Chronic metabolic disease in which bone loss causes decreased density.

Occurs when osteoclastic (bone resorption) activity is greater than osteoblastic (bone building) activity related to changes in hormone levels or other disease processes. The result is decreased bone mineral density.

Trabecular or concellous bone is lost then cortical bone

Generalized or Regional

Primary generalized - more common in postmenopausal women and men > age 70

Secondary generalized may result from other medical conditions

Regional - occurs with immobility of a limb for > 8-12 weeks

Intervention

Exercise

Exercises for strengthening the abdominal and back muscles are recommended for those at risk for vertebral fracutes. These exercises improve posture and support for the spine.

Abdominal muscle tightening, deep breathing, and pectoral stretching are stressed to increase lung capacity. Exercises for the extremity muscles include muscle tightening, resistive, and range-of-motion exercises. These exercises improve join mobility and increase muscle tone.

A weight-bearing exercise program should be impolemented for muscle strengthening.

Exercise is important in the prevention and management of osteoporosis. It also plays a vital role in pain management, cardiovascular function, and an improved sense of well-being.

Intervention

Drug Therapy

Calcium

Vitamin D supplements

Estrogen

Hormone therapy

Bisphosphnates

Selective estrogen receptor modulators

Calcitonin

 Used to treat as well as prevent osteoporosis

Selective Estrogen receptor Modulator - Mimics estrogen in some parts of the body while bocking its effect elsewhere

-Increases BMD, reduces bone resorption, and reduces the incidence of osteoporotic vertebral fractures. 

Age 65 years and older in all women

Age 75 years and older in Men

Family history

History of low-trauma fracture after age 50

Caucasian or Asian ethnicity

Low body weight, think build

Chronic low calcium intake

Estrogen or androgen deficiency

Women with other risk factors 

Smoking 

High alcohol intake

Lack of physical exercise

Osteoporosis

Common Manifestations

1. Dowager's hump or kyphosis of the dorsal spine

2. Back pain that is worse with activity and relieved by rest

3. Movement restriction

4. Spinal deformity

Intervention

Nutrition Therapy

A nutritional plan that emphasizes frutis and vegetables, low-fat dairy and protein sources, increased fiber, and moderation in alcohol and caffeine intake is most benificial to maintaining bone health.

Adequate amounts of protein, magnesium, vitamin K, and trace minerals are needed for bone formation. Increase vitamin D and calcium.

Biochemical markers can provide information about bone reabsorption and formation activity. The markers are sensitive to bone changes and can be used to monitor effectiveness of treatment.

Biochemical markers: Bone-specific alkaline phosphatase is used to indicate bone formation status

Osteocalcin increases during bone resorption activity

Pyridinium occur during bone resorption

N-teleopeptide and C-telepeptide are released when bone is broken down

24-hour urine test

Increased levels of NTX and CTX indicated a risk for osteoporosis

Labratory Assessment

Rule out Secondary Osteoporosis

Calcium

Vitamin D

Phosphorus

Urinary calcium

Serum protein

Thyroid function

X-ray - used to show decreased bone density and fractures

Dual-x-ray absorptiometry - used to measure bone mineral density

Quantitative computed tomography - used to measure bone density

Qantitative ultrasound - used to deteck osteoporosis and predict risk for hip fracture

Used as preventative strategies for reducing bone loss 

-Used in postmenopausal women

-Increased risk for cardiovascular disease, breast cancer, and venous thromboembolism

-Use in low doses and short duration

Parathyroid hormone agent is a bone building agent approved for treatment of osteoporosis in postmenopausal women with high risk for fracture. 

Stimulates new bone formation, increasing bone marrow density

-Side effects: dizziness or leg cramping

-Daily subcut injection

Calcium is important to prevention of osteoporosis

-Calcium is most readily utilized by the body when fasting and immobile

-Increase fluids to prevent calcium-based urinary stones

Hypercalcemia-causes damage to the urinary system

Vitamin D is needed for optimal calcium absorption in the intestines

-High doses can can hypercalcemia and hyperphosphatemia

Bisophosphonates - slow bone resporption by binding with crystal element in bone

-Used for prevention and treatment

Side effects: Esophagitis

-Take med early in the morning with 8 oz water and stay upright for 30 minutes

Pamidronate IV - given when oral bisophophnates are not effective

-Can cause jaw ostenocrosis (jaw bone death)

Thyroid hormone that inhibits osteoclastic acitivity, thus decreasing bone loss

-Given subcut or intranasally

-Nasal route is preferred because it imporves drug adherence, decreases side effects

-Effect may decrease after 2 or more years

-Medication holiday to maintain treatment

Potential Complications

Physical/Psychosocial

Physical complications: Back pain

Compression vertebral fractures

Movement restriction and spinal deformity may result in constipation, abdominal distension, reflux esophagitis, and respiratory compromise

Fractures in the distal end of the radius (wrist) and the upper third of the femur (hip) 

Psychosocial complications:insomnia, depression, fallophobia (fear of falling),suffering, derormity, and disability can affect the patitn's well-being and life satisfaction and decrease quality of life. Decreased social interactions, sexuality changes, poor self-esteem, anxiety 

Patient will experience increased comfort and decreased pain. 
Patient will express positive feelings about themselves
Patient will perform activities of daily living within normal limits.
Patient will maintain adequate food intake. 
Patient will maintain joint mobility and range of motion. 
Patient will demonstrate integrity intact skin. 
Patient will demonstrate the steps to prevent injury.

Patient will verbalize how to decrease risk for falls.

Patient will verbalize how to decrease modifiable risk factors.

Risk factors

How to decrease modifiable risk factors

Read food labels for appropriate nutrition

Explain the importance of sun exposure

Limit the amount of carbonated beverages

Exercise

Activites to avoid

Safety

Fall Prevention strategies

Medication Management and side effects

Pain Managment Nutritional Therapy