Medical-Surgical

1
Medical-Surgical

• Musculo-Skeletal System Disorders

2
Review of Musculo-Skeletal System Anatomy and
Physiology

• Bone hard tissue that makes up most of the
  skeletal system.
• Functions 1. support
• 2. protection
• 3. movement
• 4. storage of calcium and
• other ions
• 5. manufacture of blood
  cells

3
Cartilage

• Specialized fibrous connective tissue.
• It provides firm but flexible support for the
  embryonic skeleton and part of the adult skeleton
  
• Differs from bone in that its matrix has the
  consistency of a firm plastic or gristle-like
  gel.
• Cartilage cells are called chondrocytes and are
  located in tiny spaces that are distributed
  throughout the matrix.

4
Terminologies

• Acrosclerosis
• Amputation
• Ankylosis
• Arthritis
• Arthrocentesis
• Arthrogram
• Arthroplasty
• Arthroscopy
• Bursitis

• Cast
• Dislocation
• Electromyogram
• Fasciotomy
• Fracture
• Gangrene
• Gout
• Halo Device
• Kyphosis
• Laminectomy

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Terminologies

• Lordosis
• Myelogram
• Orthopedics
• Osteomalacia
• Osteomyelitis
• Prosthesis
• Replantation
• Rickets

• Sclerodactyly
• Scoliosis
• Sequestration
• Skeletal Traction
• Spinal Stenosis
• Sprain
• Strain
• Synovectomy
• Tenosynovitis

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Acronyms

• AEA
• AKA
• BEA
• BKA
• CK
• CMS
• CPM
• DJD
• ECG
• EEG

• ESR
• HNP
• IVD
• OA
• ORIF
• RA
• RF
• SLE
• THA
• TMJ
• TLSO

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Joint Structure and Function

• Connective tissue disorders are often manifested
  as joint disorders since joint mobility is
  dependent on functional connective tissues.
• Joint is the site at which two or more bones of
  the body are joined.
• Joint permits motion and flexibility of the rigid
  bone
• Hyoid bone the only bone in the human body that
  does not articulate with at least one other bone,
  to which the tongue is attached.

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Ligaments

• Are strong and flexible fibrous bands of
  connective tissue that connect bones and
  cartilage and support muscles.
• Yellow ligaments and white ligaments have
  distinctively different functions.
• Yellow ligaments, located in the vertebral
  column, are elastic and allow for stretching.
• White ligaments, found in the knee, do not
  stretch but provide stability.

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Joint Structure and Function

• Classification on basis of the extent of
  movements
• Synarthroses fixed joints
• ex. Skull allow no movement at all
• Amphiarthroses slightly movable joints
• ex. Juncture of the ulna and radius in the
• forearm.
• Diarthroses freely movable joints
• ex. Elbows, shoulders, fingers, hips, and
  knees.
• sometimes called synovial joints. They are
  
• encased in a fibrous capsule made of strong
  cartilage and lined with synovial membrane

10
Tendons

• Are composed of very strong and dense fibrous
  connective tissue.
• They are in the shape of heavy cords and anchor
  muscles firmly to bones.
• Achilles tendon, one of the most prominent tendon
  which can be felt at the back of the ankle just
  above the heel.

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Joint Structure and Function

• Synovial membrane is very smooth, thus permitting
  structures to move without friction.
• Ligaments are tough fibrous cords that bind the
  capsule.
• Synovial fluids fills and lubricates the space in
  the middle of the joint.
• Bursae permit tendons to sl,ide easily with
  movement of the bones.

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Definition of Terms

• Orthopedics specialty of medicine that examines
  and treats diseases and injuries of the
  musculoskeletal system.
• Orthopedists- Surgeon who specialize in the area
  of orthopedics.
• Orthopedic nursing involves preventing further
  complications for clients with musculoskeletal
  conditions.

