Metabolic bone disorder
A reduction in bone mass sufficient enough to interfere with the mechanical function of the bone.
A decrease in bone mass increases fracture risk due to porous, brittle bone.
Bone resorption exceeds bone formation
A Multifactoral disease having two main causes:

Affects more than 25 million Americans
Women \u00b1 eight times more likely than men
Occurs in men at an older age & lower rate
Caucasian post-menopausal, petite female
Asian women of slight build at risk for low BMD
90% of women have disease by age 75

bone density & Ca absorption decrease after age 35- can be slowed with dietary & estrogen replacement
therapy
resorption (act of removal by absorption) exceeds bone formation resulting in decreased bone density
Ca must be carried by blood to be available for bone growth & metabolism
over time, thin, weakened bones may lead to crippling effect
regulation in body

calcitonin is a hormone secreted by the thyroid gland in response to increased serum Ca levels
(hypercalcemia); it decreases serum levels by increasing its deposition in the bone
parathyroid gland secretes parathormone which makes it possible for the blood to carry dissolved

Medications \u00b1 Corticosteroids and heparin; alters Ca utilization or decreases GI uptake of CA
Cigarette smoking \u00b1 one pack a day throughout adulthood can lower bone density by 10% in women
Excessive caffeine ingestion \u00b1 over 2 cups/day
Endocrine disorders- thyroid disorders, diabetes
Prolonged bed rest- not putting stress on bones so no increase in bone cell production

Alcoholism
Soft drink consumption- Phosphorous inhibits Ca absorption; 3-4 cans a day \u00b3bone threatening\u00b4
Normal aging process- bones thinning; decrease in mobility; decrease of ROM, joint stiffness
Withdrawal of estrogen at menopause- no hormone in history of breast cancer
Lack of weight bearing exercise

Small, thin framed female
Caucasian or Asian heritage
Low calcium diet

Nutritional factors
o Vitamin D \u00b1 Ca absorption, normal bone mineralization
o Dietary Ca, vitamin D adequate to maintain bone remodeling, body functions

o Best source Ca / Vitamin D = fortified milk
Bone formation enhanced by stress of weight, muscle activity
Immobility contributes to development
When immobilized by casts, paralysis, general inactivity, bone resorbed faster than formed, osteoporosis
occurs

Medications \u00b1 Can affect the body\u00b6s use and metabolism of Ca
o Corticosteriods, Isoniazid, heparin, tetracycline
o Aluminum containing antacids
o Furosemide, anticonvulsants, thyroid supplements
o Lithium \u00b1 Long term

A mineral which is important to blood coagulation, enzyme activation, acid-base balance, give firmness and rigidity to bones and teeth, functioning of nerves and muscles including myocardium and maintenance of membrane permeability. The body will steal calcium from the bones if there is a chronic shortfall

Adequate calcium intake
o 9-19 years of age: 1300 mg/day
o 19-51 years of age: 1000
o 51 +: 1200-1500

Moderate consumption of alcohol and caffeine
Stop smoking
Weight bearing exercise to promote bone formation (20-30 min., 3 days/wk)- elderly can walk

Is the \u00b3traffic Cop\u00b4 that flags down calcium as it makes it way through your digestive tract and
channels it into the bloodstream and bones. The cheapest way to get the daily
requirement of 400 IU is get some sun

X-rays identify osteoporosis when there is a 25% to 40% demineralization- looks like honeycomb
Lab studies including calcium and phosphorus lvls
Dual energy x-ray absorptiometry (DEXA) provides information about spine and hip bone mass and bone

Humpback- thoracic area
Cervical lordosis \u00b1 abnormal anterior convexity
Could experience respiratory problems due to vertebral collapse
Back pain- lower back
Fracture- b/c not in proper alignment

skeletal demineralization
Tums - Cheapest Ca supplement
3 glasses skim or whole vitamin D milk or other food high in Ca (cheese, other dairy products, steamed
broccoli, canned salmon with bones) daily

Ca supplement (Ca carbonate) taken with meals or beverage high in vitamin C to promote absorption
o Take one hour before meals
o Common side effects Ca supplements

fractures
\u00a7 Been associated with slightly increase incidence breast, endometrial cancer
\u00a7 Using lowest effective dose decreases cancer risk
\u00a7 Combined with progesterone diminish potential risk for endometrial cancer

o Alternative to HRT
o Produces increase in bone mass by inhibiting osteoclast function (Dec bone loss)
o Taken early AM with 8oz of water while sitting up. 30-60 minutes before food (must be on empty

stomach) or before other meds for maximum absorption
o Adequate Ca, Vitamin D needed for max effect
Common Side Effects of Fosamax