Osteoporosis

WHAT WENT WRONG?
This is a decrease in bone density, making bones more brittle and increasing the
risk of fracture. The body continuously replaces older bone with new bone through
a balance between the osteoblastic and osteoclastic activity. When bone-building
activity does not keep up with bone-resorption activity, the structural integrity of
the bone is compromised.
Increased age, lack of physical activity, poor nutrition, having a small frame,
being Caucasian, Asian, or female all increase the risk of osteoporosis. Osteoporosis
can also occur as a secondary disease, due to another condition. These causes
include use of medications such as corticosteroids or some anticonvulsants, hor-
monal disorders (Cushing’s or thyroid), and prolonged immobilization.



PROGNOSIS
The risk of fracture is significantly increased in patients with osteoporosis. The
most common fracture sites in patients with osteoporosis are hip, vertebrae, pelvis,
and distal radius. Some fractures such as vertebral compression fractures affect
quality of life. There is increased morbidity and mortality in patients who sus-
tain a hip fracture. The cost of healthcare for these patients is significant, and
includes the immediate care of the fracture as well as the necessary rehabilitation.

SIGNS AND SYMPTOMS

• Asymptomatic
• Back pain due to compression fractures in vertebral bodies
• Loss of height
• Excessive forward curvature of the thoracic spine (kyphosis) due to patho-
logic vertebral fractures; collapsing of the anterior portion of the vertebral
bodies in the thoracic area
• Fracture with minor trauma
TEST RESULTS
• X-ray shows demineralization of the bone—not an early sign.
• Dual energy x-ray absorptiometry (DEXA) shows decrease in bone mineral
density in the hip and spine compared to young normal patients, and com-
pared to age-matched, race-matched, sex-matched patients.

TREATMENT
It is much more cost-effective to focus on prevention of osteoporosis. Encourage
adequate exercise and nutrition. Calcium supplementation may be necessary for
patients who are not getting the recommended daily requirement of calcium in the
diet. The body stores calcium in the bones. If there is insufficient dietary intake,
the body will remove the calcium from the bone, further weakening the structural
integrity. Once osteoporosis occurs, proper medical management is important to
prevent fractures and increase bone density.
• Administer bisphosphonate drugs to inhibit osteoclastic bone resorption and
increase bone density:
• alendronate, risedronate, ibandronate sodium orally
• parenteral preparations zoledronic acid, pamidronate
• Administer calcitonin nasal spray to increase bone density, also has analgesic
effect on bone pain after 2 to 4 weeks.
Administer calcium, 1000 to 1500 mg per day in divided doses to enhance
absorption.
Encourage weight-bearing activity.
Perform range-of-motion activities.
Increase vitamins and calcium in diet.
• Administer selective estrogen receptor modulator for postmenopausal women

NURSING DIAGNOSES
• Impaired mobility
• Pain
• Risk for injury
NURSING INTERVENTION
• Pain control if fracture occurs.
• Explain to the patient:
• How to properly take medications.
• Bisphosphonates must be taken first thing in the morning on an empty
stomach, with a full glass of water. The patient can’t lie down for 30 to 60
minutes after taking the medication; this is to reduce risk of esophageal
irritation.
• Monitor for side effects of medications—GI effects with bisphosphonates.
• Encourage weight-bearing activity.
• Encourage appropriate nutrition.
for prevention of osteoporosis:
• raloxifene
• Administer teriparatide to stimulate the production of collagenous bone to
increase bone density.
• Administer vitamin D, which enhances the absorption of calcium; many
patients with osteoporosis are also deficient in vitamin D.