Group-1 Osteoporosis

A Case Analysis on
OSTEOPOROSIS
In Partial Fulfillment of the

Requirements in NCM 216 - RLE
CARE OF CLIENTS WITH PROBLEMS IN PERCEPTION & COORDINATION
NURSING ROTATION
Submitted to:
KRISTOFFER ANDREW MAGARIN, RN
Clinical Instructor
Submitted by:
Sittie Maliejah H. Ampatuan, St. N.
Earl Wayne E. Bangay, St. N.
Ela Carolane S. Brato, St. N.
Kyle Andrei A. Caballero, St. N.
Kim Zascney Guiang, St. N.
Marielle Ayn Ines, St. N.
Eloisah Maglinte, St. N.
BSN 3F - Group 2 - Subgroup 1
March 12, 2023

TABLE OF CONTENTS
I. INTRODUCTION AND OBJECTIVES ……………………………………………… 2

II. DATA BASE ……………………………………………………………………….. 4
A. Biographical Data ………………………………………………………………4
B. Clinical Data ………………………………………………………………….. 5
C. Family Health History .……………………………………………………... 6
D. Past Health History ..…………………………………………………… 7
E. History of Present Illness ………………………………….……………… 7
III. PHYSICAL/NEURO ASSESSMENT ………………………………………………. 8
IV. DEFINITION OF DIAGNOSIS ………………………………………………… 13
V. ANATOMY & PHYSIOLOGY ……………………………..…………………… 14
VI. PATHOPHYSIOLOGY …………………………………………………………….. 16
A. Etiology ………………………………………………………………………. 17
B. Symptomatology ……………………………………………………………. 29
C. Schematic tracing ………………………………………………………… 33
D. Narrative …………………………………………………………………….. 37
VII. MEDICAL MANAGEMENT ...……………………………………………………. 40
A. Diagnostic Exams (actual & possible) …………………………………… 40
B. Pharmacological ………………………………………………………….. 51
C. Non- pharmacological ……………………………………………………… 94
D. Surgical ……………………………………………………………………… 97
VIII. NURSING MANAGEMENT ……………………………………………………… 103
A. Nursing Theory ……………………………………………………………. 103
B. Nursing Care Plans ……………………………………………………….. 107
C. Discharge Planning ……………………………………………………….. 127
IX. PROGNOSIS ……………………………………………………………………… 133
X. REFERENCES …………………………………………………………………….. 136
The patient’s vital signs were taken, and the results are the following: 1
I. INTRODUCTION AND OBJECTIVES
A. Introduction
Bone remodeling, a highly coordinated process of concurrent resorption and

formation at a specific site, is in charge of preserving skeletal integrity through
rebuilding worn-out and injured bone. By carefully targeting the release and
incorporation of calcium and phosphate from and into the bone matrix, remodeling
mechanisms also maintain calcium and phosphate balance. The fact that defective
remodeling favoring bone resorption over bone production is a major pathophysiological
mechanism leading to bone diseases like osteoporosis highlights the critical importance
of remodeling in overall bone homeostasis. One of the growing public health concerns
for the aging population is osteoporosis. Osteoporosis, is labeled as an inevitable
disease that people suffer as they age, it became unavoidable because it is also
predisposed by physiologic aging processes where bones deteriorate and lose their
bone density causing bone fragility which breaks often termed as pathologic fracture.
Osteoporosis-related bone fragility can result in a variety of fractures, most notably hip
and vertebral fractures (Rinonapoli, G., et al., 2021). In this rotation, a case of a male
projecting with generalized decrease in osseous density diagnosed with lumbosacral
osteoporosis is studied for a better understanding of the disease and how osteoporosis
starts and develops in an individual.
About 10 million Americans over the age of 50 have osteoporosis, and an

additional 34 million are at risk for developing the condition. In the USA, there are an
estimated 1.5 million fragility fractures caused by osteoporotic fractures every year. In
the UK, epidemiological studies suggest that one in five men and one in two women
over 50 would experience an osteoporotic fracture during their lifetime, indicating a
similar burden of disease. (Clynes, M.A., et al, 2020)
According to the National Nutrition Health Survey (NNHeS), the general

prevalence of osteoporosis was reported to be 0.8% in adult Filipinos aged 60 to 69 and
2.5% in those over 70. The overall prevalence of fractures was 11.3% in females and
9.0% in males. This means that millions of people are at danger of developing
osteoporosis. (Wu, C. H.et al., 2021)
19.8% of the post-menopausal participants in the current community-based

cross-sectional examination of bone-health status among urban Filipino women in
Davao city were estimated to have osteoporosis, but only 1.5% reported a previous
diagnosis with the condition. In these women, getting older, being less obese, and
having more education all independently predicted osteoporosis. (Miura, S. et al.,
2008)
The significance of this study to nursing education and nursing students is that it
would serve as a promising avenue for the student nurses to develop their skills and
apply their learning in perception and coordination rotation. Additionally, this will assist
nursing students in understanding what osteoporosis is, knowing the difference and
uniqueness of this disease, and developing a clinical eye on how to diagnose this
disease accurately. It also provides potential interventions and preventative measures
regarding osteoporosis. It could also be used as a reference in future studies and to
become an efficient nurse in the succeeding years.
B. Objectives
General Objectives
At the end of the 4-week Perception and Coordination Rotation, the student
nurses from BSN 3F Group 2 Subgroup 1 aim to promote the client’s health and well
being by providing the best possible care to those patients who are suffering from
Osteoporosis. The student nurses will be able to provide theoretical and practical
knowledge related to the concept of Osteoporosis by gathering data through proper
assessment, promoting client’s health through health teaching, and alleviating concerns
of the client dealing with Osteoporosis.
Specifically, the student nurses aim to achieve the following;
a) Present an overview of Osteoporosis, the patient and the rotation briefly;

b) gather statistics of the disease occurrence globally, nationally and locally;
c) identify the significance of the study to the nursing profession;
d) construct general and specific objectives of the study;
e) summarize the patient’s database;
f) write the findings from the actual physical assessment;
g) formulate a definition of diagnosis;
h) describe the affected system’s normal anatomy and physiology
i) enumerate the etiology of disease categorized into the precipitating and
predisposing factors;
j) analyze the presence and absence of all symptoms and its rationale;
k) design a schematic diagram illustrating the disease process and its narrative;
l) recognize the markers of the disease through the Laboratory and Diagnostics;
m) tabulate the therapeutic managements rendered;
n) classify the drugs used for this disease under the Pharmacological management;
o) extract 2 applicable Nursing theories applicable for the case;
p) modify 2 specific Nursing care plans prioritized according to the patient’s need;
q) devise a specific discharge plan applicable for the patient with the help of
acronym METHOD;
r) discuss the prognosis of the disease according to the patient’s current condition;
and
s) cite the references used as sources of information for this study.
II. DATA BASE
A. Biographical Data
Patient S.M. is an eighty-year-old male Filipino patient. He was born last March
16, 1942 at Davao City and is currently married with his wife, R.M. Both the patient and
his wife are Baptists and they are currently residing at San Vicente, Acacia, Km 16,
Buhangin (Pob), Davao City. Prior to his admission, he worked as a construction worker
and his highest education level was third-year high school.
B. Clinical Data
Patient S.M. was admitted to Room 436, St. Catherine Ward, San Pedro Hospital
last February 26, 2023 (Sunday) at 7:30 PM via stretcher under the service of Dr.
Acosta. The patient had a chief complaint of body weakness with admitting diagnoses
of Acute Decompensated Heart Failure, Hypertensive Cardiovascular Disease, CAD,
LVH, SR, FCII, and Cardiorenal Syndrome Type II. Other than that, the patient’s Chest
X-ray results have also shown hazy densities in the left lower lung field, suspicious
density in the left apex, while the rest of the lung fields are clear. The heart is also not
enlarged and the rest of the included structures appear unremarkable. Based on the
chest x-ray results it has an impression of pneumonia at the left lower lung and an
apicolordotic view was suggested.
For the lumbosacral spine x-ray, there is a generalized decrease in osseous

