OSTEOPOROSIS

Osteoporosis is classified as a metabolic bone disorder.

Osteoporosis occurs when the creation of new bone doesn’t keep up with the removal of old bone.
Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture.
Osteoporosis may be classified into two types:

Primary osteoporosis. Primary osteoporosis occurs in women after menopause and in men later in life, but it is not merely a consequence of aging but of failure to develop optimal peak bone mass during childhood, adolescence, and young adulthood.
Secondary osteoporosis. Secondary osteoporosis is the result of medications or other conditions and diseases that affect bone metabolism.
Pathophysiology

Osteoporosis is characterized by reduced bone mass, deterioration of bone matrix, and diminished bone architectural strength.

Reduced total bone mass. Normal homeostatic bone turnover is altered; the rate of bone resorption that is maintained by osteoclasts is greater than the rate of bone formation that is maintained by osteoblasts, resulting in a reduced total bone mass.
Progression. The bones become porous, brittle, fragile; they fracture easily under stresses that would not break normal bone.
Postural changes. The postural changes result in relaxation of the abdominal muscles and a protruding abdomen.
Age-related losses. Calcitonin and estrogen decrease with aging, while parathyroid hormone increases, increasing bone turnover and resorption.
Consequence. The consequence of these changes is net loss of bone mass over time.
Causes

The causes of osteoporosis and their effects on bone include:

Genetics. Small-framed, nonobese Caucasian women are at greatest risk; Asian women of slight build are at risk for low peak bone mineral density; African American women are less susceptible to osteoporosis.
Age. Osteoporosis occurs in men at a lower rate and at an older age, as it is believed that testosterone and estrogen are important in achieving and maintaining bone mass, so risk for osteoporosis increases with increasing age.
Nutrition. A low calcium intake, low vitamin D intake, high phosphate intake, and inadequate calories reduce nutrients needed for bone remodeling.
Physical exercise. A sedentary lifestyle, lack of weight-bearing exercise, and low weight and body mass index increases the risk for osteoporosis because bones need stress for bone maintenance.
Lifestyle choices. Too much consumption of caffeine and alcohol, smoking, and lack of exposure to sunlight reduces osteogenesis in bone remodeling.
Medications. Intake of corticosteroids, antiseizure medications, heparin, and thyroid hormone affects calcium absorption and metabolism.
Clinical Manifestations

Common signs and symptoms found in patients with osteoporosis include:

Fractures. The first clinical manifestation of osteoporosis may be fractures, which occur most commonly as compression fractures.
Kyphosis. The gradual collapse of a vertebra is asymptomatic, and is called progressive kyphosis or “dowager’s hump” associated with loss of height.
Decreased calcitonin. Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased.
Decreased estrogen. Estrogen, which inhibits bone breakdown, decreases with aging.
Increased parathyroid hormone. Parathyroid hormone increases with aging, increasing bone turnover and resorption.
Prevention

To prevent primary and secondary osteoporosis, measures such as the following must be implemented:

Identification. Early identification of at-risk teenagers and young adults could prevent osteoporosis.
Diet. A diet with increased calcium intake strengthens the bones and avoids fractures.
Activities. Participation in regular weight-bearing exercises results in excellent bone maintenance.
Lifestyle. Modifications in lifestyle such as reduced use of caffeine, cigarettes, carbonated softdrinks, and alcohol could improve osteogenesis for bone remodeling.
Medical Management

Medical management for a patient with osteoporosis include:

Diet. A diet rich in calcium and vitamin D throughout life, with an increased calcium intake during adolescence, young adulthood, and the middle years, protects against skeletal demineralization.
Exercise. Regular weight-bearing exercise promotes bone formation, such as a 20-30-minute aerobic  exercise, 3x a week, is recommended.
Fracture management. Osteoporotic compression fractures of the vertebrae are managed conservatively, pharmacologic and dietary treatments are aimed at increasing vertebral bone density, and for patients who do not respond to first-line approaches are treated with percutaneous vertebroplasty or kyphoplasty (injection of polymethylmethacrylate bone cement into the fractured vertebra, followed by inflation of a pressurized balloon to restore the shape of the affected vertebra).
Nursing Assessment

Health promotion, identification of people at risk for osteoporosis, and recognition of problems associated with osteoporosis form the basis for nursing assessment.

Health history. The health history includes questions concerning the occurrence of osteopenia and osteoporosis and focuses on family history, previous fractures, dietary consumption of calcium, exercise patterns, onset of menopause, and use of corticosteroids as well as alcohol, caffeine, and smoking.
Symptoms. Any symptoms the patient is experiencing, such as back pain, constipation, or altered body image, are explored.
Physical examination. Physical exam may disclose a fracture, kyphosis of the thoracic spine, or shortened stature.
Nursing Diagnosis

Based on the assessment data, the major nursing diagnoses for a patient who has osteoporosis may include:

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.
Risk for injury: additional fractures related to osteoporosis.
The major goals for the patient may include:

Knowledge about osteoporosis and the treatment regimen.
Relief of pain.
Improved bowel elimination.
Absence of additional fractures.
Nursing Interventions

Nursing interventions appropriate for a patient with osteoporosis are:

Promoting understanding of osteoporosis and the treatment regimen. Patient teaching focuses on factors influencing the development of osteoporosis, interventions to arrest or slow the process, and measures to relieve symptoms.
Relieving pain. Advise the patient to rest in bed in a supine or side-lying position several times a day; the mattress should be firm and nonsagging; knee flexion increases comfort; intermittent local heat and back rubs promote muscle relaxation, and the nurse should encourage good posture and teach body mechanics.
Improving bowel movement. Early institution of high fiber diet, increased fluids, and the use of prescribed stool softeners help prevent or minimize constipation.
Preventing injury. The nurse encourages walking, good body mechanics, and good posture plus daily weight-bearing activity outdoors to enhance production of vitamin D.

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