Osteoporosis PDF

osteoporosis Dr. Amel Ahmed Osteoporosis Definition Pathophysiology Etiology & types Clinical manifestations Diagnostic studies Complications Management of osteoporosis Prevention Health education for patient with osteoporosis. Osteoporosis Definition It is irreversible m...

osteoporosis Dr. Amel Ahmed Osteoporosis Definition Pathophysiology Etiology & types Clinical manifestations Diagnostic studies Complications Management of osteoporosis Prevention Health education for patient with osteoporosis. Osteoporosis Definition It is irreversible metabolic bone disease, in which the rate of bone resorption increases over the rate of bone formation, causing a loss of bone mass and weakening of the bone making them more susceptible to fracture. Incidence: Osteoporosis is common at old age over 50 years. Osteoporosis is common in women than in men (ratio 4:1). Pathophysiology: ▪ The rate of bone resorption increase over the rate of bone formation, causing loss of bone mass. ▪ Calcium & phosphate salts are lost, creating porous, brittle & fragile bones. ▪ The bones become weakened from the demands of weight bearing. ▪ Fractures may occur with little force. ▪ The vertebral column's overall mass is diminished leading to kyphosis & loss of weight. Etiology & types According to etiology of osteoporosis, it can be classified into primary & secondary Primary osteoporosis Secondary osteoporosis o The exact cause of primary osteoporosis remains * Secondary osteoporosis is developed secondary to unknown one of the following causes: o Primary osteoporosis include two subtypes: Long therapy of steroids (e.g. corticosteroids). ✓ A-senile osteoporosis Long therapy of heparin Most commonly develops in elderly due to aging Long therapy of anticoagulants. process. Hyperthyroidism ✓ B-postmenopausal osteoporosis Cushing syndrome Estrogen deficiency is common in women after Malabsorption menopause which result in calcium deficiency Common risk factors for osteoporosis -Thin, small framed body -Prolonged immobility (e.g., hemiplegia, paralysis). -Calcium deficient diet -Heavy cigarette smoking -Vitamin D deficiency - Sedentary life-style. Clinical manifestations ▪ This disease is asymptomatic (causing no symptoms) until later stages, for this reason, it is called the "silent killer" ▪ The symptoms include: ❖Loss of height-due to collapse of bone. ❖Marked kyphosis of the thoracic spine. ❖Back pain: that radiates around the trunk, accompanied with tenderness and voluntary restriction of motion. ❖Possibility of fractures after minor stress or trauma- common sites for fractures is vertebral fractures, femoral fractures& hip fractures. Diagnostic studies ▪ Laboratory tests ❖Serum calcium & phosphorus- within normal range ❖Serum alkaline phosphatase (increase bone formation) –low level ❖Serum hydroxoproline (increase bone resorption)—high level ❖Urine calcium – is initially high then returns to normal range. Radiographic measures ❖ Bone x-ray: show typical degeneration in the lower thoracic & lumbar vertebrae. ❖ Bone density measures: 1-DEXA (dual-energy x-ray absorptiometry) This technique provides information about bone mass at the spine & hip These studies are useful in identifying osteoporotic bone and assessing response to therapy Less radiological exposure. 2-ultrasonic heel-density (bone sonometer) studies: Are used to diagnose osteoporosis and predict risk of fracture. Complications: ▪ Fractures ▪ Bone deformities Management of osteoporosis General management Pharmacological management Surgical management Nursing management General management o Nutritional supplements of dietary calcium & vitamin D – to support normal bone metabolism. o Adequate exposure to sunlight especially for Childs. o Weakened vertebrae should be supported with a back brace o Physical therapy program including gentle exercise and activity – to held calcium in bones o Secondary osteoporosis can be managed by the treatment of underlying disease. o Pain management using prescribed types of analgesics. o Mobility in a hazard-free environment. Pharmacological therapy Drug therapy Action Route Complications Nursing measures Estrogen o Estrogen has an effect on *Oral * Vaginal bleeding -Instruct pt. regarding monthly HRT intestinal absorption of calcium *transdermal patch * Breast tenderness breast self-examination. (Hormonal & enhances the availability of * Weight gain - Instruct pt. to report about any replacement the active metabolite of VD. * Headache abnormal vaginal bleeding. therapy) o Decrease bone resorption * Mood alterations - Gynecological examination / o Increase bone mass 2months. - Instruct pt. to take missed doses as soon as remembered. Calcitonin o Increased vertebral bone mass -Subcutaneous * Allergic reaction. - Intradermal skin testing before after long therapy. injection. *Facial flushing. initial dose. o Inhibit bone resorption. * GIT disturbances, - Teach pt. how to self- inject - Nasal spray nausea, vomiting himself. * Urinary frequency. - Ask pt. to take drug at bedtime Nasal discomfort. as this tend to minimize side effects Alendornate o Alternative to HRT (hormone Oral route * esophagitis -It should be taken each morning sodium replacement therapy) with water 30-60 min. before (fosamax) o Increase bone mass meal for maximum absorption. o Reduce bone resorption. -pt. must remain upright for 30 minutes after taking pills to prevent esophagitis. Calcium o Promote optimal bone health. Oral route * Constipation -24 hrs urine collection urine (Calcium * Kidney stones specimen to detect urine carbonate) excretion of calcium.  Surgical management Surgery may be indicated to correct pathologic fractures by open reduction, Internal fixation with plaster cast immobilization. Nursing management for patients with osteoporosis (In form of nursing process) Assessment: ▪ Presence of increased kyphosis ▪ Loss of height ▪ Possibility of fractures of hip or compression fractures of vertebrae. ▪ Backache ▪ Neck pain ▪ Pain radiating to legs and arms ▪ Self-concept & self-esteem disturbances ▪ Body image disturbances  Nursing diagnosis: ▪ Pain related to weakened vertebral bones, compression fractures as manifested by back pain ▪ Impaired physical activity related to osteoporotic changes, weakened pain, back pain as manifested by limited daily living activities and difficult movement. ▪ Alteration in nutritional needs: less than body requirements related to calcium imbalance as manifested by backache, difficult movement. ▪ Altered body image related to kyphotic changes as manifested by isolation & depression ▪ Self-esteem. Disturbance related to kyphosis & pain as manifested by depression, isolation. ▪ Knowledge deficit related to osteoporotic process and treatment regimens as manifested by many patients' questions & anxiety. ▪ Risk for injury/fractures related to osteoporosis Patient Education for Patients with Osteoporosis Get enough vitamin D each day. Eat a healthy diet. Get moving. Don’t smoke. Make home safe. Prevention of osteoporosis ▪ Prevention should start at childhood-because peak bone mass occurs at approximately 30 years of age. ▪ Eat a balanced diet that includes the recommended amounts of calcium (1200 mg for adolescents & adults, 1500 mg for postmenopausal women. ▪ Ensure adequate sunlight exposure for children. ▪ Avoid high caffeine intake, which causes the body to lose calcium. ▪ Avoid smoking: women who smoke experiences menopause earlier than nonsmoking women. ▪ Avoid alcohol intake, which interfere with the intestinal absorption of calcium. ▪ Exercise regularly: lack of regular exercise cause bone to lose minerals. ▪ Avoid stress, which causes loss of calcium from the body.