Osteoporosis Flashcards
Bone cells that break down bone
Osteoclasts
Bone cells that rebuild bone
Osteoblasts
Term for bone loss
Osteopenia
Most common areas of bone loss
Lumbar spine
Hip
Distal radius (wrist)
Risk factors for osteoporosis
- Cigarette smoking
- Early menopause
- Excessive use of alcohol
- Family history
- Female gender
- Increasing age
- Decreased calcium intake
- Sedentary lifestyle/Immobility
- Thin, small frame
- White (European descent) or Asian Race
What is the name if this condition?
- Bone demineralization occurs through loss of calcium and phosphorous salts leading to fragile bones and increased risk for fracture
- Bone reabsorption accelerates, while bone formation decreases
Osteoporosis
What type of osteoporosis is this?
Occurs most often in postmenopausal women and men with low Testosterone levels
Primary
What type of osteoporosis is this?
Prolonged steroid use, thyroid-reducing medications, aluminum-containing antacids, or antiseizure medications
Secondary
All of the following are clinical manifestations of what?
“Silent Disease” because patients are usually not diagnosed until a fracture occurs after an unremarkable fall or strain
“Dowager’s Hump” – kyphosis of the dorsal spine
Loss of height (as much as 2 -3 inches)
Back pain (sharp or acute)
Pain increased with activity and relieved by rest
Restriction of movement (thoracic and lumbar regions)
Fear of falling and/or history of previous falls
Previous fractures
Constipation
Abdominal distention
Reflux esophagitis
Osteoporosis
kyphosis of the dorsal spine
Dowager’s hump
Normal T-score on a DEXA scan
-1.0 or higher
Abnormal T-score on a dexa scan
Anything below -1.0
T-Score on a DEXA scan between -1.0 and -2.5 indicates what?
Ostepenia
DEXA Scan -2.5 or lower
Osteoporosis
What type of test is this?
- Gives precise body measurements at specified skeletal points throughout the body
- Used for screening and diagnosis
- May diagnose osteopenia or osteoporosis
DEXA scan
measures volumetric bone density of spine and hip
Used for diagnostic management (to confirm diagnosis)
QCT
Normal Calcium levels
9-11
A calcium level less than 8 indicates what?
Calcium deficiency
Normal vitamin D level
- 30-50
Vitamin D level of 20-30 indicates what?
Vitamin D insufficiency
Level of vitamin D toxicity
above 50
The following are S/S of what?
- Dehydration
- Hypercalcemia
- Kidney damage
Vitamin D toxicity
How will osteoporosis patients vitamin D levels present?
insufficient
Ways to prevent bone loss
- Calcium with vitamin D via supplements or dietaty intake
- 15 mins of sun exposure per day
Calcium’s role in osteoporosis
maximizes bone growth early in life and maintains bone integrity later in life.
Vitamin D’s Role on osteoporosis
ensures calcium absorption
These are the two most important bone supplements for advanced aging and to preserve bone health
What medication used to treat osteoporosis is this?
- Impedes bone resorption by stopping osteoclastic activity, increasing total bone mass
Bisphosphnates
Contraindications for bisphosphonates
- Clients with esophageal disorders that can impede swallowing
- Clients who cannot sit or stand for at least 30 minutes after administering
Adverse effects of Bisophosphonates
Notify care provider should be notified immediately if any of the following occur:
* Esophagitis
* Muscle pain
* Ocular problems
How to administer bisphosphonate
- In the morning before eating and drinking
- with a full glass of water
- Sit upright for 30 mins
- Do not eat or drink anything for at least 30 minutes
- Take with regular tap water for best absorption
If a client is prescribed bisphosphonate Ibandronate must do what after taking?
- Sit or stand for at least 60 mins after taking
- no food or drink for 60 mins after taking
What medication is this?
- Decreases osteoclastic activity in bone, decreases mineral release and collagen breakdown, and assists with renal excretion of calcium
- Routes of administration salmon: intranasal, SQ, or IM
Calcitonin-salmon or Calcitonin-human
Special administration instructions for calcitonin
- Inspect nares for irritation
- Alternate nares for each dose
Calcitonin human can only be given how?
SQ
Patients taking calcitonin should be monitored for what?
Hypocalcemia
What medication is this?
- assists with bone remodeling and osteoclastic activity
- Risk for causing DVT
Estrogen or estrogen HRT
What medication is this?
- Assists with bone remodeling and osteoclastic activity
- contraindicated in clients with a history of a DVT
Estrogen
Teaching with estrogen agonist
- Needs to be D/C’d 72 hours before prolonged immobilization periods (extended periods of bedrest, etc.)
- Instruct client to avoid extended periods of restricted activity (such as traveling long distances)
- Contraindicated in pt’s with a hx of DVT
What medication is this?
- Stimulates new bone formation, increasing bone mass and increases osteoblastic activity
- Given to clients at very high risk for fractures
- Has been associated with development of Bone Cancer
Parathyroid Hormone
What medicine is this?
- Inhibits osteoclastic function, formation, and survival reduces osteoclastic bone resorption
- Treats hypercalcemia
- Treats bone cancer and bone problems in clients with cancer
Monoclonal Antibody
Priority Nursing assessment for osteoporosis
Assess fall risk
Assess pain level
Assess nutritional status
Assess level of activity and exercise
Assess body image disturbances, if applicable
Dietary teaching for Osteoporosis patients
protein, magnesium, vitamin K, calcium, vitamin D, vitamin C and iron, increased fluid intake
Fall precations at home
- Remove throw rugs
- Provide adequate lighting
- Clear walkways of clutter
- Wear non-slip socks when walking in the house
- Clearly mark thresholds, doorways, and steps
What kind matress should an osteoporosis patient use?
Firm
What should be applied during an acute episode of osteoporosis
Apply back brace to immobilize and protect vertabral column
Client education for osteoporosis
- Use of correct body mechanics
- Exercises to strengthen core muscles to improve posture and support spine
- Avoid activities that can cause vertebral compression
- Diet high in protein, calcium, vitamins C and D, and iron
- Maintain adequate fluid intake to prevent kidney stones
What kind of exercises do osteoporosis patients need to do?
How often?
How long
weight bearing
3-5 times a week
for 30 minutes
The following are sources are
Eggs
Chicken
Lean beef
Fish
Turkey
Cheese
Greek yogurt
Milk
Protein
All of the following foods are rich in what?
Greens
Nuts
Seeds
Dry beans
Whole grains
Wheat germ
Wheat and oat bran
Magnesium Sources
The following foods are rich in what?
Green, leafy vegetables
Soybean
Fortified meal replacement shakes
Vitamin K sources
The following food is rich in what?
Dairy and fortified plant-based milks
Cheese
Yogurt
Fortified OJ
Butternut squash
Green, leafy vegetables
Avocado
Calcium
The following foods are rich in what?
Fortified milk, cereal, and juices
Salmon
Eggs
Tuna and sardines
Trout
Beef liver
White mushrooms
Vitamin D
To decrease bone loss osteoporosis patients should limit what?
Caffine
alcohol
carbonated drinks