density. There is a decrease in height of the bodies of T12, L1 to L3. Osteophytes were
also noted in the thoracic and lumbar margins. The rest of the visualized vertebral
bodies, facets, pedicles, and disc spaces appear intact. Vertebral alignment is
maintained. The rest of the included structures appear unremarkable. Based on the
results, it has an impression of osteoporosis, compression deformities/fractures,
thoracic lumbar spine, and thoracolumbar spondylosis.
For the cervical x-ray, osteophytes are seen in the anterior margins of the mid to
lower cervical vertebra. The rest of the visualized vertebral bodies, facets, pedicales,
and disc spaces appear intact. Vertebral alignment is maintained. Paravertebral soft
tissues appear remarkable. Based on the results of the cervical x-ray, it has an
impression of hypertrophic degenerative osteoarthropathy, cervical spine.
The patient’s final diagnoses were: (1) cardiogenic shock secondary to acute
decompensated heart failure secondary to non - ST- elevation myocardial infarction, (2)
hypertensive cardiovascular disease, coronary artery disease, left ventricular
hypertrophy, complete left bundle branch block, Killip 1 TIMI V, Functional Class II, and
(3) Osteoarthritis.
C. Family Health History
a. Genogram
b. Narrative
The genogram above illustrates three family generations of patient S.M. The
first generation starts from his grandparents from both maternal and paternal side,
followed by his parents (2nd generation), and then the patient and his 12 siblings. The
cause of death of patient S.M.’s father was pneumonia while his mother died of
hypovolemic shock due to the bombing that happened during World War II. Based on
the patient’s chart they also have a family history of Diabetes Mellitus and
Hypertension, which the patient confirmed to be true. However, the patient is unable to
recall which specific family member/s have/had those conditions. Among his siblings,
four of his brothers and five of his sisters died of pneumonia, and one of his sisters died
of heart disease. Currently, only the patient and his two other siblings (one sister and a
brother) are alive. Before his current admission, the patient had a health history of a
vehicular accident (1973), myocardial infarction and prostate (1990), and Urinary Tract
Infection (2022). Overall, the presented genogram is only a rough overview of the
family’s health history because the patient is unable to clearly recall the information
needed.
D. Past Health History
The patient had a previous admission last 1973 due to a vehicular accident.
According to the patient, the accident happened while he was driving his Boss’ car on
his way to Sasa. He mentioned that the steering wheel of the car kept on wobbling and
by the time that he reached the bridge, the car swerved to the right side. As a response,
he shifted the steering wheel to the opposite direction which caused him to crash at the
other side of the road. The patient went through the windshield and hit his face with the
wiper which caused him to fracture his face; particularly his right zygomatic bone and
right supraorbital margin. Other than that, his left leg was also swollen because it was
stuck between the driver’s seat and the steering wheel. Because of that he underwent a
surgery because of his fractured facial bones. The patient also had a previous
admission due to myocardial infarction and prostate. Prior to his current admission, the
patient also had a previous admission due to UTI, last year, 2022.
E. History of Present Illness
Patient S. M was admitted on the 26th of February 2023 (Sunday) at San Pedro
Hospital, St. Catherine Ward to room 436 under the service of Dr. Acosta, due to body
weakness. When asked about the symptoms that he felt and experienced, the patient
recalled having chest pain, difficulty breathing, and pain at the left knee. According to
the patient, his joint pain at his knee started last february 23, 2023, while the joints that
are found in his foot also started experiencing pain last February 27, 2023. The patient
stated that whenever he experiences joint pain, it would last from an hour or more. It
also occurs randomly with a pain scale of 10 out of 10 due to the fact that the patient
cannot move to the site where the pain would occur. Other than that, the patient
mentioned that he loves to eat tinapa, ginataang munggo, and lamang loob, which are
all factors that can trigger joint pains. Prior to his admission at San Pedro Hospital, he
was admitted at Tibungco Doctors Hospital under the service of Dr. Acosta due to joint
pains. He was prescribed ketoprofen but at home the remedies and initial treatments
that he had were efficascent oil, omega ointment, and medicol. After his admission at
Tibungco Doctors Hospital, he was transferred to San Pedro Hospital, where he is
currently receiving professional treatment.
III. PHYSICAL/NEURO ASSESSMENT
A. Cephalocaudal
General Survey:
A physical assessment was done on patient S.M., an 80-year-old male, last

Tuesday, February 28, 2023 at 8:30 in the evening. The patient has an ectomorph body
type, a weight of 64 kilograms, a height of 163 cm, and a BMI value of 24.1 which falls
under the Normal category. Upon assessment, the student nurses were unable to
assess the patient’s posture and gait due to painful joints. However, the patient claimed
that he has a kyphotic posture, which his wife agreed. Other than that, the patient was
drowsy upon assessment because he was woken up by her granddaughter prior to our
assessment. Despite being drowsy, the patient’s verbal response is oriented as he was
able to dictate the proper time, place. However, due to old age, he failed to recall
multiple past events in his life. The patient was also well-groomed and his mood was
also deemed stable and direct.
VITAL SIGNS PATIENT’S DATA NORMAL RANGE INTERPRETATION
TEMPERATURE 37.4°C 35.6 to 37.5°C Normal
BLOOD 120/80 mmHg 110/70 - 130-90 Normal

PRESSURE mmHg
CARDIAC RATE 82 60 to 100 bpm Normal
PULSE RATE 78 60 to 100 bpm Normal
RESPIRATORY 24 16-20 cpm Abnormal

RATE
PAIN 4/10 See Fig. 1 Moderate
Figure 1. Pain Intensity and Facial Grimace Scale
Skin
The patient’s general skin color has bronzing and tanning, particularly from his
elbow down to the back of his hands. This is because the patient used to work as a
construction worker and he is constantly exposed to sunlight. He also had a rough skin
texture due to past allergic reactions to cement. The patient has a good skin turgor, yet
dry skin. Upon observation, there were no lesions, ulcerations, and edema observed
and the patient’s nails are also well-trimmed.
Head
The patient has a normocephalic head and a symmetric skull with closed
fontanelles. He also has a clean scalp with hair of normal distribution. Other than that, it
was also observed that the patient’s face had symmetrical movements. The patient also
has normal jaw muscle strength, but he claimed that it was not as strong as how it used
to be when he was younger, yet feels normal for his old age.
Eyes
Upon the assessment, it was observed that the patient has thick, and aligned
eyebrows, with symmetrical movement. His lids are symmetrical, while his lashes are
facing down, yet curling outward. However, the patient’s left eye has some opacity,
which may be due to cataract. The patient’s lacrimal duct had slight tearing and his
palpebral conjunctiva was slightly pale. He has anicteric sclerae and isocoric pupils with
both brisk reactions to light. Both pupils had a uniform reaction to accommodation.
Patient’s eyes have normal extraocular movements and uniform convergence. During
the assessment, the patient was not using any corrective lenses but he mentioned that
he uses corrective lenses only when he is reading. The patient does not have a very
low vision, which means that he does not belong to any of the three categories in
functional vision, namely: counting fingers, hand movement, and light perception. In
terms of the patient’s visual fields, the patient mentioned that he only has clouded vision
due to cataract but does not have loss of vision in certain visual fields.
Ears
The patient’s pinna are symmetrical. Upon inspection, his external canal was
moist but did not contain foul smelling or purulent discharges. Other than that, his
hearing acuity was also normal since the patient is able to answer the questions without
having to ask for repetition.
Nose
Upon the assessment, the patient had an O2 inhalation via nasal cannula. The
patient’s nose has symmetrical nasolabial fold, a septum found at the midline, and no
discharges were observed. Both of his nostrils are patent and his sinuses are also
non-tender. Other than that, nasal-flaring was also not observed during assessment and
the patient even told the student nurses that he does not want to use the nasal cannula
anymore, which they refused as it was a medical order.
Mouth
The patient’s lips are symmetrical, slightly pale, and moist. His tongue is
positioned midline and he has four missing teeth. His gums, mucosa, and palate are
pinkish in color.
Pharynx
The patient’s uvula is found at the midline portion. He has a pinkish mucosa and
his tonsils are not inflamed. Moreover, the student nurses used a tongue depressor to
touch the palatal arch of the patient and confirmed that he has a positive gag reflex.
Neck
The patient's trachea is found at the midline portion. His lymph nodes are
nonpalpable and not tender. The thyroid is nonpalpable and not tender. The student
nurses also failed to assess the range of motion and muscle strength of the patient’s
neck because he cannot sit up straight due to joint pain and weakness.
Thorax
Upon assessment, the patient’s thorax has a symmetrical shape. The student
nurses failed to assess the spinal alignment of the patient because he refused to get up
due to joint pain and weakness, but he did verbalize that he has a kyphotic posture.
Bulges, tenderness, and lesions were also not assessed because of the patient’s
position. The patient has an effortless breathing pattern, given that he has an O2
inhalation via nasal cannula. He has a good chest skin turgor ( 2 seconds). The student
nurses also failed to assess for respiratory excursion, tactile fremitus, and percussion.
However , other than that, no adventitious breath sounds were heard upon auscultation.
Heart
The patient has a normodynamic precordium and no abnormal sounds were

heard during auscultation. The temporal pulse, carotid pulse, brachial pulse, radial
pulse, popliteal pulse, dorsalis pedis pulse, and the posterior tibial pulse are all strong.
The apical pulse was also regular upon auscultation. The student nurses did not assess
for calf tenderness or the Homan’s Sign to avoid promoting more pain to the patient.
Breast
The patient’s breasts were equal in size with no masses or dimpling observed.
The student nurses were unable to assess breast tenderness due to refusal. Other than
that, the nipple and areola of the patient were dark brown in color without any
discharges.
Abdomen
The skin of the patient’s stomach is intact. It is slightly globular but not distended
and no abnormalities such as masses, visible peristaltic waves, visible pulsations, and
bladder distention were noted. Other than that, the patient had normoactive bowel
sound, .friction rub is absent, bladder is nonpalpable, and the patient was also negative
for ascites. Muscle guarding was not observed and tenderness was absent.
Genito-Urinary System
The student nurses were not able to assess this section of the physical
assessment because the patient refused and he is also not comfortable doing so.
Musculoskeletal
Upon the assessments, the student nurses were very careful not to inflict pain to
the patient, so they ended up not assessing the joints of the patient. Also, the patient
refused to allow the student nurses to assess his joints because he is in pain. The
patient had equal muscle sizes. Other than that, the patient verbalized that he
experiences no paralysis at all but has weakness at both of his hands and feet. The
range of motion was also not assessed because of pain and position.
Neurological
The patient was drowsy but oriented to the time and place. He does not have
any difficulty in speaking and has a GCS of 15. Throughout the interview, there were
instances wherein the patient failed to recall his past experiences, including the
birthdays of his siblings, parents, and even their ages. However, the patient was able to
remember the time when he got into an accident, his birthday and his recent
admissions. The patient was also assisted by his wife to ask some of the interview
questions.
IV. DEFINITION OF DIAGNOSIS
Osteoporosis is a bone disease that occurs when the body loses too much of its
bone through the process of bone remodelling. As a consequence the bones turn fragile
and can easily break from a fall or any serious cases, or just by sneezing or minor
bumps (BHOF, 2023).
Osteoporosis is a condition leading to loss of bone mass. The structure of the

bone in osteoporotic bone is shaped like a normal bone. However, the inside of the
bones becomes more porous during the aging process as a result of loss of calcium
and phosphate. An individual may have a fracture before getting diagnosed with the
disease (Horowitz, 2022).
Osteoporosis is a condition that causes bones to gradually thin and weaken,
which makes them more at risk of fractures. The bones of the spine, hip and wrist are
more likely to break. When an individual with this disease stays still for a long period of
time during the healing process it may lead to complications such as blood clots or
pneumonia (Ratini, 2021).
V. ANATOMY & PHYSIOLOGY
The bone is a metabolically active connective tissue which provides

