Osteoporosis

1
Osteoporosis

• Debilitating disease in which bones become
  fragile and are more likely to break. It affects
  more than 28 million Americans, 80 of whom are
  women.
• Risk factors
• Gender- women are more likely to develop than
  men due to thinner, lighter bones the decrease
  in estrogen production that occurs during
  menopause.
• Age- the longer you live, the greater the
  likelihood of developing.

2
Osteoporosis

• Family history-is due part to heredity.
• Ethnicity-Caucasian Asian women are at highest
  riskAfrican-American Hispanic women at lower
  but significant risk.
• Body size- low body weight (lt 127 lbs.) a
  small-boned frame place at increased risk.
• Lifestyle- a diet low in CA, inadequate vitamin
  D, little or no exercise, current cigarette
  smoking or excessive use of alcohol are all risk
  factors.

3
Osteoporosis

• Assessment Assess for backache with pain
  radiating around trunk Evaluate for
  skeletal deformities. Assess for pathologic
  fractures. Evaluate lab finding 1. Serum
  CA, phosphorus alkaline phosphatase are
  usually normal.
• 2. Parathyroid hormone may be elevated.

4
Osteoporosis

• Diagnostic tests 1. Routine x-ray when
  there is 25 to 45 demineralization. 2.
  Single-photon absorptionmetry identifies degree
  of bone in wrist. 3. Dual-photon
  absorptionmetry identifies bone loss at hip or
  spine

5
Osteoporosis

• Nursing Diagnoses
• 1. Risk for injury-altered mobility, minimal
  trauma, falls, advanced age, previous fall.
• 2. Impaired physical mobility- decreased bone
  mass, decreased strength, musculoskeletal
  impairment, pain.
• 3. Situational low self-esteem- chronic
  illness,anxiety, loss of usual role, body
  changes, limitation in mobility, chronic pain,
  loss of independence.

6
Osteoporosis

• Prevention- by age 20, the average woman has
  acquired 98 of her skeletal mass. Building
  strong bones during childhood adolescence can
  be the best defense against developing
  osteoporosis.
• 1. Balanced diet rich in CA Vitamin D.
• 2. Weight-bearing exercises
• 3. A healthy lifestyle with no smoking
  limited alcohol intake.
• 4. Bone density testing medication when
  appropriate.
  
  
  

7
Osteoporosis

• Prevent fractures 1. Instruct in safety
  factors-watch steps, avoid use of scatter rugs.
• 2. Keep side rails up to prevent falls.
• 3. Move gently when turning positioning.
• 4. Assist with ambulation if unsteady on
  feet.
• Provide pain control.
• Instruct in good use of body mechanics.
• Provide diet high in protein, vit. D avoid
  excessive use of alcohol coffee.

8
Osteoporosis

• Administer medications 1.Estrogen
  progesterone-decrease rate of bone reabsorption
  at menopause.
• 2. Calcium vitamin D-support bone
  metabolism.
• Instruct in regular exercise program. 1. ROM
  exercise 2. Ambulation several times per day.

9
Osteomalacia (adult rickets)

• Metabolic bone disorder characterized by
  inadequate mineralization of bone matrix. Bone
  mineralization requires adequate calcium
  phosphate ions in extracellular fluid. When
  either of these ions are insufficient because
• (1) inadequate CA intake or decreased CA
  absorption from intestines d/t insufficient Vit.
  D or (2) increased renal losses or decreased
  intestinal absorption of phosphate the bony
  matrix is not mineralized thus unable to
  sustain weight bearing. Marked deformities of wt.
  Bearing bone pathological fractures occur. Can
  be corrected with treatment.

10
Osteomalacia

• Incidence Health problem in cultures which tend
  to be deficient in calcium vitamin D. Almost
  non existent in the U.S.-many foods are fortified
  with Vitamin D. Increased incidence in elders,
  very low birth weight infants, strict vegetarian.
• Primary Causes in U.S.- Vitamin D deficiency-
  decreased intake, absorption, impaired renal
  tubular reabsorption d/t acquired or genetic
  disorders-most common cause alcohol abuse.

11
Osteomalacia

• Assessment
• 1. Bone pain- vague generalized first,
  becoming more intense with activity as the
  disease progresses, occurs most frequently in the
  pelvis, long bones of extremities, spine ribs.
• 2. Difficulty changing from lying to sitting
  position, sitting to standing.
• 3. Muscle weakness, waddling gait, dorsal
  kyphosis (severe), pathological fractures.

12
Osteomalacia

• Assessment
• 1. X-rays- effects of generalized bony
  demineralization-trabecular bone loss, cyst
  formation, compression fracture, bowing bending
  deformities of the long bones, osteoid defosits
  (vertebral bodies/pelvis). Loosers lines or
  zones-pseudofractures-they represent stress fx.
  that have not mineralized. They often appear
  symmetrically in the inner femora, ribs,
  inferior pubic rami may progress to complete
  fx. with minimal trauma.

13
Osteomalacia

• Serum calcium-normal or low depending on cause
• Serum phosphorus- typically is low may be up
  renal failure.
• Serum parathyroid hormone (PTH)-elevated as a
  compensatory response to hypocalcemia in client
  with renal failure or vitamin D deficiency.

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Differential Features of Osteoporosis
Osteomalacia
Definition Decreased bone mass Demineralized bone
Pathophysiology Lack of calcium Lack of Vitamin D
Radiographic findings Osteopenia fractures Pseudofractures, loosers zones, fractures
Calcium level Normal Low or normal
Phosphate level Normal Low or normal
Parathyroid level Normal High or normal
Alkaline phosphatase Normal High
15
Osteomalacia

• Pharmacology- Vitamin D therapy-only if not
  enough with diet- 10ug or 400 IU to 600-800 IU.
  Fortified milk.
• Nursing Diagnoses
• 1. Alteration in nutrition lt body requirements.
• 2. Risk for injury- evaluate home for hazards.
  PT consult-assistive devices. 3. Impaired
  physical mobility-conserve energy,gait devices,
  get brief exposure to sun.