Osteoporosis Flashcards
Risk Factors 1
- > 65 y/o
- female gender
- low body weight
- cigarette smoking
- nontraumatic fracture
- inactive lifestyle
- family hx of osteoporosis
Risk factors 2
- diet low in calcium or vit. D
- excessive alcohol ( >2 drinks a day)
- postmenopausal
- White and Asian American descent
- low testosterone in men
Risk Factors 3
many drugs can interfere w/ bone metabolism
- Corticosteroids: increases bone loss and stimulates breakdown
- Antiseizure drugs (valproate [Depakote], phenytoin [Dilantin])
- aluminum- containing antacids
- certain cancer tx
-
Corticosteroids
long-term use is a major contributor to osteoporosis
Antiseizure drugs
can affect bone marrow
celebrex (phosphenytoin)
When should a DEXA scan be performed
65 or older for women
not much benefit for men
DEXA Scan
Osteoporosis vs Osteopenia
Osteoporosis = BMD > or equal to -2.5 standard deviations below a young adult BMD.
Osteopenia = BMD > / equal to -1.0 but less than -2.5 standard deviations below a young adult BMD
bone biopsy
can be done to differentiate between osteoporosis and osteomalacia
Bone Mineral Density (BMD)
- normal = >1.0
- osteopenia = -1.0 to < -2.5
- osteoporosis = < -2.5
Osteopenia
more than normal bone loss but not yet osteoporosis
Appropriate Diagnostics
H&P: -hip, vertebra, or wrist fracture
- back pain
- loss of height
- spinal deformities (kyphosis/ stooped posture)
Quantitative US: -sound waves to evaluate bone mass
-may see increased use due to cost effectiveness
Diagnostics cont.
Serum calcium, phosphorus, and alkaline phosphatase may be normal.
alkaline phosphatase may be elevated after fracture
Blood Tests
many used to screen for disease processes that may contribute to osteoporosis
- calcium
- liver function (ALT, AST)
- high TSH (hypothyroidism)
Gold Standard
DEXA scan
CBC
anemia, sickle cell disease, alcohol abuse (with liver function tests)
Serum chemistry levels
- Ca: underlying disease states. Hypercalcemia may reflect underlying malignancy or hyperparathyroidism. Hypocalcemia can contribute to osteoporosis
- creatinine levels may decrease w/ increasing PTH levels or may be elevated in patients with myeloma
- Mg important in calcium homeostasis. Decrease in Mg may affect absorption and metabolism
Calcium Homeostasis
calcium level in blood balanced by:
1. PTH- secreted by the parathyroid gland.
If calcium level is low PTH raises calcium level by stimulating osteoclasts to breakdown bone.
Increases calcium resorption from kidneys.
- calcitonin
secreted by thyroid gland.
If serum calcium too high, calcitonin moves calcium into bones.
Decreases calcium reabsorption.
Two major hormones involved with Calcium
Two antagonistic hormones;
- PTH
- Calcitonin
Calcium- Phosphorus
Relationship
When Calcium is high(> 11.0), phosphorus is low (<3.0)
When phosphorus is high ( > 4.5), calcium is low (< 9.0)
Ca and Phosphorus levels
Calcium= 9.0 - 11.0 Phosphorus= 3.0 - 4.5
Phosphates
used to treat;
- hypophosphatemia
- hypercalcemia
require doctor care
Osteoporosis
“silent thief”
chronic, progressive metabolic bone disease -porous bone -low bone mass -structural deterioration of bone tissue -increased bone fragility -
Etiology and Pathophysiology
bone resorption exceeds bone deposition
most commonly in spine, hips, and wrists
Resorption
loss of bone
Osteoporosis
-Clinical manifestations
“silent killer”
- usual first signs are; back pain, spontaneous fractures
- loss of height
- easy fracture
Physiology of bone growth
Bone is living tissue undergoing change
- about 10% of skeleton is broken down each year
OsteoClasts- break down (Crush) areas of old/ damaged bone
OsteoBlasts- Build new bone in those areas
osteocytes maintain and monitor mineral content
Etiology and Pathophysiology
wedging and fractures of vertebrae produce gradual loss of height and a humped back known as dowager’s hump/ kyphosis
usual first signs are back pain or spont. fractures
Biphosphonate
- take on an empty stomach
- upright for 30 min. after taking med.
- give with full glass of water
remember: tell patient to go for a walk after taking
Recommended exercise
low-impact weight bearing exercise
- walking
- hiking
- weight training
- dancing
Collaborative Care
Focus
Proper nutrition Ca supplements Exercise Prevention of fract. Drug therapy Vertbroplasty Kyphoplasty
Vertbroplasty
Kyphoplasty
Vertebroplasty- bone cement is injected into collapsed vertebra to stabilize it. Does not correct deformity
Kyphoplasty- air bubble inserted into collapsed vertebra and inflated to regain vertebral body height
Collab. Care
-Nutrition
milk cheese ice cream yogurt salmon ---- sea food---- broccoli---- spinach
Collab. Care
-supplements
Calcium- lower doses now recommended. Do not take with biphosphonate
- -1500 mg/day post menopausal women
- 1000 g/day premenopausal or postmenopausal taking estrogen - Supp. vit. D recommended
- 800 units to 1000
- 20 min. of sunlight daily - Calcitonin promotes bone building
- inhibits osteoclastic bone resorption, interacts w/ active osteoclasts
- Salmon Calcitonin (Calcimar): IM, subq, intranasal
- when calcitonin is used, Ca supp. necessary to prevent hyperparathyroidism.
