OSTEOPOROSIS

Question 1

Chronic, progressive metabolic bone disease that involves an imbalance between new bone formation ( osteoblastic) and bone resorption (osteoclastic).

Silent disease: decreases bone mineral density > thin, fragile bone tissue > increased risk for fractures, most often at the spine, hip & wrist.

Answer 1

Osteoporosis

Question 2

Bone softening d/t lack of Vit. D (needed for Ca absorption in the intestines.

Answer 2

Osteomalacia

Question 3

Precursor to osteoporosis, low bone mineral density relative to client’s age and gender. Bone mineral density peaks between the ages of 18-30. After peak years, bone density decreases with a significant increase in rate of loss in postmenopausal women due to estrogen loss.

Answer 3

Osteopenia

Question 4

Causes of Osteoporosis

Answer 4

Primary: normal aging process

Secondary: from a specific disorder (endocrine disorders or thyroid/ parathyroid gland disorder), nutritional deficiencies, DM I, HIV, AIDS.

Question 5

S/Sx of Osteoporosis

Answer 5

Reduced height (postmenopausal), acute back pain after lifting or bending, restriction in movement, spinal deformity, hx of fractures (wrist, femur, thoracic spine), thoracic kyphosis, pain upon palpation of affected area

Question 6

Risk factors

Answer 6

Primary Risk factors: female, family hx, thin, lean body builds, age>60, genetics, joint d/t repetitive stress on joints, obesity, excess caffeine consumption (causes calcium loss), chronic low intake of protein/calcium/vitamin D, malabsorption syndromes, Asian, White Euro American, Caucasian, post-menopausal, older pts w/ hip fractures have an increased mortality rate, smokers, excessive alcohol intake, long term steroid use

Secondary Risk factors: DM or other metabolic disorders

Question 7

Labs

Answer 7

D3 levels, serum calcium, vitamin D, phosphorus, protein, and alkaline phosphatase

24 hour urine can evaluate the rate of calcium excretion

Question 8

DXA Tscore of 0

Answer 8

young, healthy 30 yo adult

Question 9

DXA Tscore -1 to -2.5 indicates

Answer 9

osteopenia

Question 10

DXA Tscore -2.5 or below indicates

Answer 10

osteoporosis

Question 11

Decreases bone resorption by inhibiting osteoclast activity for treatment w/ osteoporosis, hypercalcemia, and Paget’s disease of the bone

Answer 11

Thyroid hormone - Calcitonin

Question 12

What is the leading complication of Osteoporosis?

Answer 12

fractures

Question 13

Med Reminders

Answer 13

Os-Cal (Calcium w/ vitamin D)
Encourage increased fluids, observe for signs of hypercalcemia

Alendronate (Bisphosphonates)
Teach pts to take drug on an empty stomach first thing in the morning, do not give the drug to pts who are sensitive to aspirin because bronchoconstriction may occur

Raloxifene (Estrogen Agonist/antagonist)
Teach the patient s/sx of venous thromboembolism (VTE), esp. In the first 4 months of therapy

Question 14

Nursing Care

Answer 14

-diet w/ adequate calcium & vitamin D
Foods rich in vitamin D are most fish, egg yolks, fortified milk, and cereal
Food rich in calcium are milk products, green veggies, fortified orange juice and cereals, red and white beans, and figs

-Take calcium supplement w/ vitamin D (Os-Cal) if dietary intake is inadequate

-Limit carbonated beverages (contain phosphorus and can cause calcium loss)

-Sun exposure 5 to 30 min 2x a week, wear sunscreen

-Female clients should discuss pros and cons of hormone replacement therapy w/ provider

-Engage in weight bearing exercises

-Home safety (remove throw rugs, adequate lighting, clear walkways)