OSTEOPOROSIS

Characteristics of osteoporosis include a reduction of bone density and a change in bone structure, both of which increase susceptibility to fracture. The normal homeostatic bone turnover is altered: the rate of bone desorption is greater than the rate of bone formation, resulting in a reduced total bone mass.. Definition

With osteoporosis, the bones become progressively porous, brittle, and fragile; they fracture easily under stresses. Osteoporosis frequently results in compression fractures of the thoracic and lumbar spine, fractures of the neck and region of the femur, and fractures of the wrist.

prevention Primary osteoporosis occurs in women after menopause and later in life in men, but it is not merely a consequence of aging. Failure to develop optimal peak bone mass during childhood, adolescence, and young adulthood contributes to the development of osteoporosis without resultant bone loss. Early identification of at-risk teenagers and young adults, increased calcium intake, participation in regular weight- bearing exercise, and modification of lifestyle (e.g., reduced use of caffeine, cigarettes, and alcohol) are interventions that decrease the risk for development of osteoporosis, fractures, and associated disability later in life.

Cont,…….. Secondary osteoporosis is the result of medications or other conditions and diseases that affect bone metabolism. Medications (e.g., corticosteroids, antiseizure medications) that place patients at risk need to be identified and therapies instituted to reverse the development of osteoporosis. Disease states, nutritional deficiencies, and medications. Coexisting medical conditions (e.g., malabsorption syndromes, alcohol abuse, renal failure, liver failure, hyperthyroidism, and hyperparathyroidism) contribute to bone loss and the development of osteoporosis.

Pathophysiology Normal bone remodeling in the adult results in gradually increased bone mass until the early 30s. Gender, race, genetics, aging, low body weight and body mass index, nutrition, lifestyle choices (e.g., smoking, caffeine and alcohol consumption), and physical activity influence peak bone mass and the development of osteoporosis.

Cont,…….. Age-related loss begins soon after the peak bone mass is achieved (i.e., in the fourth decade). Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time.

Cont,…….. The withdrawal of estrogens at menopause causes an accelerated bone resumption that continues during the postmenopausal years. Women develop osteoporosis more frequently and more extensively than men because of lower peak bone mass and the effect of estrogen loss during menopause. More than half of all women older than 45 years of age show evidence of osteopenia.

Risk Factors Individual Risk Factors Female, Caucasian, non-Hispanic or Asian Increased age Low weight and body mass index Estrogen deficiency or menopause Family history Low initial bone mass Contributing, coexisting medical conditions (e.g., celiac disease) and medications (e.g., corticosteroids, antiseizure medications)

Cont,…….. Lifestyle Risk Factors Diets low in calcium and vitamin D. Cigarette smoking. Use of alcohol and/or caffeine. Lack of weight-bearing exercise. Lack of exposure to sunshine. Risk-Lowering Strategies Increased dietary calcium and vitamin D intake. Smoking cessation. Alcohol and caffeine consumption in moderation. Regular weight-bearing exercise regimen. Walk or exercise out of doors.

Assessment and Diagnostic Findings Osteoporosis is diagnosed by dual-energy x-ray absorptiometry (DEXA), which provides information about BMD at the spine and hip. Laboratory studies (e.g., serum calcium, serum phosphate, serum alkaline phosphatase, urine calcium excretion, urinary hydroxyproline excretion, hematocrit, erythrocyte sedimentation rate) and x-ray studies are used to exclude other possible medical diagnoses (e.g., multiple myeloma, osteomalacia, hyperparathyroidism, malignancy) that contribute to bone loss

Medical Management An adequate, balanced diet rich in calcium and vitamin D throughout life. Regular weight-bearing exercise promotes bone formation. From 20 to 30 minutes of aerobic exercise (e.g., walking), 3 days or more a week, is recommended. Weight training stimulates an increase in BMD. In addition, exercise improves balance, reducing the incidence of falls and fractures.

Pharmacologic therapy Selective estrogen receptor modulators (SERMs), such as raloxifene (Evista), reduce the risk for osteoporosis by preserving bone mineral density without estrogenic effects on the uterus. They are indicated for both prevention and treatment of osteoporosis. Calcitonin (Miacalcn). Natural estrogens (plant-derived phytoestrogens) have not been shown to be effective in reducing osteoporosis-related fractures

FRACTURE MANAGEMENT Fractures of the hip are managed surgically by joint replacement or by closed or open reduction with internal fixation (e.g., hip pinning). Surgery, early ambulation, intensive physical therapy, and adequate nutrition result in decreased morbidity and improved outcomes.

: Nursing Diagnose Deficient knowledge about the osteoporotic process and treatment regimen Acute pain related to fracture and muscle spasm Risk for constipation related to immobility or development of ileus (intestinal obstruction) Risk for injury: additional fractures related to osteoporosis