Vit. D
20 min a day in sunlight is recommended
older adults need 400 - 800 IU
Drug Therapy
Biphosphonates inhibit osteoclast- mediated bone resorption
Biphosphonate “nates”
- etidronate (Didronel)
- alendronate (Fosomax)
- pamidronate (Aredia)
- can hurt jaw and cause cancer
- should not take mannitol while on this med.***
Calcium recommendation
1500 mg/day
prevents future loss
does not build new bone
Prevention of Fractures
- install grab bars
- sit to shower
- make shower less slippery
- raise your toilet seat
- make last step stand out
- reduce clutter
- keep items within reach
- use a step stool
Drug Therapy cont.
- selective estrogen receptor modulators: raloxifene (Evista)
- teriparatide (Forteo): portion of parathyroid hormone. First drug to stimulate new bone formation**
Hip Fracture Risks in older adults
-falls
-poor balance
-limited shock
absorbers (fat, muscles, bulk)
-gati
-decreased vision and hearing
-slow reflexes
-hypotension
-medication use
-loose rugs
-furry friends
Hip Fracture Assessment Findings (clinical manifestations)
- external leg/foot rotation
- shortening of affected leg
- muscle spasm
- severe pain and tenderness
Bucks Traction
used to pull leg and decrease spasms occurring from the injury
Hip Fractures defenition
disruption/ break in continuity of the structure of bone
- fracture of proximal third of femur extending up to 5 cm below lesser trochanter
- intracapsular fracture (femoral neck)
many develop disabilities requiring long-term care
Fractures
- subcapital neck fracute: right under head
- transcervial neck fracture: in the middle of the neck
- intertrochanteric fracture: under the neck
- subtrochanteric fracture: lowest, on the femur bone
- greater trochanter fracture
- lesser trochanter fracture
Hip Fracture: Initial Assessments
wiggle toes, check temp., pulses, sensation, resp. status
past medical Hx
x-ray
Pain management
analgesics
muscle relaxants
positioning
Teaching upmost importance
- Surgery
- exercise unaffected leg to prevent clots
- use trapeze bar
- pt to begin to teach chair transfer
Overall goals for hip fracture treatments
anatomic realignment of bone fragments
immobilization to maintain realignment
restoration of normal or near-normal function of injured parts
Skin traction (Buck’s Traction)
- used for short-term treatment until surgery is possible: used for 24-48 hrs
- traction weights: 5-10 lbs
- apposing force pulling
Buck’s Traction purpose
decrease muscle spasms
immobilize joint or part of body
decrease of fracture or dislocation
treat a pathological joint condition
Care for client in TRACTION
T- temperature: extremity infection R- ropes hang freely A- alignment C- circulation check (5 Ps) T- type & location of fracture I- increased fluid intake O- overhead trapeze N- no weights on bed or floor
Surgical Repair
Open reduction (ORIF)
- correction of bone alignment through surgical incision
- includes internal fixation with use of wires, screws, pins, plates, intramedullary rods, nails
Surgical Disadvantages
- infection
- complications with anesthesia
- effects of preexisting medical conditions
Prior to surgery
- monitor V.S
- nerovasc. checks
- maintain proper alignment
- monitor Buck’s traction if applicable
- medicate for pain/ muscle spasms
- pre-op teaching
Post-op
- monitor v.s.
- monitor for bleeding
- monitor I&Os
- turn, cough, deep breathe
- medicate for pain
- maintain abduction
- mobilize asap (first day post-op)
- prevent complications of DVT, infection (osteomyelitis takes 6-8 weeks to remove infection)
5 Ps
1- pain 2- paresthesia 3- paralysis 4- pallor 5- pulses
Post-op Education
- fall precautions
- avoid flexing >90 degrees
- watch for sudden severe pain, lump in buttock, limb shortening, external rotation (dislocation)
- place large pillow between legs when turning
- avoid turning on affected side until approved by surgeon
Joint Arthroplasty
replacement or reconstruction of a joint to decrease pain, improve ROM, decrease deformity
Hip Arthroplasty Care
for posterior approach hip arthroplasties, do not flex >90
knees must be apart
avoid bending
DVT prophylaxis: **knees and hips pose highest risk
may be on warfarin (Coumadin), rivaroxiban (Xarelto), apixaban (Eliquis),
Osteoarthritis
- affects joints mostly
- weight-bearing joints: hands, knees, hips, spine
- unsymmetrical
- does not affect other systems of the body
- from “wear or tear”
- inflammation not present: grating of bones, bone breakdown, bone spurs, cartilage/bone spurs floating in bone space
RA
- affects joints symmetrically
- most common: fingers and wrist
- can also affect neck, shoulders, elbows, ankles, knees, feet
- systemic: can extend to heart, skin, eyes, mouth, lungs, cause fever, anemia
- affects women more than men (ages 20-60 yo)
- inflammation present
