Osteoporosis part 2

Question 1

What are the 3 vitamins for osteoporosis prevention?

Answer 1

calcium
vitamin D (bone formation and calcium absorption) 
vitamin C (for absorption of calcium)

Question 2

When should calcium supplements be taken and what is a special consideration when taking them?

Answer 2

• calcium and vitamin d should be taken if daily requirements are not met through diet
• these need to be taken with food
• the supplement should also be taken in single doses no greater than 500 mg because of absorption issues

Question 3

What types of exercise should we promote for prevention of osteoporosis?

Answer 3

• weight bearing exercises (weight training and resistance training) 20 to 30 minutes per day
• reduces falls and increases balance
• these types of exercises stimulate bone mineral density (BMD)

Question 4

What drugs are widely used for osteoporosis?

Answer 4

Biphosphonates

Question 5

What do biphosphonates do?

Answer 5

-they inhibit osteoclast mediated bone reabsorption which increases total bone mass and BMD- bone mineral density

Question 6

What are the 4 biphosphonates?

Answer 6

Alendronate (Fosomax): daily or weekly tablet
Ibandronate (Boniva): once a month tablet or Q3 months IV
Risendronate (Actonel): for men and women on corticosteroids
Zoledronic Acid (Reclast): once a year IV infusion, prolonged use can cause acute kidney injury

Question 7

What are the important nursing considerations for biphosphonates?

Answer 7

• take with a full glass of water
• remain upright for 30 minutes after taking
• take 30 minutes before food or other medication

Question 8

What is a rare and serious side effect of biphosphonates?

Answer 8

-jaw osteonecrosis

Question 9

What does calcitonin do?

Answer 9

-secreted by thyroid and inhibits osteoclast bone resorption. Calcitonin decreases with age.

Question 10

What is the calcitonin medication and what forms is it available in?

Answer 10

• salmon calcitonin (calcimar)

- available IM, SQ, and intranasal

Question 11

What supplementation is necessary when calcitonin hormone substitute is used?

Answer 11

calcium to prevent secondary hyperparthyroidism

Question 12

This drug increases the action of osteoblasts.

Answer 12

parathyroid hormone

Teriparatide (Forteo)

Question 13

How long does a patient taking bisphosphonates need to stay upright after administration?

Answer 13

3o minutes

Question 14

What is important to assess for a pt with Osteoporosis?

Answer 14

Occurrence of osteopenia and osteoporosis 
Family history
Previous fractures
Dietary consumption of calcium
Exercise patterns
Onset of menopause
Use of corticosteroids as well as alcohol, smoking, and caffeine intake 
Symptoms such as back pain

Question 15

What are important parts of the physical assessment of a person with osteoporosis?

Answer 15

Localized pain
Constipation
Altered body image

Question 16

What are the major goals for a pt with osteoporosis?

Answer 16

• Knowledge about osteoporosis and the treatment regimen
• Relief of pain
• Improved bowel elimination
• Absence of additional fractures

Question 17

What are some interventions for a pt with osteoporosis?

Answer 17

-Relieving pain:
Short periods of rest,
Supportive mattress,
Intermittent local heat and back rubs
-Improving bowel elimination:
High fiber diet, increase fluids, stool softeners
-Preventing injury
Physical activity to strengthen muscles, improve balance, and prevent disuse atrophy

Question 18

An x-ray examination of the thoracic spine reveals a collapsed vertebra at T7 and bone density changes in the spine. What could this result indicate?

Answer 18

Vertebral body fracture related to osteoporosis

Question 19

M.S. has never had an osteoporosis screening. She confides that her mother and grandmother were diagnosed with osteoporosis when they were in their early 50s.What diagnostic test is most commonly used to diagnose osteoporosis?

Answer 19

Dexa scan to get a T score

Question 20

M.S.’s diagnostic test revealed a bone density T-score of –2.7. How will this be interpreted?

Answer 20

osteoporosis

Question 21

. M.S. receives a prescription for alendronate (Fosamax) 70 mg/wk. Which instructions are appropriate as you provide patient teaching to M.S. about this drug

Answer 21

• “Take the medication with 8 ounces (236 ml) of water immediately on arising.”
• “You need to sit or stand upright for at least 30 minutes after taking the medication.”
• “If you experience any severe abdominal pain, vomiting, or jaw pain, notify your doctor immediately.”

Question 22

What foods are high in calcium?

Answer 22

milk, cheese and other dairy foods.
green leafy vegetables – such as curly kale, okra and spinach.
soya drinks with added calcium.
bread and anything made with fortified flour.
fish where you eat the bones – such as sardines and pilchards.

Question 23

Which problem may occur during therapy with denosumab? How is denosumab given?

Answer 23

• Osteonecrosis of the jaw

- Given SQ every 6 months