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Common Diagnostic Tests Related to
Musculo-Skeletal Disorders

• Diagnostic Tests nursing clients with
  musculoskeletal disorders is likely to involve
  preparation for physical examination,
  radiographic tests, and other diagnostic
  procedures.
• Be sure to explain the actual procedures to
  reduce tension or anxiety that clients may
  experience.

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Laboratory Test

• Diagnostic Studies for Diagnosing Connective
  Tissue Disorder.
• Studies help to determine whether a disorder is
  inflammatory or non-inflammatory.
• Complete Blood Cell ( CBC) Count
• - identifies the total number of blood cells
• (WBCs, RBCs and platelets as well as
• hemoglobin (Hgb) and hematocrit (Hct),
• percentage of blood consisting of RBCs
• and RBC indices.
• WBC Count increase in infection, tissue
• necrosis, inflammation, may decrease in
  SLE.
• RBC Count detects and differentiates
  blood
• dyscrasias. Decreased in RA and SLE.

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Laboratory Test

• Erythrocyte Sedimentation Rate (ESR) Determines
  presence of inflammation as
• in Rheumatoid Arthritis (RA), Rheumatic
• Fever, and decreased with osteoarthritis.
• Fasting not required. Apply pressure to
  venipuncture site. Assess
• site for bleeding
• C- Reactive Protein Determination
• - Detects active inflammation as in RA and
• disseminated lupus erythematosus.
• Restrict food and fluids for 4 hours.
• Apply pressure to venipuncture site. Assess
• site for bleeding

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Laboratory Test

• Venereal Disease Research Laboratory
• (VDRL) Measures antibodies to syphilis.
• Sometimes decrease in SLE. Fasting not
• required. Apply pressure to venipucture
• site. Assess for bleeding.
• Rheumatoid Factor ( RF) Detects antibodies
  often present with RA. Fasting not required.
  Apply pressure to venipucture
• site. Assess for bleeding.

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Laboratory Test

• Antinuclear Antibodies (ANA) Positive in SLE,
  systemic sclerosis, Reynauds disease, Sjorens
  sysndrome, and necrotizing arteritis. Fast for 8
  hours. Apply pressure to venipuncture site.
  Assess site for bleeding.
• Creatinine- Assesses renal function. Increase
  with SLE, PSS, polyarthritis. Fasting not
  required. Apply pressure to venipuncture site.
  Assess site for bleeding.

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Laboratory Test

• Urine maybe tested also for creatinine and uric
  acid level.
• 24- Hour Urine Creatinine
• - Measures renal function and status of
  muscles diseases. Instruct the patient to collect
  a 24-hour urine specimen.
• Urinary Uric Acid ( 24-Hour Collection).
• - Measures uric acid metabolism increase in
  gout, liver disease, chronic myelogenous
  leukemia, fever.
• Requires a 24-hour urine specimen.

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Radiologic Studies

• Arthrography Use contrast medium to show
  soft-tissue joint structures. Question patient
  about allergy to contrast agent, seafood, iodine.
  Tell patient that needle insertion may cause
  swelling that last several days. Assess and
  document discomfort, swelling. Instruct patient
  to avoid strenuous activity 12-24 hr. after test.
  Joint may be wrapped.

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Computed Tomography (CT)

• Detec tumors and some spinal fractures.
• Tell patient that procedure may be lengthy
• (up to 30 min per body part). Patient lies on
  a stretcher while a machine scans area being
  studied. No post procedure nursing care required.
  
• Diskography
• Visualizes vertebral disk after contrast medium
  injected into disk. Preparation and post nursing
  care is same as in arthrography

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Magnetic Resonance Imaging

• Visualizes soft tissue. May detect avascular
  necrosis , disk disease, tumors, osteomyelitis,
  and torn ligaments.
• - tell the patient the procedure is painless
• must lie still for 30 min. or more . Some
• equipment has videos that patient can
• view to reduce anxiety. Ask whether patient
  is
• claustrophobic. Give sedation if ordered for
  agitated or anxious patients. Remove any
  metallic object such as jewelry. Inquire whether
  patient has any implanted devices such as cardiac
  pacemaker or intracranial aneurysm clips and
  notify radiologist. Procedure is contraindicated
  with some implants. Metal may not a problem with
  some newer equipment. No post procedure care
  requires. Safety is needed is sedated.

