Name: Johne Vincent V.

Sarian Year/Section/Group: BSN 4-6 Group 4

Osteoporosis
- progressive disease in which the bones gradually become
weaker , causing changes in posture and making the
individual extremely susceptible to bone fracture

-also called the “silent disease because bone loss occurs

without sympthoms.

Strength of osteoporotic
bone is impaired by:
3 Major types of Osteoporosis • Loss of bone mass
Malignant Infantile form
• Reduction in bone
- A severe type of osteoporosis. quality:
- It is inherited when both parents have an
abnormal gene that is passed to the child. • Loss of horizontal
- The disease is apparent from birth and
frequently ends in death. struts
- Despite its name, the disease is not related to cancer.
• Loss of
Intermediate form connectivity
- A type of osteoporosis is less severe. • Conversion of
trabecular plates to rods
• Resorption pits are
“stress concentrators”
 geometry

- Found in children younger than 10 years old.

- It is more severe than the adult form of osteoporosis but usually does not shorten life
expectancy.

Adult form
- This is milder type of osteoporosis that is found in between 20-40 years old.
- Rarely causes significant reduction of life expectancy.

Risk Factors

- Females (Due to low estrogen levels caused by menopause)

- Thin body frame
- Family hx
- Low testosterone levels in men
- Inactive lifestyle
- Diet
- Alcohol
- Cigarette Smoking

Signs and Symptoms

 Backache (Isn’t necessarily normal, nor should be connecting part of growing older. The
backbones are the most common fracture sites and cause muscle spasms or localized
pain.

 Loss of height (One reason why doctors routinely read your height is to check for
development of spinal osteoporosis).

 Tooth loss (A loss of tooth bearing bone and most common in osteoporotic women and
maybe detected early by dental x- rays. Regular check-ups and proper care of teeth and
gums treat the problem early).

 Curvature of the spine (Resulting in dowager’s hump and rounded back, which may be
accompanied by a protruding abdomen.

Anatomy and Physiology

The skeleton is a living structure that supports the entire body. Bone is made up of an outer
shell of very dense bone that surrounds a honeycomb-like structure of softer bone. Bone mainly
consists of protein and calcium. Without calcium, bone will become weak.
The human skeleton can be divided into two sections:

* Axial skeleton:
A total of 80 bones including the skull, spine, and chest
* Appendicular skeleton:
A total of 126 bones including the pelvic girdle, limbs, feet and hands

Pathophysiology

Early Inadeq Low

menopa uate bone
usal peak mass/
bone bone
Decrea impair
Calcium/
loss mass
se in
vitamin ed Fractures
bone bone
D mass/b
deficienc quality
one
y quality
Other Trauma
factors
Lab and Diagnostic test

- X- ray

- Bone scan

- History and physical examination

- CT scan

- Transiliac bone biopsy

Management

Nursing Management

Nursing Diagnosis for Osteoporosis

* Chronic pain
* Disturbed body image
* Dressing or grooming self-care deficit
* Imbalanced nutrition: Less than body requirements
* Impaired physical mobility
* Risk for impaired skin integrity
* Risk for injury

Key outcomes Nursing care Plans for Osteoporosis

 The patient will experience increased comfort and decreased pain.

 The patient will express positive feelings about herself.
 The patient will perform activities of daily living (ADLs) within the confines of the
disease.
 The patient will maintain adequate dietary intake.
 The patient will maintain joint mobility and range of motion (ROM).
 The patient will exhibit intact skin integrity.
 The patient will demonstrate measures to prevent injury.