structural support, facilitates movement, and protects the vital organs. The bone
consist of two types of bone tissues which are the cortical bone and the
trabecular bone. The cortical bone is the hard outer shell of the bone, which is
highly resistant to bends and torsion which enables them to bear the weight of
the body (Hampton, 2020). While the trabecular bone is the honeycomb-like
bone found in the center of the long bones and the middle of the vertebrae.
Trabecular bones function by transferring mechanical loads from the articular
space to the cortical bone. The resorption takes place along the bone surface in
the trabecular bone (Ott, 2018). These two types of bone continuously
undergoes bone remodelling through a cycle of bone build up and breakdown to
keep bones strong.
Cellular process of the bone remodelling begins when osteoblasts detect

microcracks, where they would secrete a receptor activator of nuclear factor kB
ligand (RANKL). The RANKL then binds to the RANK receptors on the
monocytes causing osteoblast and osteoclasts precursor cells to fuse forming
multinuclear osteoclastic cells. This multinuclear osteoclastic cell then attaches
to the bone surface and starts the resorption. Which works to break down the
bone matrix working together with the lysosomal enzymes and hydrogen ions.
The resorption process leaves scooped out regions in the bone called the
lacunae. Then the differentiated mesenchymal precursors would fill in the
lacunae through deposits of new collagen and minerals. When the osteblast has
completed the task it will flatten and become a cell to line the bone surface,
because an osteocyte which is a cell type in a mature bone then would undergo
apoptosis. When the bone is matured the osteocytes would send out signals
bone is stressed or used. In short the osteocytes instruct the surrounding cells
when to compensate and adapt the mechanical stress exerted (Rowe, Koller, &
Sharma, 2022).
The bone modelling-remodelling process initially starts during fetal life

whereas there is a very rapid growth and patterning of the skeletal system.
Ossification centers occur by 6-7th week to coordinate the rapid growth.
Continuously during childhood and adolescence stage bone liner growth and
mineral increases in different ways and velocities in varying skeletal sites. As
puberty hits the bone growth differs among gender due to the levels of the sex
hormones. Estrogen produced during childhood and puberty helps increase bone
growth, it acts on the osteoblast and osteoclast to inhibit bone breakdown in all
stages of life. A high concentration of this hormone stops further growth in height
closing the epiphyseal plates that allows growth of the long bones. While
testosterone has a direct effect on the musculoskeletal system stimulating bone
and muscle growth, this hormone exerts great stress on the bone thus increasing
bone formation (Thompson, 2018).
Other hormones affecting the bone modelling-remodelling process are the

parathyroid hormones that maintains the level of the calcium and stimulates
bone resorption and formation, calcitrol which is a hormone derived from vitamin
D stimulating the intestine to absorb enough calcium and phosphorus and
supplies minerals needed by the bones, while calcitonin inhibits bone breakdown
by inactivating osteoclast and protect bones from excessive levels of calcium in
the circulation (Nandiraju and Ahmed, 2019).
VI. PATHOPHYSIOLOGY
A. Etiology
Etiology determines the cause of a disease as well as its factors that may be
linked back to clinical study results. Thus, the following tables list the potential
precipitating and predisposing factors of Osteoporosis.
I. Predisposing Factors
The table below shows the predisposing factors that make a person more
vulnerable and susceptible to the disease which increase the likelihood of Osteoporosis
developing.
PREDISPOSING PRESENT RATIONALE

FACTORS OR
NOT PRESENT
Age ✓ Bone loss accelerates with age, whereas

new bone formation slows. As people age,
bones gradually weaken and deteriorate
over time, increasing the risk of
osteoporosis. According to the study of
Johnston & Dagar (2020), the prevalence
of fragility fractures increases progressively
beyond the age of 50. Moreover, over 54
million people living in the US aged 50 and
older experience osteoporosis or have an
increased risk due to low bone density.
This factor is present in our case since the
patient is currently 80 years old.
Gender ✓ A study conducted by Babhulkar & Seth

(2021) showed that among males and
females, the prevalence of osteoporosis
was 17.3% and 19.4% respectively.
Females have a higher risk of having
osteoporosis since females have smaller
bones and lower peak bone mass than
men. Men, on the other hand, are still at
risk, especially after the age of 70. This
factor is present in our case since the
patient is male over the age of 70.
Race ✓ Women in white and Asian subjects had

increased rates for all age groups beyond
the age of 50. Men had a greater rate than
women among Hispanic subjects aged 50
to 59 years, however this gender
association reversed after age 60. Until the
age of 70, black men had greater rates
than black women; beyond that, women
had higher rates. The rates grew
dramatically with age for all genders and all
races and ethnic backgrounds (Cauley &
Nelson, 2021). This factor is present in our
patient as he is Filipino.
Family history of 𝙓 A positive family history of osteoporosis, as

osteoporosis well as fractures, are risk factors for
osteoporosis. It is thought that hereditary
factors influence bone density completion
up to the age of 25. Studies have
discovered gene polymorphisms that are
responsible for a hereditary predisposition
to osteoporosis. Several studies have also
demonstrated that genetic factors play a
significant role in bone mineral density.
Moreover according to the study of Bijelic,
Milicevic, & Balaban (2019), the existence
of osteoporosis in close relatives (typically
the mother) is a prominent and
independent risk factor for the occurrence
of osteoporosis, which indicates the
significance of genetic susceptibility to the
development of osteoporosis. This factor is
not present in our patient.
Hormonal changes 𝙓 There is a decreased estrogen production

for women at the time of menopause.
Decreased estrogen levels promote bone
resorption by prolonging the osteoclasts'
life span and less bone formation by
reducing the lifespan of osteoblasts.
Therefore, estrogen deficiency following
menopause has been linked to an increase
in bone loss and bone turnover, resulting in
an increased risk for osteoporosis and
fracture (Johnston & Dagar, 2020).
Females have a lifetime risk of any fracture
of 40-50%, whereas males have a risk of
13-22%. There is also a decrease in
testosterone in men as they age leading to
the occurrence of testosterone deficiency.
Serum testosterone levels in older men
reduce about 1% each year, which could
cause a number of different clinical
symptoms of late-onset hypogonadism
(LOH) syndrome (Shigehara, Izumi,
Kadono, & Mizokami, 2021). LOH
syndrome is associated with sexual
dysfunction, decreased muscle mass and
strength, and decreased bone mineral
density. Men with conditions such
hypogonadism that cause low testosterone
are at risk for osteoporosis. This factor is
not present in our patient.
II. Precipitating Factors

Precipitating factors include those that prompt the onset of disease. The
following table shows the precipitating factors that lead to the onset of Osteoporosis.
PRECIPITATING PRESENT RATIONALE

FACTORS OR
NOT PRESENT
Low dietary calcium ✓ Calcium and vitamin D, which are

intake essential for bone strength, are found in
the bone mineral matrix as calcium
phosphate. Vitamin D deficiency has
negative health repercussions, and this
vitamin is critical for bone health
maintenance, maintenance of muscular
mass and strength, as well as bone
structure. Vitamin D primarily regulates
calcium homeostasis therefore, vitamin D
deficiency may worsen osteoporosis in
older or postmenopausal women. A diet
lacking in calcium and vitamin D can
increase the likelihood of osteoporosis
and fractures from childhood through old
age. Also, extreme dieting or a lack of
protein may add to the likelihood of bone
loss and osteoporosis (Muñoz-Garach,
García-Fontana, & Muñoz-Torres, 2020).
This factor is present in our patient since
his serum calcium results are low which is
1.00 mmol/L (N: 1.13-1.32 mmol/L).
Low body mass index X According to the study of Cheraghi et al.

(2019), leanness (BMI 20 kg/m2),
regardless of age, gender, or loss of
weight, is related with higher bone loss
and an increased risk of fracture. Those
with a BMI of 20 kg/m2 showed an almost
two-fold increase in the risk ratio for hip
fracture when compared to those with a
BMI of 25 kg/m2. Obesity, however, is
increasingly recognized as a risk factor for
certain fractures and fractures in general,
even after bone mass density is taken into
consideration. Our patient has a BMI of
24.1 which indicates that this is not
present as a precipitating factor.
Eating disorders X Anorexia nervosa is a type of eating

disorder characterized by a low body
weight and an unreasonable fear of
gaining weight. Low bone mineral density
and decreased bone form and strength
are two of the many major physical effects
of anorexia nervosa. Anorexia nervosa
often begins between the ages of 16 and
17. It was stated in the study of Steinman
& Shibli-Rahhal (2019) that because
childhood and adolescence are key
periods for bone formation, this is a
problem for bone health. Teenagers with
anorexia nervosa had decreased bone
mass density and bone accrual rates than
normal-weight adolescents of the same
age and maturity. People with a history of
anorexia are 2 to 3 times more likely to
have a bone fracture. This factor is not
present in our patient.
Excessive alcohol ✓ The link between alcohol use and fracture

consumption susceptibility is nonlinear. There is no
substantial increase in risk for daily
consumption of 2 units or less (e.g. 2
glasses of 120 ml of wine). However,
alcohol consumption over this level is
related with an elevated risk of any
fracture, any osteoporotic fracture, and
hip fracture of 23%, 38%, and 68%,
respectively, as compared to individuals
who drink moderately or do not consume
alcohol at all. The balance between
osteoblastogenesis and
osteoclastogenesis is responsible for
bone development. This delicate balance
is disrupted due to excessive and chronic
alcohol consumption, resulting in
alcohol-induced osteoporosis.Thus,
chronic heavy drinking of alcohol is a
significant risk factor for osteoporosis
(Cheraghi et al, 2019). This is present in
our case since the patient drinks alcohol.
Prolonged tobacco use ✓ A study by Yang et al. (2021) stated that

