Bone Up on Osteoporosis By Joyce Seabolt, LPN LPN2007, November/December ANCC/AACN contact hours Online: © 2007 by Lippincott Williams & Wilkins. All world rights reserved.

Growing Bones Osteoblasts: form new bone cells in a process called remodeling Osteocytes: maintain bone as a living tissue Osteoclasts: break down calcium and phosphorus in a process called resorption

Possible Causes of Osteoporosis personal history of nontraumatic fracture low peak bone mineral density body weight less than 27 pounds unexplained cessation of menstruation anorexia nervosa low lifetime calcium intake vitamin D deficiency lifestyle lacking weight-bearing exercises

Possible Causes of Osteoporosis alcohol consumption of more than two drinks per day cigarette smoking family history of nontramautic fracture (primary relative) and/or osteoporosis long-term use (more than 6 months) of corticosteroids, medroxyprogesterone (Depo-Provera), thyroid hormones, anticonvulsants, aluminum-containing antacids, methotradate sodium, cholestryamine white or Asian race

Risk Factors for Osteoporosis Age - Older people more likely to develop osteoporosis Race - White and Asian most susceptible Sex - Women lose bone more rapidly than men Heredity - Family history increases chances Low weight and bone structure Estrogen deficiency or menopause

Risk Factors for Osteoporosis Contributing medical conditions/medications - Celiac disease, corticosteroids, antiseizure medications Excessive alcohol use or smoking Diet low in calcium and vitamin D Inactivity and lack of weight-bearing exercise Lack of exposure to sunshine

Types of Osteoporosis Primary - Most common in 95% of cases; occurs spontaneously Secondary - Results from a disease such as diabetes or a medication such as steroids

Diagnosis Bone mineral density (BMD) test - Best determinant of bone health -- Dual energy x-ray absorptiometry (DXA) - gives information to calculate fracture risk -- T-score with negative numbers = bone loss

More Diagnostic Tests Computed tomography scan (CT) - can measure spinal bone density Ultrasound - evaluates bones strength using sound waves to measure bone density

Blood Tests to Evaluate and Monitor Osteoporosis calcium levels vitamin D levels thyroid function parathyroid hormone levels estradiol levels follicle-stimulating hormone testosterone osteocalcin levels

Urine Tests 24-hour urine to measure calcium metabolism NTx, a new biochemical urine test that shows rate of bone breakdown

Lifestyle Modifications Eat diet rich in calcium and vitamin D to 1500 mg calcium over 25 years of age to 1500 mg calcium in children and young adults to 800 international units of vitamin D Exercise - as little as 5 to 6 weight-bearing exercises two to three times a week - walking, dancing, climbing

Lifestyle Modifications Fall prevention - wear low-heeled, nonskid shoes - remove clutter from walkways - secure or remove all rugs - place skid-proof mats next to tubs and sinks - make sure walkways are lit

Medication Choices Biphosphonates - slow bone loss - Fosamax - Actonel - Boniva Selective estrogen receptor modulators - decrease bone resorption - Estiva

Medication Choices Cacitonin-salmon - peptide hormone inhibits bone breakdown - Miacalcin - Calcimar - Fortical - Cibacalcin Hormone replacement therapy - decreases bone breakdown in menopausal women (discuss with health care provider due to many adverse effects)

Scary Statistics 10 million Americans over age 50 have osteoporosis. About 1.5 million people have an osteoporosis-related fracture each year. About 20% of people with a hip fracture end up in a nursing home within the year. About 20% of people with a hip fracture will die within the year due to complications.

Scary Statistics The World Health Organization reported that 50% of people with hip fractures become permanently disabled; they expect the number of hip fractures due to osteoporosis to triple by the year 2050, bringing the worldwide total number of hip fractures to 6 million. The lifetime risk of fracture in a 50-year-old woman is about 40%.