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Nuclear Scintigraphy (Bone Scan)

• Detects bone malignancies, osteoporosis,
  osteomyelitis and some fractures.
• Contraindicated during pregnancy. Tell patient
  that a small amount of radioactive
• material will be injected intravenously, then
  a scanner will move slowly back and forth over
  the body as the patient lies on a stretcher . May
  take 1 hour procedure is painless except for
  venipuncture. Radioactive isotopes are not
  harmful except to fetus. Empty bladder
  immediately before procedure for comfort and
  prevent blocked view of pelvis.

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Common Diagnostic Tests Related to
Musculo-Skeletal Disorders

• Radiography (X-Ray)
• - is the most common method of assessing the
  general state of the bone.
• - non-invasively visualizes bones and other
  internal structures, so that health care provider
  can diagnosed abnormalities and monitor the
  effectiveness of treatments.
• - Some types of radiographic exams requires use
  of radiographic dyes

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Radiography

• Shows density, texture, and alignments of bones
  reveals soft tissue involvement. Tell patient to
  expect to lie on an X-ray table or to stand next
  to a special device while films are taken. Remove
  any radiopaque objects ( jewelry, etc.), that can
  interfere with results. Advise radiology of
  patients physical limitations r/t moving,
  turning, climbing.

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Tomography

• Provides details of structure otherwise hidden by
  bone.Requires lying in a cylindric scannerassess
  for claustrophobia and inform radiologist.
• Ultrasonography
• - reveals masses or fluid in soft tissue.
• Arthroscopy
• - A surgical procedure to visualize a joint
  cavity and structure and to obtain fluid and/or
  tissue for study. Inform patient that procedure
  is performed in operating room under local or
  general anesthesia.

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Arthrogram

• X-Ray study of the joint ( e.g. Knee or shoulder)
• Radiopaque or radiolucent substance is injected,
  and then a sequence of x-rays is taken to
  determine the joints condition.
• Myelogram
• Is an x-ray examination of the spinal cord and
  vertebral canal after injection of a contrast
  medium or air into the spinal sub-arachnoid
  space. Valuable in evaluating spinal cord
  abnormalities cause by tumors, herniated
  intervertebral disk, or other lesions.

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Ultrasound

• Uses sound waves and their echos to display
  images helps to evaluates soft tissue masses,
  osteomyelitis, infection, congenital and acquired
  pediatric disorders, bone mineral density, sports
  injuries, and fracture healing.
• Non-invasive, inexpensive, readily available, and
  safe because it does not involve ionizing
  radiation.

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Arthrocentesis

• Aspiration of synovial fluid, blood, or pus from
  a joint cavity. By examining these fluids, a
  health care provider can diagnosed infections,
  inflammatory conditions and bleeding
• Compression dressing is a joint after the
  procedure and the joint is rested for 1 day.

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Arthroscopy

• Invasive procedure using specialized endoscope
  design to view joints.
• Use tiny incision known as stab wound.
• It is a close procedure.
• Performed in OR or same day surgery often under
  local anesthesia.
• Arthroscopy use to diagnosed and treat joint
  disorders.
• E.g. Foreign or loose objects ( piece of
  cartilage or a bone spur can be removed.
• Rough and worn joint can be made smoother and
  more comfortable.
• Tissue samples can be obtained for biopsy.
• Torn meniscus or ligament can be diagnosed and
  possibly repaired.
• Much safer, more comfortable, and more cost
  effective than open surgery.
• Post procedure, elevate clients joint and apply
  ice to control edema and pain. Teach client to
  monitor for s/s of infection.