prolonged tobacco use may disrupt the
process of bone turnover, which leads to
decreased bone mass and bone mass
density and an elevated risk to
osteoporosis. Men who are tobacco
users, in particular, are at a higher risk of
developing osteoporosis. Cigarette
smoking exposes individuals to cadmium,
which is a proven risk factor for
osteoporosis. It is suggested that
cadmium from tobacco smoke may play a
role in smoking-induced osteoporosis.
According to Li et al. (2020), the indirect
effects via cadmium were calculated to
represent 43% of the overall harm caused
by smoking for whole-body body mass
density. This is present in our case since
the patient smokes from his teenage
years up to 70 years of age.
Sedentary lifestyle X Physical inactivity can lead to an
increased incidence of bone loss. They
also result in poor physical shape, which
raises the likelihood of falling and
fracturing a bone. Furthermore, physical
inactivity and sedentary lifestyle, along
with compromised neuromuscular function
(e.g., decreased muscle strength, altered
gait and balance), are associated with the
development of fragility fractures.
Sedentary lifestyles are more likely to
result in a hip fracture than active
lifestyles. Women who sit for more than 9
hours per day, for example, are 50% more
likely to develop a hip fracture than those
who sit for fewer than 6 hours per day
(Tański, Kosiorowska, &
Szymańska-Chabowska, 2021). This
factor is not present in our patient.
Hypercalciuria X The calcium homeostasis is maintained

by activating the release of calcium and
phosphate from the bones, promoting
calcium reabsorption, and suppressing
phosphate reabsorption in the kidneys. A
prolonged increase in PTH concentration,
on the other hand, leads to increased
bone resorption and decreased bone
mineral density. Hypercalciuria is often
regarded as the most frequent metabolic
risk factor for calcium nephrolithiasis. It
also leads to osteopenia and
osteoporosis. Hypercalciuric calcium
stone formers have lower bone mineral
density on average than matched controls
who are neither stone formers nor
hypercalciuric (Leslie & Sajjad, 2022).
This factor is not present in our patient.
Androgen-deprivation X Prostate cancer is an

therapy (ADT) androgen-dependent disease, and the
mainstay of therapy for hormone-sensitive
metastatic or advanced PCa is androgen
deprivation therapy (ADT). Long-term
usage can lead to osteoporosis and
reduced bone mineral density. In males
undergoing ADT, BMD may drop by up to
13% each year. Moreover, males with
PCa may undergo considerable bone loss
as a result of the disease, even before
ADT is initiated. Because many PCa
patients are older, BMD loss is
compounded by the natural decline in
bone density that occurs with aging. As a
result, ADT contributes to an increased
risk of osteoporosis in up to 53% of males
(Cho et al, 2019). This factor is not
present in our patient.
Long-term use of X Glucocorticoids are the most regularly

corticosteroid used involved class, influencing both the
medications amount and the bone quality. It has been
found to inhibit calcium absorption.
Moreover, it lowers osteoblast and
osteocyte lifespan and action, as well as
bone vascularity, which may indicate why
bone strength declines more than bone
mass declines (Kobza, Herman,
Papaioannou, Lau & Adachi, 2021). This
factor is not present in our patient.
Other diseases ✓
- Hyperthyroidism Thyroid hormones are necessary for
optimal skeletal development and carry
out an essential physiological function in
adult bone formation, strength
maintenance, and bone metabolism in
adults, however thyroid dysfunction can
have a negative impact on bone
structures. Untreated severe
hyperthyroidism affects bone mass and
increases the likelihood of high bone
turnover osteoporosis (Delitala, Scuteri, &
Doria, 2020).
- Turner Women who have Turner syndrome are

syndrome more likely to develop osteoporosis and
longitudinal bone development is
influenced. Turner syndrome has been
associated with skeletal malformations
such as short stature, delayed skeletal
maturity, angular limb deformity, spinal
deformity, and early-onset osteoporosis
(Augoulea, Zachou, & Lambrinoudaki,
2019).
- Hyperprolactine Antipsychotics may induce osteoporosis

mia by increasing blood prolactin levels.
Moreover, almost all antipsychotics cause
hyperprolactinemia by inhibiting dopamine
D2 receptors in the anterior pituitary
gland, hence counteracting dopamine's
inhibitory effect on prolactin production.W
hile many of the known side effects of
high prolactin levels diminish with age, the
danger of exacerbating osteoporosis
remains critical (González-Rodríguez,
Labad, & Seeman, 2020).
- Klinefelter Osteoporosis is seen in up to 40% of

syndrome Klinefelter syndrome patients and is
typically associated with decreased
testosterone levels. Also, one of the most
common causes of male osteoporosis is
hypogonadism. Testosterone affects male
bone metabolism both indirectly and
directly via the androgen receptor on
osteoblasts, facilitating periosteal bone
production during puberty and lowering
bone resorption during adulthood (Selice,
2020).
- Cushing's Cushing's syndrome causes a number of
disease metabolic disorders and pathological
abnormalities throughout the body as a
result of an abundance of glucocorticoids
in the patient's body. Increased
glucocorticoid production in CS patients
can be caused by external (also known as
iatrogenic) or endogenous causes.
Endogenous glucocorticoid excess has
been proven to have a negative impact on
bone health and is the most prevalent
cause of secondary osteoporosis and
bone fracture. In addition, Cushing's
syndrome is characterized by
osteoporosis (Chen, Tsai, Chen, & Shen,
2022).
- Diabetes Diabetes mellitus type 2 (T2DM) is a risk

mellitus factor for osteoporosis and one of the
most prevalent concurrent disorders in
elderly patients. Furthermore, the cause
of osteoporosis in T1DM comprises lower
peak bone mass attributed to insulin and
insulin-like growth factor insufficiency,
which inhibits osteoblast development,
inactivates p27 (responsible for
osteoblastogenesis), and results in
inadequate collagen synthesis (Xu et al,
2020). This is present in our case since
the patient has a family history of
Diabetes Mellitus which reveals this
predisposing factor.
B. Symptomatology
SYMPTOMS PRESENT RATIONALE

OR
NOT PRESENT
Severe Back Pain ✓ Caused by fractures experienced

in the lower back or spine. When
the bone loses its density and
weakens, the more likely a
vertebral fracture may occur.
Multiple spinal fractures may
progress to loss of stature and
continuous paraspinal musculature
to maintain posture (Mattia et al,
2018).
This symptom is present as the

patient has verbalized that he has
joint pain which led him to decline
to seat up for the assessment.
Muscle Spasm ✓ As the spine collapses caused by

the contraction of the paraspinal
muscles which increases the load
of effort exerted on the spine
resulting in compression of
fractures which then causes
nerves to be pinched as the
muscles tense to protect the joints
and bones from further injury
(Osteoporosis Canada, 2022).
This is present in our case

because in the present health
history of the patient he
complained to have random joint
pain which he cannot move from
his position and rated it 10 out of
10 in the pain scale.
Hunched Posture ✓ Due to the bone's increased

resorption the bones lessen its
density thereby thins the spinal
bones and weakens the structure.
Typically the front of the vertebrae
collapses, loses its height and
causes the spine to arc abnormally
forward (Lowenstein, 2022).
This is present as the patient

verbalized that when he walks he
assumes a hunched posture.
Height Loss ✓ Bone mineral density decreases

as the age increases. An 1 1/2
inch loss of height may indicate
presence of fracture in the spine.
Multiple fractures of the spine can
change the appearance causing
loss of height, curving of shoulders
and back and thickening waistline
(NYSOPEP, 2019).
This is present as it shows

evidence in the X-ray done to him,
there is a decrease of height in the
T12, L1 - L3.
Respiratory Impairment ✓ A low bone mass density can

make a person at risk for fractures
and airflow obstruction as there
would be an abnormal curvature of
the vertebrae which have
weakened and collapsed upon one
another. The curvature can lead to
ineffective breathing due to the
inability of the ribs to expand fully
upon inhalation (Camacho, 2019).
This is not manifested by out

patient. He has a normal
respiratory rate given he has O2
therapy at 2 liters per minutes via
nasal cannula. His breathing is
effortless and no unusualities were
noted.
Stress Fracture 𝙓 A result from microscopic bone

injury resulting from repeated
submaximal physical loads to the
bone over a period of time. Stress
fracture occurs when the bone
repair mechanism fails and
physical load persists on the
injured bone (Gurbuz and Gur,
2022).
This is not present in our case as

there were no imaging studies that
showed evidence about any
fractures obtained from any
physical activities.
Pathologic Fracture 𝙓 Due to the decreased bone

density and altered bone
microarchitecture pathologic
fractures occur when multiple
minor events cause a cumulative
load on the weakened bones
(Ibrahim, 2022).
This is also not present in our case

as no imaging studies have shown
minor fracture obtained from
multiple minor events.
C. Schematic tracing
D. Narrative
Triggered by external or internal factors termed precipitating and predisposing

factors, the events start cascading to Osteoporosis. Previous pathophysiological
theories of osteoporosis concentrated on endocrine causes, such as secondary
hyperparathyroidism and vitamin D or estrogen shortage. Yet, there are many more
factors that contribute to the development of osteoporosis. Pathways, including cellular
senescence, the gut microbiota, and interactions between bone and the immune
system are coined as osteoimmunology.
OSTEOIMMUNOLOGY
The osteoclast, a cell that breaks down bone, can be thought of as the precursor
of an osteoimmune cell because it shares progenitor cells with monocytes,
macrophages, and (myeloid) dendritic cells.
A chain of events occurs as testosterone and estrogen levels decline as a result

of aging's physiological effects. The hormonal adjustment raises the quantity of IL-7 and
IL-15 produced by proinflammatory cells triggered by the BMDCs, which in turn raises
the number of bone marrow dendritic cells (BMDCs). A subgroup of memory T cells are
induced by IL-7 and IL-15 to produce IL-17A and TNF without the need for an antigen
(TMEM). Activated T lymphocytes promote bone resorption and disrupt bone
homeostasis.
Regulatory T (Treg) cells are a different subclass of T-cells that have been
shown to function at the immune-skeletal system interface. These cells' primary role in
immune suppression, preventing excessive immunological responses, inflammation,
and tissue damage, as well as their participation in bone biology, all point to an
anti-osteoclastogenic effect. T-reg cell deficiency resulted in decreased bone mass and
an increased number of osteoclasts.
GUT MICROBIOME
Regulatory T (Treg) cells are a different T-cell subclass that are increasingly
showing signs of acting at the immune-skeletal system interface. These cells have an
anti-osteoclastogenic role in bone biology and their primary function is to suppress
various immune cell types, avoid overactive immune responses, inflammation, and
tissue damage. Lack of T-reg cells led to a reduction in bone density and an increase in
osteoclasts.
Moreover, microbial fermentation of dietary fibers to short chain fatty acids

