Name of Disorder: Osteoporosis

Description: Osteoporosis is a bone disease that occurs when the body loses too much
bone or does not make enough bone. Bones become fragile as a result, and can crack as a
result of a fall, sneezing, or minor bumps. Osteoporosis is referred to as “porous bone".
When viewed under a microscope, healthy bone resembles a honeycomb. In osteoporosis,
the holes and spaces in the honeycomb are much wider than in healthy bone. The tissue
structure of osteoporotic bones is abnormal, and they have lost density or mass. When
bones become less dense, they become weaker and more prone to cracking.
Causes: High Risks:
Although there is no known cause for While some bone loss is a normal part of
osteoporosis, the mechanism that causes aging, some women are at a higher risk of
bone to become brittle is well understood. developing osteoporosis. Women who are
Early in life, bone is continually broken thin or have a small body, as well as those
down and replaced, a process known as who smoke, drink excessively, or lead a
bone remodeling. Bone mass usually peaks sedentary lifestyle, are at an increased risk.
in a person's mid- to late-twenties. Women who have had their ovaries
removed, especially before the age of 40,
and those who have a family history of hip
fracture are also at a higher risk.

Assessment: Signs and Symptoms

The gradual collapse of a vertebra may be asymptomatic; it is observed as progressive
kyphosis. With the development of kyphosis ("dowager's hump"), there is an
associated loss of height. Frequently, postmenopausal women lose height from
vertebral collapse. The postural changes result in relaxation of the abdominal muscles
and a protruding abdomen. The deformity may also produce pulmonary insufficiency.
Many patients complain of fatigue.
Diagnostic Procedure
Osteoporosis is diagnosed by dual-energy x-ray absorptiometry (DEXA), which
provides information about BMD at the spine and hip. The DEXA scan data are analyzed
and reported as T-scores. Quantitative ultrasound studies of the heel and DEXA of the
wrist, hip, or spine are used to screen for osteoporosis and to predict the risk of hip and
nonvertebral fracture.
Medical Management Nursing Management
 A diet rich in calcium and vitamin D
throughout life, with an increased  Promoting understanding of
calcium intake during adolescence, osteoporosis and the treatment
young adulthood, and the middle regimen. Patient teaching focuses on
years, protects against skeletal factors influencing the development of
demineralization. osteoporosis, interventions to arrest or
 To ensure adequate calcium intake, a slow the process, and measures to
calcium supplement (eg, Caltrate, relieve symptoms.
Citracal) with Vitamin D may be
 Relieving pain. Advise the patient to
prescribed and taken with meals or
rest in bed in a supine or side-lying
with a beverage high in vitamin C to
position several times a day; the
 promote absorption. The mattress should be firm and
recommended daily dose should be nonsagging; knee flexion increases
split and not taken as a single dose. comfort; intermittent
 Regular weight-bearing exercise local heat and back rubs promote
promotes bone formation. From 20 muscle relaxation, and the nurse should
to 30 minutes of aerobic exercise encourage good posture and
(eg, walking), 3 days or more a teach body mechanics.
week, is recommended. Weight
 Improving bowel movement. Early
training stimulates an increase in
institution of high fiber diet, increased
BMD. In addition, exercise
fluids, and the use of prescribed stool
improves balance, reducing the
softeners help prevent or minimize
incidence of falls and fractures.
constipation.
 Fracture
management. Osteoporotic  Preventing injury. The nurse
compression fractures of the encourages walking, good body
vertebrae are managed mechanics, and good posture plus daily
conservatively, pharmacologic and weight-bearing activity outdoors to
dietary treatments are aimed at enhance production of vitamin D.
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).

Medication:
 Calcium Supplement with vitamin D
 Bisphosphonates
 Calcitonin
 Selective estrogen receptor modulators (SERMs)
 Teriparatide

Nursing Diagnosis
1. Acute pain related to fracture and muscle spasm
2. Risk for constipation related to immobility or development of ileus.
3. Risk for injury: additional fractures related to osteoporosis.