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Biopsy

• Biopsy of bone, tissue, or muscle must be
  performed using local anesthesia to diagnose
  tumors, infections, muscle inflammation or
  arthophy and various other problems.
• Post procedure , monitor site for bleeding,
  swelling, infection or hematoma.

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Electromyogram (EMG)

• Test of electrical conductivity, similar to ECG
  or the EEG. Provider places fine needles into the
  clients muscle and measures the electrical
  impulses within the muscle, both at rest and
  during activity. The provider can then determine
  whether or not the clients muscle respond
  appropriately to stimuli.

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Commom Medical Treatments

• Joint, bone and muscle disorders often cause pain
  and limit movement.
• Common treatments include
• - Heat application e.g. hot soaks or baths
• paraffin baths.
• - Cold application e.g. cold compress or packs
• Physical Therapy PROM and AROM
• Massage if joints are not damage or inflamed,
  often helps to soothe aching joints.
• External immobilization braces, corsets,
  splints, cast and traction.

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Common Surgical treatments

• Performed to remove or repair damaged or diseased
  parts.
• Disorders that require surgery include
• fractures, ligament ruptures, arthritic
  joints, or accidental limb amputation
• Surgery necessary when fractured joint or bone
  cannot heal with external fixation.
• Fracture resulting to multiple fragments using
  surgical hardware such as pins, screws, or plates

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Example of surgery

• Common treatment for client with either arthritis
  or severe fractures that may not heal.
• - Joint replacement surgery
• - Arthroplasty
• Amputation surgical choice if a limb is damage by
  injury or disease beyond repair.

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Common Therapeutic Measures

• Splint, Cast and Immobilizers
• Use to secure the position of the body parts
  being treated.
• Hold the bone in alignment while allowing enough
  movement for other parts of the body to carry
  out activities of daily living.
• Cast- is a solid mold that is used to immobilized
  a fracture can be made of plaster of Paris,
  fiberglass, thermoplastic resins, thermolabile
  plastic and polyester-cotton knit impregnated
  with polyurethane.

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Common Therapeutic Measures

• Plaster of Paris anhydrous calcium sulfate
  embedded in gauze. Least expensive type of cast
  used.
• Dries after about 24 to 72 hours depending on the
  size and location.
• Can withstand weight-bearing and other stresses
  as long as dry and strong.
• Petaling short pieces of tape placed over the
  edges of the cast to prevent skin irritation by
  rough edges and to protect the cast from moisture
  and soiling.

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Cast fiberglass

• is a synthetic material used for cast that is
  lighter and has shorter drying time than plaster
  of Paris.
• Drying time 10 -15 minutes, and can stand
  weight-bearing 30 minutes after application.
• Cast split down the front to allow the casting
  material and padding to spread.
• Bivalved cast is cut down both sides so that the
  front portion can be removed while the back
  portion maintain immobilization.
• Windowed cast opening is cut into the cast to
  allow inspection of the body area or to relieve
  pressure. Cut out window need to be saved.

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4 main groups of cast

• Upper extremity cast use for breaks in the
  shoulder, arm, wrist and hand. Wearing an arm
  cast should keep the arm elevated above the heart
  when lying in bed to prevent swelling. Arm is
  kept in a sling for support when the patient is
  up.
• Lower extremity- used for breaks in the upper and
  lower leg, ankle and foot. A leg cast is used to
  allow mobility and maybe used with crutches.
  Affected leg should be elevated on several
  pillows during the first few days after the break
  to prevent swelling.
• Cast brace supports the affected part while
  allowing the knee to bend . Applying a cast above
  and below the knee and connecting them with
  hinge.

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Body or spica cast

• Used when a fracture is located somewhere in the
  trunk of the body. The body cast encircles the
  trunk , whereas a spica cast encase the trunk
  plus one or two extremities.
• Body or spica cast severely limit mobility and
  may cause complications related to lack of
  movement such as skin breakdown, respiratory
  problem, constipation, and joint contractures.