(SCFAs) play a significant part in this process. Consuming various prebiotic diets that
can be fermented into SCFAs was linked to a higher rate of calcium absorption in
adults. Beyond this impact on nutrition absorption via the intestinal wall, SCFAs have
shown to be powerful regulators of osteoclast development and activity as well as bone
metabolism. In connection with that, alterations in the gut microbiome's ability to
ferment SCFAs results in reduced diffusion into the bloodstream, which lowers calcium
reabsorption and raises osteoclast differentiation.
Intermittent PTH therapy's ability to stimulate bone growth is dependent on the

microbiome's production of SCFAs, particularly butyrate. PTH and butyrate work
together to cause CD4+ T cells to become Treg cells, which then activate CD8+ T cells
to create Wnt10b. Osteoblast proliferation, differentiation, and survival are all increased
by Wnt10b, a crucial activator of Wnt signaling in stromal cells and osteoblasts, which is
known to encourage bone formation. In the absence of this activity, bone resorption will
rise and bone production will decrease.
CELLULAR SENESCENCE
Cellular senescence represents a cell destiny generated by many types of stress

and is associated with irreversible cell cycle arrest and resistance to apoptosis.
Senescence-associated secretory phenotype is a condition in which cells that are
approaching senescence produce an excessive amount of proinflammatory cytokines,
chemokines, and extracellular matrix-degrading proteins (SASP). Senescent cells
proliferate more as we age, which has been shown to contribute significantly to
age-related tissue malfunction and the emergence of a number of age-related disorders
including osteoporosis, diabetes mellitus, hypertension, and atherosclerosis.
B and T cells, myeloid cells, osteoprogenitors, osteoblasts, and osteocytes are
among the cell types in the bone microenvironment that age and become senescent.
Senescent myeloid cells and osteocytes are notably known to produce more important
SASP components as they age. Osteocytes, which are senescent cells, will accumulate
as a result of this, and apoptosis resistance will develop, leading to osteocyte
proliferation and the destruction of bone homeostasis.
Given the 3 listed theories which could either be one or all of the causes for a
destruction in bone homeostasis causing bone resorption to occur faster than bone
formation. Next to that there will be thinning of the cortical bone, widening of the
Haversian canals and a decrease in the number of trabeculae in the spongy bone.
Leading to decreased bone density which manifests as muscle spasm. And then
increased bone fragility due to the decreased density which manifests as fracture.
Usually after a fracture the patient is sent to the hospital thus he/she is subjected to
diagnostics and laboratories which will identify the presence of osteoporosis.
If the patient receives the right care and the bone loss is detected in its early
stages, the prognosis is favorable. A positive prognosis was achieved by managing
patients in a variety of approaches, including surgical, nursing, and pharmaceutical and
non-pharmacological therapy.
However, if the condition is left untreated, it can result in complications like

restricted mobility, fractures in the hips, spine, and distal radius, which can necessitate
prolonged bed rest, posture changes (kyphosis), disability, deep vein thrombosis,
pressure ulcers, pulmonary embolisms, sepsis, and ultimately, death.
VII. MEDICAL MANAGEMENT
A. Diagnostic Exams (actual & possible)
I. Actual Diagnostic Exams
1. Roentgenographic Report (X-ray)

Examination: Chest PAL; L/S & Cervical APL
Clinical History/Diagnosis: DOB; LBP & Neck Pain
FINDINGS
RESULT SIGNIFICANCE NURSING

RESPONSIBILITIES
Chest PAL Hazy densities are in A chest PA Lateral 1. Remove all

metallic
the left lower lung X-ray is a radiograph
objects. Items
field. Suspicious of the thoracic cavity such as
jewelry, pins,
densities are noted in that is used to check
buttons etc can
the left apex. The rest the heart's major hinder the
visualization of
of the lung fields are blood arteries, the
the chest.
clear. Heart is not lungs, and the chest
2. No
enlarged. The rest of cavity and its
preparation is
the included divisions, such as the required.
Fasting or
structures appear mediastinum cavity.
medication
unremarkable. The most frequent restriction is
not needed
diagnostic X-ray
unless directed
Impression: procedure is this by the health
care provider.
- Pneumonia left process.
lower lung 3. Ensure the
patient is not
- Apicolordotic
pregnant or
view suggested suspected to
be pregnant.
Lumbosacr There is a generalized Lumbosacral spine X-rays are
usually not
al APL decrease in osseous x-rays may show: recommended
for pregnant
density. There is a Abnormal curves of
women unless
decrease in height if the spine. Abnormal the benefit
outweighs the
the bodies of T12, L1 wear on the cartilage
risk of damage
to L3. Osteophytes and bones of the to the mother
and fetus.
are noted in the lower spine, such as
4. Assess the
thoracic & lumbar bone spurs and patient’s
ability to hold
margins. The rest of narrowing of the joints
his or her
the visualized between the breath.
Holding one’s
vertebral bodies, vertebrae. Cancer
breath after
facets, pedicles, and (although cancer often inhaling
enables the
disc spaces appear cannot be seen on
lungs and heart
intact. Vertebral this type of x-ray). to be seen
more clearly in
alignment is
the x-ray.
maintained. The rest
5. Provide
of the included
appropriate
structures appear clothing.
Patients are
unremarkable.
instructed to
remove
clothing from
the waist up
Impression: and put on an
X-ray gown to
- Osteoporosis
wear during the
- Compression procedure.
deformities/frac
6. Instruct
tures, patient to
cooperate
thoracolumbar
during the
spine procedure.
The patient is
- Thoracolumbar
asked to
Spondylitis remain still
because any
Cervical Osteophytes are seen The source of neck, movement will
AP in the anterior margins shoulder, upper back, affect the clarity
of the image
of the mid to lower or arm pain, as well
cervical vertebra. The as tingling, numbness,
rest of the visualized or weakness in the
vertebral bodies, arm or hand, can be
facets, pedicles, and determined by a
discs appear intact. cervical spine X-ray. It
Vertebral alignment is can reveal cervical
maintained. vertebral fractures
Paravertebral soft (breaks) or
tissues appear dislocations of the
unremarkable. joints in between the
vertebrae.
Impression:
- Hypertrophic
degenerative
osteoarthropat
hy, cervical
spine
2. Blood Chemistry & CBC
Normal Result Significance Nursing

Range Responsibilities
Blood Creatinine Creatinine (H) - A chemical

Chemistry - 80.00-1 - 423.98 byproduct of
15.00 umol/L your muscles'
umol/L energy-genera
ting
mechanisms is
creatinine. The
blood is 1.Explain test
filtered by procedure. Explain
healthy that slight
kidneys to discomfort may be
remove felt when the skin is
creatinine.Ser punctured.
um creatinine R: So that the
reflected patient will be
muscle mass, aware of the
and low serum procedure.
creatinine was
independently
associated
2.Encourage to
with low bone
avoid stress if
mineral
possible.
density in
R: Because altered
subjects with
physiologic status
normal kidney
influences and
function (Shin
changes normal
et al., 2018).
hematologic
values.
Calcium Calcium (L) A blood test
- 1.00 called serum
- 1.13-1.3
mmol/L calcium 3. Explain that
2 measures the fasting is not
level of necessary.
mmol/L
calcium in the
blood. In order R: Fatty meals may
to detect or alter some test
track bone results as a result
diseases or of lipidemia.
problems of
calcium
control, serum
calcium is 4.Apply manual
frequently pressure and
tested dressings over
(diseases of puncture site on
the parathyroid removal
gland or R: To minimize
kidneys). blood loss and
Albumin Low serum swelling
albumin
-3.4 to 5.4 g/dL
concentration
(34 to 54 g/L
is associated
with 5. Monitor the
osteoporosis puncture site for
or low bone oozing or
mineral hematoma
density, but its formation.
link to
fractures has
not been
6. Instruct to
extensively
resume normal
investigated.
activities and diet
Normal Result Significance Nursing

Range Responsibilities
CBC Hemoglobin Hemoglobin A high or low

- 140-180 (L) level of iron in
g/L - 119 g/L the body might
be indicated by 1.Explain test
abnormal procedure. Explain
hemoglobin that slight
levels. By discomfort may be
boosting felt when the skin
osteoclastic is puncture
activity and R: So that the
resulting in patient will be
bone loss, this aware of the
may have an
effect on
skeletal health.
procedure.
2.Encourage to
avoid stress if
possible.
R: Because altered
physiologic status
influences and
RBC RBC (L) Even a minor
changes normal
- 4.5-5.0 - 4.22 decrease in the
hematologic
10^12/L 10^12/L red blood cell
values.
count can point
to an
overgrowth of
fat cells in the 3. Explain that
bone marrow. fasting is not
In addition to necessary.
crowding out
hematopoietic R: Fatty meals
stem cells, may alter some
which generate test results as a
RBCs, an result of lipidemia.
abundance of
fat cells raises
levels of
PPAR-gamma, 4.Apply manual
a protein that pressure and
activates dressings over
osteoclasts to puncture site on
break down removal
bone. Also, R: To minimize
because blood loss and
osteoblasts swelling
play a crucial
part in
hematopoiesis 5. Monitor the
by secreting puncture site for
substances oozing or
that promote hematoma
the formation formation.
of red blood
cells, a low
RBC count
may signify a 6. Instruct to
decreased resume normal
number of activities and diet
bone-forming
osteoblast
cells.
MCV MCV An early

