Osteoporosis

Metabolic Bone Disease

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.

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

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
womans skeletal reserve of calcium
5. Longevity increases likelihood of
osteoporosis; women live longer than men

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

Etiology
Risk factors (contd)
Excess alcohol intake
Cigarette smoking
Anorexia
Oophorectomy
Sedentary lifestyle
Insufficient calcium intake
Low testosterone levels (hypogonadism
in men)

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
Bones become weakened and prone to
fracture, loss of height, and kyphosis.

Etiology and Pathophysiology

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

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

Osteoporosis

Can the disease be

prevented?

Treatment and Nursing Care

Diet Therapy

Weight bearing Exercises

Decrease Risk Factors

Quit smoking and decrease consumption of alcohol

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

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

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?

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

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

Osteomalacia
Metabolic Bone Disease

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

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

Diagnosis
Blood work
Decreased serum calcium or phosphorus
Decreased serum 25-hydroxyvitamin D
Elevated alkaline phosphatase
X-Rays
Show loosers transformation zone
ribbons of decalcification in bone

Osteomalacia
Treatment and Nursing Care
Drug Therapy

Diet Therapy
Milk, yogurt, cheese
Dark green leafy vegetables, okra, broccoli
Fish and seafood
Almonds

Pagets Disease

Pagets Disease
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

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

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

Pagets Disease
Diagnosis
Elevated serum alkaline phosphatase
X-ray will show increase in bone size
Bone scan shows increased uptake in
affected bones

Drug Treatment for Pagets

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.
NSAIDS
Bisphosphonates

Pagets 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 inwhat?