1. Osteoporosis Metabolic Bone Disease

2. Osteoporosis Characterized by low bone mass and structural deterioration Normal homeostatic bone remodeling is altered – the rate of bone resorption is greater than the rate of bone formation.

3. Osteoporosis Chronic, progressive metabolic bone disease characterized by –Porous bone –___ ____ ____ –Structural deterioration of bone tissue –Increased bone fragility

4. Osteoporosis Eight times more common in women than men for several reasons 1.Lower calcium intake than men 2.Less bone mass because of smaller frame 3.Bone resorption begins earlier and accelerates after menopause 4.Pregnancy and breastfeeding deplete woman’s skeletal reserve of calcium 5.Longevity increases likelihood of osteoporosis; women live longer than men

5. Etiology Risk factors (non-modifiable) –Female gender –Increasing age –Family history –White or Asian ethnicity –Small stature –Early menopause

6. Etiology Risk factors (cont’d) –Excess alcohol intake –Cigarette smoking –Anorexia –Oophorectomy –Sedentary lifestyle –Insufficient calcium intake –Low testosterone levels (hypogonadism in men)

7. Etiology and Pathophysiology Peak bone mass is achieved before age 20 – Bone loss after midlife is inevitable but rate of loss is variable Bone resorption exceeds bone deposition Bone resorption exceeds bone deposition Bones become weakened and prone to fracture, loss of height, and kyphosis. Bones become weakened and prone to fracture, loss of height, and kyphosis.

8. Etiology and Pathophysiology Diseases associated with osteoporosis Intestinal malabsorption Kidney disease Rheumatoid arthritis Hyperthyroidism Chronic alcoholism Cirrhosis of the liver Hypergonadism Diabetes mellitus

9. Osteoporosis Diagnostic Studies Clinical Manifestations –Known as silent disease Diagnosis –Bone Mineral Density (BMD) –Dual-energy x-ray absorptiometry (DEXA) –History and physical –Quantitative ultrasound

10. Osteoporosis Can the disease be prevented?

11. Treatment and Nursing Care Diet Therapy – Weight bearing Exercises – Decrease Risk Factors –Quit smoking and decrease consumption of alcohol

12. Drug Treatment of Osteoporosis Estrogen Replacement Therapy Calcium & Vitamin D supplements Calcitonin Biphosphonates (Fosamax, Didronel, Actonel, Boniva, Aredia, Bonefos, Skelid) Selective Estrogen receptor modulator – Evista Teriparatide (Forteo) –Portion of parathyroid hormone First drug to stimulate new bone formation

13. Medications Used in Treatment of Osteoporosis Hormone Replacement Therapy – Estrogen –Controversy over use. Should discuss with health care provider Calcium –There are a variety of calcium supplements available (See Table 64-16, p. 1689). They should be taken with _______ _ to aid in absorption. Also if taking large doses i.e. 1000 mg. / day – take in divided doses of 500mg BID for better absorption

14. Medications Used in Treatment of Osteoporosis Calcitonin –If calcitonin inhibits bone resorption by opposing the effects of parathyroid hormone, how does that affect serum calcium levels? –What is needed to counter that effect?

15. Medications Used in Treatment of Osteoporosis Bisphosphenates – (Fosamax) –Inhibit osteoclast-mediated bone resorption thereby increasing BMD and total bone mass. –Side effects – anorexia, weight loss, gastritis –Patient Teaching

16. Medications Used in Treatment of Osteoporosis Selective Estrogen Receptor Modulators –Mimic effect of estrogen on bone by reducing bone resorption without stimulating the breasts or uterus. –Side effects Leg cramps Hot flashes

17. Osteomalacia Metabolic Bone Disease

18. Osteomalacia Decalcification and softening of the bone Caused mainly by: vitamin D deficiency **Vitamin D is required for the absorption of **Vitamin D is required for the absorption of calcium from the intestine and calcium is calcium from the intestine and calcium is responsible for mineralization of bone responsible for mineralization of boneEtiology –Lack of exposure to __________ ____ –GI malabsorption, extensive burns, chronic diarrhea, pregnancy, drugs such as Dilantin.

19. Osteomalacia Signs & Symptoms Most Common –____ ____ –Difficulty rising from a chair –Difficulty walking Additional Signs and Symptoms –Low back pain, muscle weakness –Weight loss, progressive deformities

20. Diagnosis Blood work –Decreased serum calcium or phosphorus –Decreased serum 25-hydroxyvitamin D –Elevated alkaline phosphatase X-Rays –Show loose’rs transformation zone – –ribbons of decalcification in bone

21. Osteomalacia Treatment and Nursing Care Drug Therapy – – Diet Therapy –Milk, yogurt, cheese –Dark green leafy vegetables, okra, broccoli –Fish and seafood –Almonds

22. Paget’s Disease

23. Excessive bone resorption followed by replacement of normal marrow by vascular, fibrous connective tissue. The new bone is ______, ____________, ___ ______ ___ ______ Most often affect the pelvis, long bones, spine, ribs, sternum, and cranium

24. Clinical Manifestations In milder form, none Common early symptom-- Fatigue Waddling gait Loss of height Increased head size

25. Complications Pathological fractures (may be a first sign of disease) Bone tumors

26. Paget’s Disease Diagnosis –Elevated serum alkaline phosphatase –X-ray will show increase in bone size –Bone scan shows increased uptake in affected bones

27. Drug Treatment for Paget’s Drug Therapy Calcitonin-salmon (Miacalcin) –Bone is in a constant state of remodeling, whereby old bone is removed by osteoclasts, and new bone is laid down by osteoblasts. Calcitonin inhibits bone removal by osteoclasts, and promotes bone formation by osteoblasts. NSAIDSBisphosphonates

28. Paget’s Disease Other treatments and Nursing Care –Back support by firm mattress –Teaching about use of splints or braces to support bones and joints and help prevent weakened bones - skin care, circulation, etc. –Teach how to correctly use canes or walkers –Physical therapy –Diet high in…what?