- 82.00- - 89.0 fl indicator of
98.00 fl platelet cell
activation in
low-grade
inflammation is
elevated MPV.
All chronic
diseases,
including
osteoporosis,
are primarily
fueled by
low-grade
chronic
systemic
inflammation.
Neutrophil Neutrophil An elevated

- 40-70 % - 58% neutrophil to
Lymphocyte Lymphocyte lymphocyte
- 19-48 % - 29% ratio is an
indicator of
chronic
systemic
inflammation
and is
negatively
associated with
bone mineral
density. NLR
greater than
2.5 is
correlated to
low bone
density.
RDW The size of red

12% to 15% blood cells
becomes more
variable with
age and the
RDW is an
indication of
this variability.
An RDW
greater than
15% carries a
greater risk for
fracture.
MPV This is a
7 fL to 9 fL measure of the
average size of
red blood cells.
When
elevated, it
may indicate a
deficiency in
vitamin B-12
and/or folate.
Pernicious
anemia is a
condition that
reduces the
absorption of
vitamin B-12
and calcium.
Vitamin B-12
has a direct
influence on
osteoblastic
bone-building
activity. An
elevated MCV
is a flag to look
at
homocysteine,
a protein
metabolite that
contributes to
chronic
systemic
inflammation
and reduced
bone quality.
II. Probable Diagnostic Exams
3. Bone Density Scan (DEXA Scan)
A high and low intensity x-ray beam (a type of ionizing radiation) is passed
through the body during a DEXA (dual x-ray absorptiometry) scan to assess bone
density (the thickness and strength of the bones). Typically, the hip and the spine are
used for this procedure. This treatment may be repeated over time to detect changes in
bone density and is crucial for diagnosing osteoporosis or bone loss in a patient.
The radiation exposure from DEXA scans is quite minimal and comparable to
that of standard x-rays. Ionizing radiation is something we are all exposed to on a daily
basis from the environment, but further exposures can modestly raise the risk of getting
cancer in later life.
T-score Results Nursing Responsibilities
Between +1 and -1 Normal Bone Density 1. Inform client to

a. Not have
prior
People who have a score
radionuclide
in this range do not studies for 2
weeks
typically need treatment,
b. Not do
but it is useful for them to barium
contrast
take steps to prevent bone
studies for 2
loss, such as having weeks
c. Have no
adequate amounts of
metal in
calcium and vitamin D and clothing
2. Perform
doing weight bearing
neurological checks
exercise (Finklestein et al, and vital signs and
compare with
2021).
baselines.
Between -1.1 and -2.4 Low bone mass 3. Complications and
(osteopenia) precautions: Note
and report
Low bone mass suspected fracture
or injury to the
(osteopenia) is the term
cervical spine or
health care providers use neck pain.
to describe bone density

that is lower than normal
but that has not yet
reached the low levels
seen with osteoporosis A
person with osteopenia
does not yet have
osteoporosis but is at risk
of developing it
(Finklestein et al, 2021).
-2.5 or less Osteoporosis
The lower the bone

density, the greater the risk
of fracture. Medications
combined with calcium and
vitamin D along with
exercise programs can
help reduce the chances of
breaking bones once you
are diagnosed with
osteoporosis (Finklestein
et al, 2021).
TEST Component Normal Range Significance Nursing
Responsibiliti
es
ESR M- 0 to 22 Sed rate, also

mm/hr known as
F- 0 to 29 erythrocyte
mm/hr sedimentation 1.Explain test
rate (ESR), is a procedure.
blood test that Explain that
can identify slight
your body's discomfort may
inflammatory be felt when
status. if an the skin is
ESR test puncture
shows that R: So that the
your red blood patient will be
cells sink faster aware of the
than normal, it procedure.
may mean you
have a medical
condition
2.Encourage to
causing
avoid stress if
inflammation.
possible.
The speed of
R: Because
your test result
altered
is a sign of
physiologic
how much
status
inflammation
influences and
you have.
changes
Faster ESR
normal
rates mean
hematologic
higher levels of
values.
inflammation..
ALKALINE 44 -147 (IU/L) ALP levels that

PHOSPHATAS or are abnormal 3. Explain that
E 0.73 to 2.45 can indicate a fasting is not
(µkat/L) variety of necessary.
illnesses,
including liver R: Fatty meals
disease, bone may alter some
abnormalities, test results as
and chronic
renal disease. a result of
However, an lipidemia.
alkaline
phosphatase
test by itself is
unable to 4.Apply
pinpoint the manual
cause of ALP pressure and
in your blood, dressings over
necessitating puncture site
other tests in on removal
order to reach R: To minimize
a diagnosis. blood loss and
swelling
5. Monitor the
puncture site
for oozing or
hematoma
formation.
6. Instruct to
resume normal
activities and d
B. Pharmacological Management
● Bisphosphonates - Bisphosphonates inhibit bone resorption by attaching to

hydroxyapatite binding sites on bone surfaces during active resorption. This
hampers osteoclasts forming the border, the adherence to the bone surface, and
the production of protons necessary for their action. They also reduce osteoclast
progenitor development and recruitment and promote osteoclast apoptosis.
Generic Name Alendronate
Brand Name Binosto, Fosamax, Fosamax plus D
Dosage Osteoporosis: Adult and geriatric: PO
10 mg/day or 70 mg/wk
Drug Classification Func. class.: Bone-resorption inhibitor
Chem. class.: Bisphosphonate
Mechanism of Action Decreases rate of bone resorption and
may directly block dissolution of
hydroxyapatite crystals of bone; inhibits
osteoclast activity
Indication Treatment and prevention of
osteoporosis in postmenopausal
women, treatment of osteoporosis in
men, Paget’s disease, treatment of
corticosteroidinduced osteoporosis in
postmenopausal women not receiving
estrogen and in men who are on
continuing corticosteroid treatment with
low bone mass
Contraindication Hypersensitivity to bisphosphonates,
delayed esophageal emptying, inability
to sit or stand for 30 min, hypocalcemia
Side Effect Resp: Asthma exacerbation CV: Atrial
fibrillation Integ: Rash, photosensitivity
CNS: Headache GI: Abdominal pain,
constipation, nausea, vomiting,
esophageal ulceration, acid reflux,
dyspepsia, esophageal perforation,
diarrhea, esophageal cancer META:
Hypophosphatemia, hypocalcemia MS:
Bone pain, osteonecrosis of the jaw,
bone fractures
Adverse Effect ocular inflammation such as
conjunctivitis, uveitis, episcleritis and
scleritis.
Drug Interaction Drug-drug:Medicines such as antacids,
calcium, or vitamin supplements will
also decrease the absorption of
alendronate.
Nursing Responsibilities
1. sit upright or stand for at least 30
minutes when taking the drugs.
R: Alendronate can cause serious
problems in the stomach or
esophagus. You must stay upright for
at least 30 minutes after taking this
medicine.
2. Take only in the morning, not at
bedtime or before arising
R: Alendronate works only if taken on
an empty stomach. It may not be
absorbed and you may have side
effects.
3. Assess any muscle or joint pain.
R: This medication has the potential
to induce significant bone, joint, and
muscular pain. If you experience any
of these symptoms, stop taking
alendronate and contact your doctor
immediately. Jaw osteonecrosis: This
medication may cause a lack of blood
circulation to your jaw. This could
result in jaw osteonecrosis bone
death.
4. If you are using alendronate oral
liquid, drink at least 2 ounces (a
quarter of a cup) of water
immediately after taking the
medicine.
R: This will allow the medicine to
reach your intestines and be
absorbed by the body more quickly.
5.Swallow the tablet whole with a full
glass (6 to 8 ounces) of plain water.
R: the tablet because it may cause
throat irritation.
References
Alendronate (Oral Route). (2023,
February 7). Retrieved March 12, 2023,
from
https://www.mayoclinic.org/drugs-supple
ments/alendronate-oral-route/proper-us
e/drg-20061571#:~:text=Take%20the%2
0medicine%20on%20an,alendronate%2
0absorbed%20by%20the%20body.
Mosby's 2021 Nursing Drug Reference
(Skidmore Nursing Drug Reference)
34th Edition
Generic Name Risedronate
Brand Name Actonel, Atelvia, Actonel DR
Dosage osteoporosis • Adult: PO 5 mg/day or
35 mg/wk or 75 mg/day × 2
consecutive days 2× monthly or 150
mg/mo Glucocorticoid osteoporosis •
Adult: PO 5 mg/day Osteoporosis in
men • Adult: PO 35 mg/wk
Drug Classification Func. class.: Bone resorption inhibitor
Mechanism of Action Inhibits bone resorption, absorbs
calcium phosphate crystal in bone, and
may directly block dissolution of
hydroxyapatite crystals of bone
Indication Paget’s disease; prevention, treatment
of osteoporosis in postmenopausal
women; glucocorticoid-induced
osteoporosis; osteoporosis in men
Unlabeled uses: Osteolytic metastases
Contraindication Hypersensitivity to bisphosphonates,
inability to stand or sit upright for ≥30
min, esophageal stricture, achalasia,
hypocalcemia
Side Effect CNS: Dizziness, headache,
depression, asthenia, dizziness,
insomnia, weakness CV: Chest pain,
hypertension, atrial fibrillation GI:
Abdominal pain, diarrhea, nausea,
constipation, esophagitis MISC: Rash,
UTI, pharyngitis, hypocalcemia,
hypophosphatemia, increase PTH MS:
Osteonecrosis of the jaw, severe
muscle/joint/bone pain, fractures SYST:
Angioedema
Adverse Effect renal disease, active upper GI
disorders, dental disease,
hyperparathyroidism, infection, vit D
deficiency, coagulopathy
Drug Interaction Increase: GI irritation—NSAIDs,
salicylates Decrease: absorption of
risedronate— aluminum, calcium, iron,
magnesium salts, antacids Decrease:
absorption of del rel risedronate H2
antagonists, proton pump inhibitors, do
not use together Drug/Food Decrease:
bioavailability—take 1/2 hr before food
or drinks other than water Drug/Lab
Test Decrease: calcium, phosphorus
1. Swallow the tablet With a full