Patient teaching Nursing care Plans for Osteoporosis

  Explain all treatments, tests, and procedures. For example, if the patient is undergoing
surgery, explain all preoperative and postoperative procedures and treatments to the
patient and her family.
 Make sure the patient and her families clearly understand the prescribed drug regimen.
Tell them how to recognize significant adverse reactions. Instruct them to report them
immediately.
 Teach the patient taking estrogen to perform breast self-examination. Tell her to
perform this examination at least once a month and to report lumps right away.
Emphasize the need for regular gynecologic examinations. Also instruct her to report
abnormal vaginal bleeding promptly.
 If the patient takes a calcium supplement, encourage liberal fluid intake to help
maintain adequate urine output and thereby avoid renal calculi, hypercalcemia, and
hypercalciuria.
 Tell the patient to report new pain sites immediately, especially after trauma.
 Advise the patient to sleep on a firm mattress and to avoid excessive bed rest.
 Teach the patient how to use a back brace properly, if appropriate.
 Thoroughly explain osteoporosis to the patient and her family. If they don't understand
the disease process, they may feel needless guilt, thinking that they could have acted to
prevent bone fractures.
 Demonstrate proper body mechanics. Show the patient how to stoop before lifting
anything and how to avoid twisting movements and prolonged bending.
 Encourage the patient to install safety devices, such as grab bars and railings, at home.
 Advise the patient to eat a diet rich in calcium. Give her a list of calcium-rich foods.
Explain that type II osteoporosis may be prevented by adequate dietary calcium intake
and regular exercise. Hormonal and fluoride treatments also may help prevent
osteoporosis.
 Explain that secondary osteoporosis may be prevented by effectively treating underlying
disease, early mobilization after surgery or trauma, decreased alcohol consumption,
careful observation for signs of mal-absorption, and prompt treatment of
hyperthyroidism.
 Reinforce the patient's efforts to adapt, and show her how her condition is improving or
stabilizing. As necessary, refer her to an occupational therapist or a home health nurse
to help her cope with ADLs.

Medical Management

 Biphosphinates
 Hormonal replacement therapy
 Calcitonin therapy
  Calcium supplements
 Vitamin D supplements

Surgical Management

Vertebroplasty

- Is a minimally invasive procedure used to

reinforce vertebrae with compression fractures,
which are common in patients with
osteoporosis. Vertebroplasty involves injecting
an acrylic compound into the collapsed vertebra
to stabilize the weakened bone. The procedure
is performed in an operating room or radiology
suite and treatment of each affected
vertebra takes approximately 1 hour.

- Local anesthesia is injected into the

vertebra, a small incision is made, and a
bone biopsy needle is inserted. Several
small syringes of the cementing material
are then injected through the needle into
the vertebra. The cement hardens almost
immediately.

- Approximately 70–90% of patients experience pain relief after vertebroplasty and most are
released from the hospital the same day. Anti-inflammatory medicine may be used to relieve
pain after the procedure.

- Multiple spinal compression fractures caused by osteoporosis may lead to height loss,
kyphosis (extreme curvature of the spine), and pain.

Kyphoplasty
- Also called balloon kyphoplasty, is a
minimally invasive procedure that is used
to restore the height of the vertebrae and
stabilize weakened bone.

- Kyphoplasty cannot correct established

spine deformities and is used in patients
who have experienced recent fractures
(within 2–4 months).

- The procedure is usually performed in

the hospital under local or general
anesthesia and takes approximately 1
hour for each affected vertebra.

- In balloon kyphoplasty, a small incision is

made and a fluoroscope (device that
consists of a screen and an x-ray tube) is
used to guide the insertion of a balloon
catheter into the vertebra. The balloon is
inflated slowly to raise the compressed vertebra, and then is deflated.

- An acrylic compound (cementing material) is then injected into the vertebra through a bone
biopsy needle. The material hardens almost immediately. Pain relief usually occurs within 2
days.

Prognosis

There is no single treatment or cure for osteoporosis, although drug therapies are available that
slow bone deterioration and increase bone density. Increased bone density reduces risk of
fracture and associated pain. Newer therapies substantially decrease the risk of certain
fractures from osteoporosis. Prevention is critical in those individuals who are at high-risk.
Osteoporosis
- progressive disease in which the bones gradually become weaker , causing changes in posture
and making the individual extremely susceptible to bone fracture

-also called the “silent disease because bone loss occurs without sympthoms.

3 Major types of Osteoporosis

Malignant Infantile form Intermediate form Adult form

Risk Factors

- Females - Thin body frame

- Family hx - Low testosterone levels in men
- Inactive lifestyle - Diet
- Alcohol - Cigarette Smoking

Signs and Symptoms

  Backache
 Loss of height
 Tooth loss
 Curvature of the spine

Lab and Diagnostic test

- X- ray
- Bone scan
- History and physical examination
- CT scan
- Transiliac bone biopsy