Bone health Flashcards
What are common bone poblems?
- Diseases osteoarthritis, osteoporosis
- Bone injuries hip fracture
What is OA
= Osteoarthritis
= slowly progressive non-inflammatory disorder of the synovial joints
- Most common form of joint disease
- More common in females
Causes of OA
- Trauma leading to uneven stress on cartilage
- Mechanical stress from repetitive physical activities causing deterioration
- Inflammation causing release of enzymes affecting cartilage integrity
- Joint instability or skeletal deformities causing uneven stress on articular cartilage
- Neurological disorders e.g. diabetic neuropathy causing abnormal movements which contribute to cartilage deterioration
- Drugs e.g. indomethacin
Pathophysiology of OA?
- Cartilage damage triggers a metabolic response = damage stimulates enzymes which trigger inflammation.
- Cartilage becomes dull, soft and less elastic unable to resist any stress.
- leads to fissuring, fibrillation and erosion.
- as inner cartilage becomes thinner, the outer cartilage and bone growth increases in size creating incongruity in joint surfaces and uneven distribution of stress among the joints.
Impacts of OA?
- Major cause of pain, loss of functioning and disability minimal movement
- Difficult to perform ADLs
- Fatigue, and psychological distress
- Signs and symptoms: pain in joints, tenderness, swelling, stiffness, limited range of motion
OA interventions non pharmacological
Aim: managing pain and inflammation, preventing disability and maintaining and improving joint function.
Non pharmacological interventions
o Managing pain
o Thermotherapy: Heat and cold applications
o Weight loss: Nutritional counselling
o Physiotherapy: maintain joint flexibility and muscle strength
- Surgery: joint replacement
What is OP?
Osteoporosis
= - Porous or fragile bone disease
- Chronic progressive metabolic bone disease characterised by low bone mass and structural deterioration of bone tissue
- More common in women than men as women
• Tend to have lower calcium intake than men
• Less bone mass than men
• Bone reabsorption begins at an earlier age and is accelerated at menopause
• Pregnancy and breast feeding deplete of woman’s skeletal reserve
Risk factors of OP?
- Female
- Increasing age
- Family history
- European or Asian descent
- Thin, Small stature
- Early menopause or Oophorectomy
- History of anorexia
- Sedentary lifestyle
- Insufficient calcium intake
- Excessive alcohol and cigarette intake
- Low testosterone levels risk factor for men
- Long term use of corticosteroids, thyroid replacements, heparin, long acting sedatives or antiseizure medication
Signs and symptoms of OP
- No obvious signs and symptoms until a fracture occurs from sudden strain, bump or fall - silent thief
Or
- If there is a collapsed verterbrae, there may be back pain, loss of height or spinal deformities
Diagnosis of OP?
- History and physical examination
- Serum calcium, phosphorus, alkaline phosphatase and vit D levels
- Bone mineral density test (BMD) - assess mass of bone pe unit volume
- Dual energy xray absorptiometry (DEXA) - measures bone density in spine, hips and forearm
Impact of OP
- affect a person’s ability to perform everyday tasks at home or at work.
- After diagnosis with osteoporosis or an osteoporotic fracture, many people suffer anxiety for fear of fracture and possible physical effects. Feelings of sadness, anger, stress and denial are also common. Many people lose self-esteem because they cannot perform their normal role at work or at home.
Prevention. and. treatement of OP
- Diet high in calcium
- Vitamin D is important for calcium absorption and function
- Moderate amounts of weight baring exercise
- Drug therapy
o Oestrogen replacement therapy (HRT)
o Bisphosphonates inhibit osteoclast mediated bone reabsorption
o Selective oestrogen receptor modulators mimic the effect of oestrogen on bone by reducing bone reabsorption without stimulating tissues of breast or uterus
Factors contributing to a hip fracture?
- Propensity to fall
- Inability to correct a postural imbalance
- Inadequacy of local tissue shock absorbers
- Underlying skeletal strength
- Reduce muscle strength, gait and balance problems
- Decreased reflexes
Complications of bone injuries?
- Pain associated with fracture, oedema, muscle spasm
- Reduced mobility from the fracture resulting in muscle atrophy
- Contracture/footdrop caused by shortening of muscle fibres and loss of elasticity of skin over joint
- Constipation secondary to immobility and analgesia
- Renal calculi resulting from bone demineralisation
- Fat embolism syndrome
- DVT and pulmonary emboli
- Infection
- Compartment syndrome
Falls prevention nursing strategies?
- Education and health promotion to prevent falls include
- Wearing shoes with stable soles and heals
- Avoidance of wet and slippery surfaces
- Careful placement of carpets and removal of mats in the home
- Adequate lighting
- Removal of obstacles form pathways and uneven surfaces
- Treat pain and discomfort from arthritis
- Get regular and frequent range of motion and weight bearing exercise 2-3 times daily to maintain strength and balance
- Try to maintain a healthy weight range to prevent added stress on joints which predisposes to osteoarthritis
- Adequate calcium and vitamin D intake
- Withdrawal of psychotropic medication
- Oestrogen replacement
- Protein and energy supplements
