Degenerative Osteoporosis

DISCRIPTION
Osteoporosis is a disorder of bone metabolism in which there is a reduction of total bone
mass, making bones abnormally prone to fracture.

*The rate of bone resorption is greater than the rate of bone formation.

*It affects 25% 0f adults,and the greatest incidence white females between ages 50 and 70.

Causes (Risk factors)

1. In adequate nutrition

2. In adequate vitamin D and calsium

3.lifestyle choices:

*Smokiing

*Caffeine intake

*Alcohol consumption

Etiology/pathophysiology
*Etiology

Osteoporosis may be iatrogenic or secondary to other disorder.presisposing factors include

postmenopausal, long-term corticosteroids use, prolonged immobilization and nutritional
defeciency.

*Pathophysiology

In osteoporosis, the rate bone loss. Exceeds bone formation, resulting in a decrease in total
bone mass.Bones affected by osteoporosis lose calcium and phophate salts.
Assessment findings
1. Clinical manifestation

a. Fractures

*.Hip fractures

*.Long bone fractures

*Vertebral compression fractures

b. Pain

c. Visible deformity

d. Loss of height

e. constipation

2. Laboratory and diagnostic study findings

a. Radiographic and bone-density studies reveal loss of bone density in clients with
25% to 40% bone demineralization.

Diagnostic Test
*Dual-energy x-ray absorptiometry or bone densitometry

*Laboratory studies ( serum calcium, serum phosphate, serum alkaline phosphate etc).
Treatments
* Alendronate (Fosamax), a weekly pill.

* Risedronate (Actonel), a weekly or monthly pill.

* Ibandronate (Boniva), a monthly pill or quarterly intravenous (IV) infusion.

* Zoledronic acid (Reclast), an annual IV infusion.

Nursing diagnosis
*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.

Nursing management
1. Administer prescribed medication

>Which may include antiresorptive therapy,non opioid analgesics, and calcium.

2. Prevent Fractures

>Use caution when turning lifting, and transferring the client to prevent fracture.

3. Promote spinal stability.

>By applying a lumbosacral corset, if indicated; avoid appliances that can decrease mobility.

4. Provide client teaching;

*Encourage increased intake of food high in calcium ( milk, cheese, salmon,

spinach,broccoli, rhubarb), vitamin D, fiber, and protein.

*Teach knee flexion and muscle-relaxing exercises.

*Teach the client to move the trunk as a unit and maintain good posture and body

mechanics.
 *Instruct the client to perform range-of-motion execises at least twice daily.

*Suggest that the client sleep on a firm, nonsagging mattress.

*Encourage a regular, moderate exercise regiment.( Walking, swimming, low-impact

aerobics).

*Teach the client about the disease process and prevention of progression.

*Teach safety measures to prevent injury from falls.

RESENT RESEARCH STUDIES

Diagnosis of osteoporosis requires several laboratory and instrumental tests (Schweser and
Brett, 2017). Patients should be prescreened starting at 50 years of age to maximize the benefit
of fracture prevention (Gillespie and Morin, 2017). Laboratory tests are used to exclude
secondary causes of the disease, such as thyroid and parathyroid dysfunctions and
hypomagnesemia (Zheng et al., 2014; Naylor et al., 2016).Dual-energy x-ray absorptiometry is
the gold-standard diagnostic technique, providing a measure of BMD, as x-ray absorption is
directly related to tissue calcium content (Compston et al., 2017). Osteoporosis is considered in
patients with a T-score of -2.5 or less (Nayak and Greenspan, 2016). ultrasonography could be
adopted in the diagnosis of osteoporosis, because it requires no radiation exposure and is cost-
effective (Hoiberg et al., 2016; Karjalainen et al., 2016).Treatment of osteoporosis is strictly
related to severity of pathology. Initially, it is important to prevent fragility fractures with an
active lifestyle and adequate nutritional supplements, including daily calcium and vitamin D
intake, performing weight bearing activities, avoiding or stopping smoking, and avoiding heavy
alcohol consumption (Pavone et al., 2015; Testa et al., 2015).

REFERENCE
Ray A. Hargrove-huttel, RN,PhD. Medical Surgical Nursing fourth edition.Pharmacological Therapy of
Osteoporosis: A Systematic Current Review of Literature. www.frontiersin.org

Prepared by:

Datu Isnirul, Dayang Dayang Yousfina A.

BSN 3RD CLUSTER. A