glass of water;
R: This will help make sure the
drug reaches your stomach
before dissolving.
2. patient should be in upright
position for 1/2 hr
R: to prevent the medication
flowing back from your stomach
and causing heartburn.
3. give tablet in am after breakfast,
only use with food (del rel)
R: Food and beverages (eg,
mineral water, coffee, tea, or
juice) will decrease the amount
of risedronate absorbed by the
body. Waiting longer than 30
minutes will allow more of the
drug to be absorbed.
4. Store in cool environment, out of
direct sunlight
R: to ensure they work as they
should as well as prevent
poisoning accidents.
5. Assess for any serious side
effects of the drug.
R: Taking a bisphosphonate
medication such as risedronate
for osteoporosis may increase
the risk that you will break your
thigh bone. You may feel pain in
your hips, groin, or thighs for
several weeks or months before
the bone break, and you may
find that one or both of your
thigh bones have broken even
though you have not fallen or
experienced other trauma.
Risedronate: MedlinePlus Drug
References
Information. (2022). MedlinePlus.
Retrieved March 12, 2023, from
https://medlineplus.gov/druginfo/meds/
a601247.html
34th Edition
Generic Name Zoledronic acid
Brand Name Aclasta Reclast, Zometa
Dosage Osteoporosis • Adult: IV
INFUSION 5 mg over ≥15 min q12mo
Drug Classification Func. class.: Bone-resorption inhibitor
Mechanism of Action Potent inhibitor of osteoclastic bone
resorption; inhibits osteoclastic activity,
skeletal calcium release caused by
stimulating factors released by tumors;
reduction of abnormal bone resorption
is responsible for therapeutic effect with
hypercalcemia; may directly block
dissolution of hydroxyapatite bone
crystals
Indication Moderate to severe hypercalcemia
associated with malignancy; multiple
myeloma; bone metastases from solid
tumors (used with antineoplastics);
active Paget’s disease; osteoporosis,
glucocorticoid-induced osteoporosis,
osteoporosis prophylaxis in
postmenopausal women
Contraindication Pregnancy, breastfeeding;
hypersensitivity to this product or
bisphosphonates; hypocalcemia
Side Effect CNS: Dizziness, headache, anxiety,
confusion, insomnia, agitation CV:
Hypotension, leg edema, atrial
fibrillation, chest pain GI: Abdominal
pain, anorexia, constipation, nausea,
diarrhea, vomiting, taste change GU:
UTI, possible reduced renal function,
renal damage META: Anemia,
hypokalemia, hypomagnesemia,
hypophosphatemia, hypocalcemia,
increased serum creatinine MISC:
Fever, chills, flulike symptoms MS:
Severe bone pain, arthralgias,
myalgias, osteonecrosis of jaw INTEG:
Steven’s Johnson Syndrome, Toxic
epidermal necrolysis
Adverse Effect fever, diffuse musculoskeletal pain,
gastrointestinal effects, and eye
inflammation.
Drug Interaction Hypomagnesemia, hypokalemia:
digoxin Decrease: effect of zoledronic
acid—calcium, vit D
1. Saline hydration must be
performed before administration;
urine output should be 2 L/day
during treatment; do not
overhydrate patient.
R: Hydration helps decrease the
calcium level through dilution
and causes the body to
eliminate excess calcium
through the urine and to to
assure that they are adequately
hydrated. because this medicine
may cause hypocalcemia (low
calcium in the blood) Zoledronic
acid is associated with reports of
renal impairment and renal
failure.
2. Should be reconstituted with
sterile water may be stored
under refrigeration for up to 24
hr.
R: Zometa was reconstituted
with 5 ml water for injection and
further diluted as can be seen
from these results, zoledronic
acid can cause renal toxicity.
3. Notify physician immediately of
deteriorating renal function as
indicated by rising serum
creatinine levels over baseline
value.
R: Zoledronic acid is associated
with reports of renal impairment
and renal failure, especially in
patients with pre-existing renal
dysfunction or other risk factors.
ZOLEDRONIC ACID. (2022). Retrieved
References
March 12, 2023, from
http://www.robholland.com/Nursing/Dru
g_Guide/data/monographframes/Z009.
html
34th Edition
Generic Name Ibandronate
Brand Name Boniva
Dosage • Adult: PO 150 mg/mo;
IV BOL 3 mg q3mo
Drug Classification Func. class.: Bone-resorption inhibitor,
electrolyte modifier Chem. class.:
Bisphosphonate
Mechanism of Action Inhibits bone resorption, apparently
without inhibiting bone formation and
mineralization; absorbs calcium
phosphate crystals in bone and may
directly block dissolution of
hydroxyapatite crystals of bone; more
potent than other products
Indication Postmenopausal osteoporosis and
prophylaxis
Contraindication Achalasia, esophageal stricture,
hypocalcemia, intraarterial
administration, renal failure,
hypersensitivity to bisphosphonates,
inability to stand or sit upright
Side Effect CNS: Fever, insomnia, dizziness,
headache CV: Hypertension, atrial
fibrillation EENT: Ocular
pain/inflammation, uveitis, esophageal
ulceration GI: Constipation, nausea,
vomiting, diarrhea, dyspepsia,
esophageal/GI cancer INTEG: Rash,
inj-site reaction META:
Hypomagnesemia, hypophosphatemia,
hypocalcemia, hypercholesterolemia
MS: Bone pain, myalgia, osteonecrosis
of the jaw
Adverse Effect low calcium levels. severe pain in your
muscles, bones, or joints irritation of
your esophagus problems with your
teeth and jaws*
Drug Interaction Increase: GI irritation—NSAIDs,
salicylates Decrease: ibandronate
effect—calcium/ vit
D/iron/aluminum/magnesium salts;
separate by 1 hr
1. Give early morning before meal

when taking the drug.
R: It should be taken first thing
in the morning at least 60
minutes before any food,
beverage, or other medicines.
Food and beverages (eg,
mineral water, coffee, tea, milk,
or juice) will decrease the
amount of ibandronate absorbed
by the body. Waiting longer than
60 minutes will allow more of the
drug to be absorbed.
2. Patient to remain upright for ≥1
hr after taking.
R: Do not lie down for 60
minutes after taking
ibandronate. This will help
ibandronate reach your stomach
faster. It will also help prevent
irritation to your esophagus
3. Instruct the patient to not suck
or chew the tablet.
R: to prevent throat ulcers.
Direct IV route •
4. Use single-dose prefilled
syringe; discard unused portion;
give over 15-30 sec; give q3mo;
do not use if discolored or
contains particulates.
R: To prevent unnecessary
waste or the temptation to use
contents from single-dose and
Particulate matter contamination
in injectable drug products,
especially in large numbers, can
cause harm to patients.
5. Store the drug at room
temperature
R: Exposure to light, humidity,
and extreme temperatures can
break down both prescription
and over-the-counter drugs
References
Mosby's 2021 Nursing Drug
Reference (Skidmore Nursing Drug
Reference) 34th Edition
● Denosumab - Denosumab, a monoclonal antibody against RANKL, is given

subcutaneously 60 mg twice a year. It is approved for postmenopausal women
and men at advanced risk for fractures and has been shown to reduce the risk
for vertebral and hip fractures. It is not recommended in subjects under the age
of 18 years; skin infections and hypocalcemia are known side effects. For the
rare side effect of jaw necrosis, the same precautions are taken as with
bisphosphonate treatment . Because of an increased rate of vertebral fractures
after discontinuing denosumab, a transition to an alternative treatment should be
initiated after ending of denosumab therapy
Generic Name Abaloparatide
Brand Name Tymlos
Dosage osteoporosis at high risk for fracture •
Adult postmenopausal female:
SUBCUT 80 mcg q day Available
forms: Solution for injection 80
mcg/dose
Drug Classification Func. class.: Parathyroid hormone
analog and modifier
Mechanism of Action A synthetic peptide analog of a
parathyroid hormone–related protein,
which acts as an agonist at the PTH
receptors
Indication For the treatment of postmenopausal
women with osteoporosis at high risk
for fracture
Contraindication Hypersensitivity
muscle weakness, nausea or vomiting,

Side Effect
pain in the bone, joint, back, arms, or
legs, pain in the side, back, or stomach
Itching, rash lack or loss of strength

Adverse Effect
muscle spasms of the leg and back
pressure in the stomach, swelling of
the stomach area, trouble sleeping,
unusual drowsiness, dullness, or
feeling of sluggishness
Drug Interaction No specific drug-drug interaction
1. Visually inspect for particulate