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Cast Syndrome

• It is cause by compression of a portion of the
  duodenum between the superior mesenteric artery
  and the aorta and vertebral column.
• Sign and symptoms
• - nausea
• - abdominal distention

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Facts

• Cast is removed only on physicians order.
• Cast cutter use to cut the plaster
• Skin under the cast will be noted tender and dry
  and may have crust of dry skin.
• Gently wash the areaand explain that the skin
  will regain its normal appearance after few days.
• Muscle atrophy may be apparent. Assure the
  patient that muscle mass will be restored with
  use of limb.

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Patient teaching plan ( Cast Care)

• Keep plaster cast dry follow physicians
  instructions regarding wetting synthetic cast.
• Do not remove any padding.
• Do not insert any foreign object inside the
• cast.
• Do not bear weight on a new plaster cast for 48
  hours ( synthetic , less than an hour.)
• Do not cover the cast with plastic for prolonged
  periods.
• Do report swelling, discoloration of toes or
  fingers, pain during motion, and burning or
  tingling under the cast to health care provider.

43
Traction

• Exerts a pulling force on a fracture extremity to
  provide alignment of the broken bone fragments.
• It is also use to correct deformity, decrease
  muscle spasm, promote rest, and maintain the
  position of the diseased or injured part.
• Applied directly to skin ( skin traction)
• Attached directly to the bone ( skeletal
  traction) by means of metal pin or wire.

44
Skin Traction

• Weight is no more than 5 to 10 lbs to prevent
  injury to the skin.
• Bucks traction used for hip and knee
  contractures, muscles spasms, and alignment of
  hip fractures.
• Skeletal Traction
• provides a strong, steady, continuous pull and
  can be used for prolonged periods of time.
• e.g. Gardner-Wells, Crutchfield, and Vinke tongs
  and a halo vest, in which pins are inserted into
  the skull on either side. Heavier weights can be
  used with skeletal traction , usually from 15
  30 lbs.
• Cruthcfield traction and a halo vest are used
  for reduction and immobilization of fractures of
  the cervical or high thoracic vertebrae.

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Complication of tractions

• Impaired circulation
• Inadequate fracture alignment
• Skin breakdown
• Soft tissue injury
• Pin track infection and osteomyelitis can occur

46
Important points to remember when patients are in
traction

• Weights always hangs freely.
• Be sure the amount of weight used is correct as
  ordered, clamps are tight, and ropes moves freely
  over pulleys.
• Maintain good body alignments so the line of pull
  is correct.
• Use padding to prevent trauma to skin where
  traction is applied. Report skin breakdown or
  irritation to the physician
• Assess affected extremities for temperature,
  pain, sensation, motion, capillary refill time
  and pulses.
• With skeletal traction, assess pin sites for
  redness, drainage, or odor which may indicate
  infection.

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Application of Nursing Process on MS Disorders

• Data collection
• Assess for skeletal
• deformity, and body build, note for asymetry,
  or deformity.
• Palpate soft tissues, joints and muscles.
• Assess skin temperature and document any
  swelling, crepitation, tenderness, or other
  abnormality.
• Evaluate the clients musculoskeletal function,
  ROM, muscle strength, balance, and gait.
• Ability and safety in using mobility aids
• Observe clients emotional response to the
  disorder or disease.

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Nursing Diagnosis

• Established nursing diagnoses based on
• data collected.
• Planning and Implementation
• Include clients and their families
• Preventing Disorders of immobility
• Providing comfortable position and proper
  alignment
• Providing skin care
• Providing adequate nutrition
• Providing activity and exercise
• Evaluation
• Periodically evaluate outcome care with clients
  families and members of the healthcare team.

