1. OSTEOPOROSIS Ann S. Goodson,R.N.,MSN,ONC Nurse Coordinator Pediatric Orthopedics University of Virginia

2. Bone Is Living, Growing Tissue CORTICAL BONE TRABECULAR BONE

3. Bone Cells 3 Types OSTEOCLASTS OSTEOBLASTS LINING CELLS OSTEOCYTES

4. The Skeleton’s Function Support the body Protect internal organs Muscles attach for movement Mineral reservoir for Calcium and Phosphorus Defense against acidosis Trap for some dangerous minerals such as Lead.

5. What is Osteoporosis? OSTEO= BONE POROSIS= FULL OF HOLES OSTEOPOROSIS IS A STEADY, PROGRESSIVE LOSS OF BONE DENSITY. OSTEOPOROSIS, THE “SILENT CRIPPLER” IS A PAINFUL BONE DISEASE THAT MAKES YOUR BONE GROW BRITTLE AND FRACTURE EASILY

6. OSTEOPOROSIS Re-absorption of bone cells slowly exceeds bone cell formation

7. Schematic view of bone formation/re-absorption

8. Risk Factors You Control Exercise Avoid alcohol Not Smoking Sex Hormones Medications Diet

9. Risk Factors You Can Not Change GENDERGENDER ETHNICITYETHNICITY BODY SIZEBODY SIZE AGEAGE

10. Exercise Bone building exercises  Walking  Dancing  Jumping rope  Lifting weights

11. Foods High in Calcium DAIRY PRODUCTS LEAFY GREEN VEGATABLES/BROCCOLI SALMON ( WITH THE BONES IN) SARDINES CALCIUM ENRICHED FOODS ALMONDS

12. Recommended Daily Calcium Intake for Males & Females AGEAMOUNT(milligrams per day) Birth-6 months210 7 months-1 year270 1-3 years500 4-8 years800 9-181300 19-501000 51-+ + +1200 Pregnant & LactatingSame as for women of comparable age

13. Diagnostics Osteoporosis is preventable and treatable, therefore early diagnosis and treatment is important. Most common technique is Dual Energy X- ray Absorptiometry (DEXA scan)  Precise measurement/high resolution  Sensitive to changes  Simple to perform, no pain or discomfort  Less Radiation

15. Consequences of Osteoporosis Vertebral Fractures Loss of height Acute and chronic back pain Morphologic changes *kyphosis *loss of waistline *protruding abdomen Physiologic changes *Digestive function *Breathing difficulties Increased mortality

16. Consequences of Osteoporosis Nonvertebral fractures (Example- hip,wrist,arm) Pain Loss of independence Possible entry in a nursing home Surgical complications

17. MEDICATIONS Antiresorptive Agents Name of Medication DescriptionFunction Estrogen Replacement Therapy (ERT) 0.625 mg recommended for women that have had hysterectomy or oophorectomy before age of 50 ERT helps reduce osteoclast activity which results in a slower rate of bone loss and increased bone mass in the spine and hip Alendronate & Risendronate Biophosphonates used in the treatment of bone loss associated with the use glucocorticords. Dosage depends on use- prevention and treatment Decrease bone loss Increase bone density RaloxifineSelective estrogen receptor modulator –produce similar benefits as ERT without the side effects Reduces the risk of spinal fractures Encourages the bone density throughout the body Calcitonin-salmonSynthetic compound identical to calcitonin found in salmon Slow bone loss by binding to orthoclase Increase spinal bone mass Reduce risk for spinal fracture in postmenopausal women

18. Demystifying Calcium Supplements Calcium supplements-1000-1500 mg per day Taken in doses not > 500 mg at a time Elemental calcium Calcium carbonate Calcium citrate Calcium Phosphate Vitamin D-is essential for Ca absorption

19. Nursing Guidelines for Osteoporosis Prevention Promote widespread patient and public education regarding osteoporosis Encourage safe physical activity Discourage smoking and excessive alcohol consumption Promote achieving and maintaining a healthy body weight and life styles Investigate safe hormone replacement therapy Fall and Injury Prevention

20. THANK-YOU!