Osteoporosis Flashcards
1
Q
Risk Factors 1
A
- > 65 y/o
- female gender
- low body weight
- cigarette smoking
- nontraumatic fracture
- inactive lifestyle
- family hx of osteoporosis
2
Q
Risk factors 2
A
- diet low in calcium or vit. D
- excessive alcohol ( >2 drinks a day)
- postmenopausal
- White and Asian American descent
- low testosterone in men
3
Q
Risk Factors 3
A
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
-
4
Q
Corticosteroids
A
long-term use is a major contributor to osteoporosis
5
Q
Antiseizure drugs
A
can affect bone marrow
celebrex (phosphenytoin)
6
Q
When should a DEXA scan be performed
A
65 or older for women
not much benefit for men
7
Q
DEXA Scan
Osteoporosis vs Osteopenia
A
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
8
Q
bone biopsy
A
can be done to differentiate between osteoporosis and osteomalacia
9
Q
Bone Mineral Density (BMD)
A
- normal = >1.0
- osteopenia = -1.0 to < -2.5
- osteoporosis = < -2.5
10
Q
Osteopenia
A
more than normal bone loss but not yet osteoporosis
11
Q
Appropriate Diagnostics
A
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
12
Q
Diagnostics cont.
A
Serum calcium, phosphorus, and alkaline phosphatase may be normal.
alkaline phosphatase may be elevated after fracture
13
Q
Blood Tests
A
many used to screen for disease processes that may contribute to osteoporosis
- calcium
- liver function (ALT, AST)
- high TSH (hypothyroidism)
14
Q
Gold Standard
A
DEXA scan
15
Q
CBC
A
anemia, sickle cell disease, alcohol abuse (with liver function tests)
16
Q
Serum chemistry levels
A
- 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
17
Q
Calcium Homeostasis
A
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.
18
Q
Two major hormones involved with Calcium
A
Two antagonistic hormones;
- PTH
- Calcitonin
19
Q
Calcium- Phosphorus
Relationship
A
When Calcium is high(> 11.0), phosphorus is low (<3.0)
When phosphorus is high ( > 4.5), calcium is low (< 9.0)
20
Q
Ca and Phosphorus levels
A
Calcium= 9.0 - 11.0 Phosphorus= 3.0 - 4.5
21
Q
Phosphates
A
used to treat;
- hypophosphatemia
- hypercalcemia
require doctor care
22
Q
Osteoporosis
“silent thief”
A
chronic, progressive metabolic bone disease -porous bone -low bone mass -structural deterioration of bone tissue -increased bone fragility -
23
Q
Etiology and Pathophysiology
A
bone resorption exceeds bone deposition
most commonly in spine, hips, and wrists
24
Q
Resorption
A
loss of bone
25
Osteoporosis
| -Clinical manifestations
"silent killer"
- usual first signs are; back pain, spontaneous fractures
- loss of height
- easy fracture
26
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
27
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
28
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
29
Recommended exercise
low-impact weight bearing exercise
- walking
- hiking
- weight training
- dancing
30
Collaborative Care
| Focus
```
Proper nutrition
Ca supplements
Exercise
Prevention of fract.
Drug therapy
Vertbroplasty
Kyphoplasty
```
31
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
32
Collab. Care
| -Nutrition
```
milk
cheese
ice cream
yogurt
salmon ----
sea food----
broccoli----
spinach
```
33
Collab. Care
| -supplements
Calcium- lower doses now recommended. Do not take with biphosphonate
1. -1500 mg/day post menopausal women
- 1000 g/day premenopausal or postmenopausal taking estrogen
2. Supp. vit. D recommended
- 800 units to 1000
- 20 min. of sunlight daily
3. 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.
34
Vit. D
20 min a day in sunlight is recommended
older adults need 400 - 800 IU
35
Drug Therapy
Biphosphonates inhibit osteoclast- mediated bone resorption
36
Biphosphonate "nates"
- etidronate (Didronel)
- alendronate (Fosomax)
- pamidronate (Aredia)
- can hurt jaw and cause cancer
- should not take mannitol while on this med.***
37
Calcium recommendation
1500 mg/day
prevents future loss
does not build new bone
38
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
39
Drug Therapy cont.
- selective estrogen receptor modulators: raloxifene (Evista)
- teriparatide (Forteo): portion of parathyroid hormone. First drug to stimulate new bone formation**
40
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
41
Hip Fracture Assessment Findings (clinical manifestations)
- external leg/foot rotation
- shortening of affected leg
- muscle spasm
- severe pain and tenderness
42
Bucks Traction
used to pull leg and decrease spasms occurring from the injury
43
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
44
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
45
Hip Fracture: Initial Assessments
wiggle toes, check temp., pulses, sensation, resp. status
past medical Hx
x-ray
46
Pain management
analgesics
muscle relaxants
positioning
47
Teaching upmost importance
- Surgery
- exercise unaffected leg to prevent clots
- use trapeze bar
- pt to begin to teach chair transfer
48
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
49
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
50
Buck's Traction purpose
decrease muscle spasms
immobilize joint or part of body
decrease of fracture or dislocation
treat a pathological joint condition
51
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
```
52
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
53
Surgical Disadvantages
- infection
- complications with anesthesia
- effects of preexisting medical conditions
54
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
55
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)
56
5 Ps
```
1- pain
2- paresthesia
3- paralysis
4- pallor
5- pulses
```
57
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
58
Joint Arthroplasty
replacement or reconstruction of a joint to decrease pain, improve ROM, decrease deformity
59
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),
60
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
61
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
