Osteoporosis (Module 5) Flashcards
Osteoporosis Patho
chronic, progressive metabolic bone disorder involving an imbalance between new bone formation (osteoblastic) and bone reabsorption (osteoclastic)
“silent disease” progressive bone density decline leads to thin fragile bones, risk to spontaneous fractures (spine, hip, wrist)
osteomalacia (bone softening due to vitamin D deficiency; needed for calcium absorption in intestine)
osteopenia (a precursor, low bone mineral density due to age and gender; bone density peaks between 18-30. after peak years bone density declines slowly with faster decline in postmenopausal women due to reduced estrogen)
Osteoporosis Causes
primary (“normal aging”)
secondary to a specific disorder (thyroid/parathyroid, eating disorders, gastrectomy, type 1 DM)
Osteoporosis Risk Factors
postmenopausal females
family history/genetics
thin, lean body build
joint injuries from repetitive traumas/overuse
obesity
excess caffeine consumption (Ca wasting in urine)
low intake of protein
calcium/vitamin D deficiency/malabsorption syndromes
smoking
asian and white american women
Osteoporosis S/S
reduced height (postemenopausal) in both men/women
acute back pain after lifting and bending (worse with activity, relived by rest)
restriction in movement and spinal deformity
hx of fractures (wrist, femur, thoracic spine)
kyphosis (thoracic dorsal curvature of spine; shorter 2-3 inches over time)
pain with palpation, movement, etc.
Osteoporosis Labs and Diagnostics
vit D/D3 level, serum Ca, P, thyroid/parathyroid hormones to rule out other bone disorders (Pagets, osteomalacia)
24 hr urine collection for Ca excretion rate
radiographs (spine and long bones reveal low bone density and fractures)
baseline screening for women in their 40s
dual-energy X-ray absorptiometry (DXA) (uses 2 beams of radiation to screen for early changes in bone density)
peripheral quantitative ultrasound (pQUS) (inexpensive, portable and low risk method for osteoporosis and risk of fractures especially men over 70)
quantitative computer tomography measures bone density, especially spine
MRI bone perfusion
DXA Scan Results
T score (relates the amount of bone density to that of a young healthy adults)
• 0-30 yr old adults; -1- (-2.5)=osteopenia; <-2.5=osteoporosis
Z-score compares clients readings with those of a group of age-matched clients who serve as a control
Osteoporosis Meds
thyroid hormone (calcitonin) (decreases bone reabsorption by inhibiting osteoclast activity for osteoporosis, hyper Ca and Paget’s disease)
calcium and vitamin D3 (encourage increased fluids to prevent calculi; monitor Ca level to determine drug effectiveness; observe for signs of hyper Ca, like calcium deposits under the skin)
biphosphonates (ALENDRONATE) (teach pts to take drug on an empty stomach first thing in the morning with full glass of water; have dental exam before starting drug; for IV drug infuse over 15-30 min to prevent rare complications like A Fib and check pts creatinine before and after administering; don’t give drug to pts who are sensitive to aspirin due to bronchoconstriction)
estrogen agonists/antagonists
RANKL inhibitors
Estrogen Agonists/Antagonists
beware of symptoms of VTE because VTE is an ADE
monitor LFTs
RANKL Inhibitors (Osteoporosis)
teach pts to report s/s of infection
monitor Ca levels, Mg and P
instruct the pt to have a dental exam
Osteoporosis Procedures
orthotic devices (immobilization of the spine immediately after compression fracture)
joint repair or arthroplasty
vertebroplasty/kyphoplasty (bone cement is injected into the fractures space of the vertebral column with/without balloon inflation)
Osteoporosis Nursing Care
diet rich in Ca and vit D, especially if vit D is <35 (fish, egg yolk, fortified milk products, cereal, green veggies, fortified Oj, red/white beans, figs)
encourage pt to take Ca/vit D supplements, especially if the diet is inadequate like lactose intolerance
limit carbonated drinks, coffee, or alcohol containing phosphates and caffeine
sun exposure 5-30 min 2x week (sunscreen to avoid burns)
HRT for women
weight bearing exercise program; low impact like walking and swimming (avoid running, horseback riding)
instruct client on adequate diet in protein, Mg, vitamin K, etc.
assess home environment for safety to prevent falls and fractures (reinforce the use of safety equipment and assistive devices, instruct the client to avoid inclement weather, clearly mark thresholds, doorways and steps)
FRACTURES ARE LEADING COMPLICATION
