Osteoporosis By: Renee Alta

Pathophysiology/Etiology Characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine and wrist. However, any boy can be affected. It is also the reduction of the mass of bone per unit of volume.

Risk Factors Personal history of fracture after age 50 Current low bone mass History of fracture in first degree relative Being thin and/or having a small frame Advanced age Vitamin D deficiency Low testerone levels in men Estrogen deficiency as a result of menopause, especially early or surgically induced Abnormal absence of menstrual periods (amenorrhea) Anorexia nervosa Low lifetime calcium intake

Risk Factors An inactive lifestyle Use of certain medications –Corticosteroids –Chemotherapy –Anticonvulsants –Antacids containing alumin –Heparin –Cyclosporine (immunosuppressive drug) Current cigarette smoking Excessive use of alcohol Being Caucasian or Asian

Clinical Manifestations Osteoporosis is often called the “silent disease” because bone loss occurs without symptoms Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis or stooped posture.

Assessment Subjective Data –Questioning complaints of back pain (low thoracic and lumbar) that worsens with straining –Questions that include lifestyle practices Objective Data –Assessing for Dowager’s hump –Increases lordosis, kyphosis, and scoliosis –Gait impairment associated with inability to maintain erect posture

Diagnostic Tests Bone Mineral Density Tests –Detects osteoporosis before a fracture before a fracture occurs –Predicts chances of fracturing in the future –Determines the rate of bone loss and/or monitor the effects of treatement Complete Blood count Serum calcium, phosphorus, and alkaline phosphatase, blood urea nitrogen, creatine level, urinalysis, liver and thyroid function X-ray DEXA

Medical Management Biphosphonates –Fosamax and Fosamax plus D –Boniva –Actonel and Actonel with Calcium –Miacalcin Estrogen/Hormone Therapy –Estrogens –Estrogens and Progestins –Parathyroid Hormone

Surgical Interventions Vertebroplasty and kyphoplasty-relieves pain from compression fractures of the spine Vertebroplasty involves high-pressure injection of a polymethyl methacrylate cement into the spine, which pushes the spine apart Kyphoplasty involves the use of a balloon that is inserted into the center of the collapsed vertebrae, which restores the position of the vertebrae so that polymethy methacrylate cement can be injected into the space created by the balloon.

Nusing Interventions Nursing interventions are aimed at preventing further bone loss and fractures –Providing a diet rich in milk and dairy products for an increase in calcum –Estrogen therapy –Safety measures, such as side rails, hand rails, bedside commodes and mats in the shower to prevent falls –Encourage weight-bearing exercise to increase bone density –Exercises such as swimming, bike riding or swimming.