NUR 212 Unit 2 Part 1: Overview & Osteoporosis PDF

NUR 212 Unit 2 Part 1: Overview & Osteoporosis Cortney Maffett, MSN, FNP-BC  Unit 2 Module 2: Metabolism ○ Osteoporosis Module 3: Mobility ○ Hand and Foot Disorders ○ Muscular Dystrophy ○ Osteomalacia ○ Osteomyelitis ○ Scoliosis ○ Amputations  Bone Metabolism Review...

NUR 212 Unit 2 Part 1: Overview & Osteoporosis Cortney Maffett, MSN, FNP-BC  Unit 2 Module 2: Metabolism ○ Osteoporosis Module 3: Mobility ○ Hand and Foot Disorders ○ Muscular Dystrophy ○ Osteomalacia ○ Osteomyelitis ○ Scoliosis ○ Amputations  Bone Metabolism Review Nutrients ○ Carbohydrates, Fats, Proteins Metabolism ○ Energy, Cell repair Hormones ○ Chemical Messengers Catabolism vs Anabolism Bone Cells  Bone Remodeling https://www.dnatube.com/video/2739/Argosy-Medical-Animation-Aging-Bone  Aging Bones Decrease bone mass and minerals Decrease calcium resorption ○ Slow resorption of interior of long bones ○ Slow production of new bone on the outside surface of bones Vertebrae shorten and intervertebral disks thin; kyphosis Cartilage on bone surfaces in joints deteriorate and bone spurs may occur  Changes Related to Aging Bone structure changes (caused by expansion and resorption) Osteopenia – decreased bone density (can lead to osteoporosis) Cartilage degeneration (can lead to arthritis) Atrophied muscle tissue (increased exercise can slow atrophy) Decreased coordination and ROM Loss of muscle strength Gait changes Slowed movement Increased fall risk Osteoporosis  Osteoporosis Definition: Chronic metabolic disease in which bone demineralization results in decreased density and subsequent fractures “Silent Disease” Osteoclastic activity is greater than osteoblastic activity Most common in postmenopausal, Caucasian women Prevention is key! 3 Types: ○ Primary ○ Secondary ○ Regional Osteoporosis – Risk Factors Non-modifiable ○ Age >50 ○ Family hx ○ Hx of low trauma fx after 50yo Modifiable ○ Low body weight, thin build ○ Chronic low calcium or vit D ○ Excess or deficient protein intake ○ Estrogen or testosterone deficiency ○ Gender confirmation ○ Smoking ○ High alcohol intake ○ Excessive caffeine or carbonated beverage  Osteoporosis - Screening Who Should Have a Bone Density Test? you are a woman age 65 or older you are a man age 70 or older you break a bone after age 50 you are a woman of menopausal age with risk factors you are a postmenopausal woman under age 65 with risk factors you are a man age 50-69 with risk factors A bone density test may also be necessary if you have any of the following: an X-ray of your spine showing a break or bone loss in your spine back pain with a possible break in your spine height loss of ½ inch or more within one year total height loss of 1½ inches from your original height  Secondary Osteoporosis Medical conditions that may be associated with osteoporosis: Diabetes Hyperthyroidism Hyperparathyroidism Cushing’s syndrome Growth hormone deficiency Metabolic acidosis Female hypogonadism Rheumatoid arthritis Prolonged immobilization Bone Cancer Cirrhosis  Secondary Osteoporosis Medications conditions that may be associated with osteoporosis:  Aluminum  Anticonvulsants  Cytotoxic drugs  Glucocorticoids  Gonadotropin-releasing hormone agonists  Immunosuppressants  Lithium  Long term heparin use  Progesterone  Tamoxifen (postmenopausal use)  TPN  Alcohol  Thyroid hormones  Osteoporosis vs. Osteoarthritis Osteoporosi Osteoarthrit s is Silent disease Painful Chronic metabolic disease Degenerative joint disease Bones become less dense Caused by repeated and more likely to fracture overuse from performing a Diet rich in calcium and particular task from vitamin D, regular weight- carrying around excess bearing exercise, and a body weight. healthy lifestyle can Treatments aimed at prevent or lessen the relieving the symptoms of effects of the disease. pain and stiffness that it causes. Both can cause pain and height loss Many individuals have both.  Osteoporosis – Clinical Manifestations Loss of height Progressive spinal curvature ○ “Dowager’s Hump” Low back pain Fractures Constipation Reflux Resp. complications  Osteoporosis – Diagnostic Imaging X-rays Bone Mineral Density (BMD) DEXA Scan: Dual-energy x-ray absorptiometry (T-score next slide) cDXA vs pDXA pQUS (peripheral quantitative ultrasound densitometry) MRI FRAX – fracture risk assessment tool  DEXA T-Score Normal: BMD is within 1 SD of a “young normal” adult Osteoporosis (T-score at -1.0 and above). -2.5 and below Low bone mass (“osteopenia”): BMD is between 1.0 and 2.5 SD below that of a “young normal” adult (T-score between -1.0 and -2.49) Osteoporosis: BMD is 2.5 SD or more below that of a “young normal” adult (T-score at or below -2.5) Patients in this group who have already experienced one or more fractures are deemed to have severe or “established” osteoporosis.  Osteoporosis – Diagnostic Labs Serum calcium Vitamin D Alkaline phosphatase Phosphorus Urinary calcium Serum protein Thyroid function tests Serum & Urinary Bone Turnover Markers  Osteoporosis - Treatment Priority problem: Potential for fractures due to weak, porous bone tissue Pharmacological treatment Diet therapy Exercise Pain management Exercise Orthotic devices Psychosocial Community Resources  Osteoporosis - Pharmacology Calcium Vitamin D Bisphosphonates Alendronate Newer Bisphosphonates: (Fosamax) IV Zoledronic acid (Reclast) Risedronate (Actonel) IV pamidronate (Aredia) Ibandronate (Boniva)  Osteoporosis – Pharmacology cont. Estrogen Agonists/Antagonists ○ Raloxifene (Evista) Monoclonal antibodies/RANKL inhibitors ○ Denosumab (Prolia) Calcitonin Parathyroid hormone-related protein drugs ○ Teriparatide (Forteo) ○ Abaloparatide (Tymlos)  Caregiver Teaching - Fall Prevention Major Risk Factors: o Delirium o Dementia o Immobility o Muscular weakness o Hx of falls o Visual or hearing deficits o Current medications o Environmental o Malnutrition o Agitation Remove rugs Adequate stair rails and grab bars Shower/bath access Use of orthotic devices THANKS !