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Common Musculoskeletal Disorders

• Amputation
• Chronic Back Pain
• Temporomandibular Joint Disorders
• Degenerative Disorders
• Repetitive Strain Injuries
• Inflammatory Disorders

50
Systemic Disorders with Musculoskeletal
Manifestations

• Gout
• Lupus Erythematosus
• Scleroderma
• Rickets and Osteomalacia
• Traumatic Injuries
• Sprains
• Strains
• Dislocations
• Fractures

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Hip/Fracture Hip Replacement

• Hip Fractures
• Common in older adults
• Refers to proximal third of the femur which
  extends up to 5 cm below the lesser trochanter.
• Intracapsular fracture - Fx occur within the the
  hip joint capsule. ( femoral neck)

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Clinical Manifestation

• External rotation.
• Muscle spasm
• Shortening of the affected extremity and
• Severepain and tenderness in the region of the
  fracture site.
• Note Displaced femoral neck fx causes serious
  disruption of blood supply to the femoral head
  which can result to avascular necrosis of the
  femoral head

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Collaborative Care

• Surgical repair preferred method of managing
  intracapsular and extracapsular hip fractures.
• Permits early mobilization of the pt. and
  decrease risk of major complications.
• Initial tx- immobility temporary with Bucks
  traction until physical condition stabilize.
• Bucks traction relieves painful muscle spasm
• Used for 24 to 48 hours maximum

54
Bucks Traction
55
Pre-operative Mgt.

• Consider when planning tx chronic health
  problems.
• Appropriate analgesics or muscle relaxant
• Comfortable positioning unless contraindicated.
• Properly adjusted traction.
• Careful preoperative teaching can affect
  mobility.
• Teaching done at the ER
• Consider cognitive abilities.

56
Preoperative Mgt.

• Teach - Method and frequency of exercising for
  the unaffected leg and both arms.
• Encourage use of overhead trapeze bar and
  opposite side rails to assist in changing
  position.
• Inform family of weight bearing status after
  surgery.

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Post- operative ORIF

• ORIF open reduction external fixation
• Monitoring V/S
• Monitoring I and O
• Supervise respiratory activities Deep breathing
  exercises, couhing, use of spirometer.
• Pain medication administration cautiously.
• Observe for dressing and insicion for s/s
  bleeding and infection.

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Early post operative

• Assess for pt. extremity on
• color
• Temperature
• Capillary refill
• Distal pulses
• Edema
• Sensation
• Motor function
• Pain

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Things to note for

• Pain resulting from poor alignment of extremity
  can be reduced by keeping pillows between the
  knees
• Sandbag and pillows are used to prevent external
  rotation.
• With PT collaboration supervise active assistance
  exercises for the affected extremity.
• Ambulation begins usually between first or second
  post-op day day

60
Complication to monitor

• Non-union avascular necrosis
• Dislocation
• Degenerative arthritis
• Hip Fx can be treated by insertion of femoral
  head prothesis.

61
Measures to prevent Dislocation

• Do not force hip into greater than 90 degrees of
  flexion
• Force hip into adduction
• Force hip into internal rotation
• Cross legs
• Put on own shoes or stockings until 8 weeks after
  surgery without adaptive device ( use long
  handled shoe horn.

62
Measures to prevent Dislocation

• Do
• Use toilet elevator on toilet seat
• Place chair inside shower or tub and remain
  seated while washing on good side or when supine
• Keep hip neutral when sitting walking or lying
• Notify surgeon if pain, deformity, or loss of
  function occurs.
• Inform dentist of presence of prosthesis before
  dental work so prophylactic ATB can be given

63
Osteoporosis

• Osteoporosis is a disease of bones that leads to
  an increased risk of fracture. In osteoporosis
  the bone mineral density (BMD) is reduced, bone
  microarchitecture is disrupted, and the amount
  and variety of proteins in bone is altered.
• Osteoporosis is most common in women after
  menopause, when it is called postmenopausal
  osteoporosis, but may also develop in men, and
  may occur in anyone in the presence of particular
  hormonal disorders and other chronic diseases or
  as a result of medications, specifically
  glucocorticoids, when the disease is called
  steroid- or glucocorticoid-induced osteoporosis
  (SIOP or GIOP). Given its influence in the risk
  of fragility fracture, osteoporosis may
  significantly affect life expectancy and quality
  of life.

