s Disease
Other treatments and Nursing Care
– Back support by firm mattress
– Teaching about use of splints or braces
to support bones and joints and help
prevent weakened bones - skin care,
circulation, etc.
– Teach how to correctly use canes or
walkers
– Physical therapy
– Diet high in…what?