64
Osteoporosis

• Osteoporosis can be prevented with lifestyle
  changes and sometimes medication
• In people with osteoporosis, treatment may
  involve both. Lifestyle change includes exercise
  and preventing falls as well as reducing protein
  intake medication includes calcium, vitamin D,
  bisphosphonates and several others.
• Fall-prevention advice includes exercise to tone
  deambulatory muscles, proprioception-improvement
  exercises equilibrium therapies may be included.
  
• Exercise with its anabolic effect, may at the
  same time stop or reverse osteoporosis.
  Osteoporosis is a component of the frailty
  syndrome.

65
Pathogenesis

• Imbalance between bone resorption and bone
  formation.
• The three main mechanisms by which osteoporosis
  develops are an inadequate peak bone mass,
  excessive bone resorption and inadequate
  formation of new bone during remodeling. Hormonal
  factors strongly determine the rate of bone
  resorption lack of estrogen (e.g. as a result of
  menopause) increases bone resorption as well as
  decreasing the deposition of new bone that
  normally takes place in weight-bearing bones. The
  amount of estrogen needed to suppress this
  process is lower than that normally needed to
  stimulate the uterus and breast gland.

66
Sign and symptoms

• Signs and symptoms
• Osteoporosis itself has no specific symptoms its
  main consequence is the increased risk of bone
  fractures. Osteoporotic fractures are those that
  occur in situations where healthy people would
  not normally break a bone they are therefore
  regarded as fragility fractures. Typical
  fragility fractures occur in the vertebral
  column, rib, hip and wrist.

67
Risk factors

• Advanced age (in both men and women) and female
  sex estrogen deficiency following menopause is
  correlated with a rapid reduction in bone mineral
  density.
• Those with a family history of fracture or
  osteoporosis,
• Excess alcohol
• Vitamin D deficiency

68
Risk factors

• Tobacco smoking
• Malnutrition
• Underweight/inactive - bone remodeling
• Excess physical activity
• Heavy metals - exposure to cadmium
• Diseases and disorders ex. Cushing syndrome.
  Hyperparathyroidism and hypothyroidism.
• Medications steroids, barbiturates, phenytoin,
  barbiturates.

69
Treatments

• There are several medications used to treat
  osteoporosis, depending on gender. Medications
  themselves can be classified as antiresorptive or
  bone anabolic agents. Antiresorptive agents work
  primarily by reducing bone resorption, while bone
  anabolic agents build bone rather than inhibit
  resorption. Lifestyle changes are also an aspect
  of treatment.

70
Treatments

• Antiresorptive agents Bisphosphonates
• Fosamax) 10 mg a day or 70 mg once a week,
  risedronate(Actonel) 5 mg a day or 35 mg once a
  week and or ibandronate(Boniva) once a month.
• Estrogen analogs
• Estrogen replacement therapy remains a good
  treatment for prevention of osteoporosis but, at
  this time, is not recommended unless there are
  other indications for its use as well.
• Raloxifene
• Calcitonin

71

• Bone anabolic agents
• Teriparatide (Forteo, recombinant parathyroid
  hormone residue
• Calcium salts come as water insoluble and soluble
  formulations.
• Sodium fluoride

72
Prevention

• Methods to prevent osteoporosis include changes
  of lifestyle..
• Fall prevention can help prevent osteoporosis
  complications.
• Nutrition- Proper nutrition includes a diet
  sufficient in calcium and vitamin D
• Patients at risk for osteoporosis (e.g. steroid
  use) are generally treated with vitamin D and
  calcium supplements and often with
  bisphosphonates.