matter and discoloration before
use.
R: to ensure that products are
essentially free from particles,
and it is not contaminated
2. Not to share pen or pen needles
with others even if the needle
has been changed
R: To avoid the risk of
bloodborne and bacterial
pathogen transmission.
3. Instruct the patient to report for
painful urination.
R: TYMLOS might cause
dangerous adverse effects such
as: decreased blood pressure
while changing postures;
increased blood calcium
(hypercalcemia); and increased
urine production.
4. Use pen only for 30 days.
Dispose of properly
R: To avoid contamination.
References
Reference (Skidmore Nursing Drug
Reference) 34th Edition
These highlights do not include all the
information needed to use TYMLOS
safely and effectively. See full
prescribing information for TYMLOS.
TYMLOS® (abaloparatide) injection, for
subcutaneous useInitial U.S. Approval:
2017. (2022, December). Retrieved
https://dailymed.nlm.nih.gov/dailymed/f
da/fdaDrugXsl.cfm?setid=712143d9-e2
1e-4013-bb3b-3426a21060a8&type=di
splay
● Osteoanabolic Therapy - Osteoanabolic medications work by stimulating
osteoblasts, in contrast to antiresorptive treatments (such as bisphosphonates,
denosumab, estrogens, and raloxifene), which inhibit bone production. As hip
fractures were not considered as a primary endpoint in intervention trials,
osteoanabolic treatment is neglected due to financial considerations and an
underestimation of the clinical effect. In actuality, teriparatide and romosozumab
are more efficient than antiresorptive medications at lowering the risk of vertebral
and nonvertebral fractures.
Generic Name Teriparatide
Brand Name Forteo
Dosage • Adult: SUBCUT 20 mcg/day up
to 2 yr Available forms: Prefilled pen
delivery device (delivers 20 mcg/day)
Drug Classification Func. class.: Parathyroid hormone
(rDNA) Chem. class.: Teriparatide
Mechanism of Action Contains human recombinant
parathyroid hormone to stimulate new
bone growth
Indication Postmenopausal women with
osteoporosis, men with primary or
hypogonadal osteoporosis who are at
high risk for fracture,
glucocorticoidinduced osteoporosis
Contraindication Hypersensitivity, increased baseline
risk for osteosarcoma (Paget’s disease,
open epiphyses; previous bone
radiation), bone metastases, history of
skeletal malignancies, other metabolic
bone diseases, preexisting
hypercalcemia
Side Effect CNS: Dizziness, headache, insomnia,
depression, vertigo CV: Hypertension,
angina, syncope GI: Nausea, diarrhea,
dyspepsia, vomiting, constipation
INTEG: Rash, sweating MISC: Pain,
asthenia, hyperuricemia MS: Arthralgia,
leg cramps, back/leg pain, weakness,
osteosarcoma (rare) RESP: Rhinitis,
cough, pharyngitis, pneumonia,
dyspnea
Adverse Effect urolithiasis, hypotension, use >2 yr,
cardiac disease
Drug Interaction Teriparatide has no serious interactions
with other drugs
1. Give by SUBCUT using
disposable pen only; inject in
thigh or abdomen; lightly pinch
fold of skin; insert needle;
release skin; inject at 90-degree
angle over 5 sec; rotate inj sites
R: To administer the proper drug
and to prevent from error.
2. Have patient sit or lie down;
orthostatic hypotension may
occur.
R: teriparatide injection may
cause fast heartbeat, dizziness,
lightheadedness, and fainting
when you get up too quickly
from a lying position.
3. Protect from freezing, light;
refrigerate pen
R:to protect from potential for
photodegradation or other
chemical reactions that affect
drug stability.

References
Reference (Skidmore
Nursing Drug Reference)
34th Edition
Generic Name Romosozumab
Brand Name Evenity
Dosage Two separate syringes (and two
separate subcutaneous injections) are
needed to administer the total dose of
210 mg of EVENITY. Inject two 105
mg/1.17 mL prefilled syringes, one
after the other.
Drug Classification sclerostin inhibitors/anabolic agent
Mechanism of Action Romosozumab, a humanised
monoclonal antibody (IgG2), binds to
and inhibits sclerostin, a regulatory
factor in bone metabolism which
inhibits the canonical Wnt signalling
pathway that regulates bone growth.
This results in increased bone
formation and decreased bone
resorption leading to immediate
increase in trabecular and cortical bone
mass and improvement in bone
structure and strength.
Indication sclerostin inhibitors/anabolic agent
Contraindication Hypersensitivity, uncorrected
hypocalcaemia, history of MI or stroke
(within the preceding year).
Side Effect Significant: MI, stroke, transient
hypocalcaemia, hypersensitivity
reactions (e.g. angioedema, erythema
multiforme, urticaria, dermatitis, rash).
Rarely, ONJ, atypical low-energy or low
trauma fracture of the femoral shaft.
Eye disorders: Cataract.
General disorders and administration
site conditions: Inj site reactions,
peripheral oedema.
Musculoskeletal and connective tissue
disorders: Arthralgia, muscle spasms,
neck pain.
Nervous system disorders: Headache.
Respiratory, thoracic and mediastinal
disorders: Nasopharyngitis, sinusitis,
cough.
Adverse Effect Major Adverse Cardiac Events Major
Adverse Cardiac Events (MACE) ].
Hypersensitivity .Hypocalcemia.
Osteonecrosis of the Jaw .
Atypical Subtrochanteric and
Diaphyseal Femoral Fractures
Increased risk of CV death.
Drug Interaction drug-drug
Abciximab The risk or severity of
adverse effects can be increased when
Abciximab is combined with
Romosozumab.
Adalimumab The risk or severity of
adverse effects can be increased when
Adalimumab is combined with
Romosozumab.
Food-drug
Administer calcium supplement.
Ensure adequate calcium
supplementation.
Administer vitamin supplements.
Ensure adequate vitamin D
supplementation.
1. Ensure an adequate intake of

calcium and vitamin D while
being treated with
Romosozumab.
R: Calcium and vitamin D work
together to protect your bones
calcium helps build and maintain
bones, while vitamin D helps
your body effectively absorb
calcium. So even if you're taking
in enough calcium, it could be
going to waste if you're deficient
in vitamin D.
2. Maintain good oral hygiene
while being treated with this
medicine.
R:To prevent from dental side
effects. Specifically, it can cause
a rare but serious side effect
called osteonecrosis of the jaw.
With this condition, cells in your
jawbone die.
3. Store in the refrigerator,
between 2-8°C.
R: to protect the integrity of
sensitive products.
4. Watch for any side effects Some
side effects may need
immediate medical help. Alert
your doctor quickly.
R:Romosozumab may cause
any of the following side effects:
joint or neck pain, cough,
common cold, headache, and
pain or redness at the injection
site. and it me compromised
your health
Team, C. B. M. (2022). Romosozumab

References
- Subcutaneous Patient Medicine
Information | MIMS Philippines.
https://www.mims.com/philippines/drug/
info/romosozumab/patientmedicine/rom
osozumab+-+subcutaneous
Team, C. B. M. (2022a). Evenity Full
Prescribing Information, Dosage & Side
Effects | MIMS Thailand. Retrieved
https://www.mims.com/thailand/drug/inf
o/evenity?type=full
● Combination therapy - Other than calcium and vitamin D supplements,

osteoporosis treatment is delivered as monotherapy. To increase the impact on
bone production and lower the risk of fracture, some clinical trials explored
combination therapy of osteoanabolic and antiresorptive drugs. Although there
were positive effects on bone mineral density in these studies, combination
therapies are neither generally advised nor endorsed by healthcare systems due
to flaws in the study design (lack of a monotherapy arm, absence of an
assessment of fracture risk, comparable outcomes with monotherapy).
C. Non-Pharmacological Management
Therapeutics
ORDER RATIONALE
Oxygen Therapy Oxygen therapy is prescribed for people

who can’t get enough oxygen on their
own. This is often because of lung
conditions that prevent the lungs from
absorbing oxygen.
Complete Bed Rest without Bathroom Bed rest is therapeutically used as a

Privileges means to decrease the metabolic
demand on the body and promote
recovery during an illness with no
permission for the client to use bathroom
facilities.
Foley Catheterization A urinary catheter is usually used when

people have difficulty peeing (urinating)
naturally. It can also be used to empty the
bladder before or after surgery and to
help perform certain tests.
SERMs In postmenopausal women, selective

estrogen receptor modulators (SERMs),
which are synthetic estrogen receptor
ligands, are authorized for both the
prevention and treatment of osteoporosis.
They increase osteoclast apoptosis and
elicit a different reaction than estradiol.
Raloxifene, lasofoxifene, and
bazedoxifene are SERMs that have been
approved for the treatment of
osteoporosis (Foger-Samwald et al.,
2020).
Hormone Replacement Therapy Estrogens inhibit bone resorption directly

by stimulating the apoptosis of
osteoclasts and suppressing the
apoptosis of osteoblasts and osteocytes.
Primarily they were prescribed for the
relief of postmenopausal symptoms like
insomnia, sweating, mood disturbances,
and vaginal dryness. In the Women's
Health Initiative studies in elderly women
hormone replacement therapy increased
the risk of breast cancer, cerebrovascular,
and thromboembolic diseases
(Foger-Samwald et al., 2020).
Diet Modification Eating a healthy diet rich in essential

nutrients such as calcium, vitamin D, and
protein can help reduce the risk of
osteoporosis. In addition, limiting caffeine
and alcohol intake may be beneficial for
bone health, especially among older
adults (Fernando, 2022).
Exercise Program Vital at every age for healthy bones,

exercise is important for treating and
preventing osteoporosis. Not only can
exercise improve your bone health, it can
also increase muscle strength,
coordination, and balance, and lead to
better overall health. Examples include
walking, dancing, low-impact aerobics,
elliptical training machines, stair climbing
and gardening. These types of exercise
work directly on the bones in your legs,
hips and lower spine to slow mineral loss.
D. Surgical Management
PROCEDURE RATIONALE NURSING

RESPONSIBILITIES
Vertebroplasty In order to assist relieve pain, Pre procedure

a procedure called ● Adequate
vertebroplasty involves intravenous access
injecting cement into a ● Proper positioning
fractured or broken spinal ○ —often
bone. Vertebrae are the bones these
of the spine. The most typical patients are
injury for which vertebroplasty frail elders
is utilized is a compression who must
fracture. These accidents are be
typically brought on by positioned
osteoporosis, a prone for
bone-weakening disorder. the
procedure.
○ Bony
prominence
s must be
protected.
○ Care must
be taken
when
moving
these
patients to
prevent
causing
fragility
fractures to
legs and
ribs.
○ Adequate
airway
maintenanc
e in the
prone
position
must be
assured.
○ Most
procedures
can be done
under
conscious
sedation
with some
local
anesthetic,
although
some might
require
general
anesthesia
depending
on their
acuity level.
Intra procedure
● Absolute sterility of
this procedure is
imperative—full
surgical scrub of
site, cap/mask for
all in room.
● Frequently assess
pain, comfort
levels, level of
sedation,
adequacy of
ventilation (O2
sats) and tolerance
of the procedure.
Postprocedure
● Rest supine for 2-4
hours. Stand and
walk after 2-4
hours.
● Discharge home
with their routine
medications.
● Instruct to look for
and report new
pain and fever.
Kyphoplasty During kyphoplasty, a 1. Maintain bed rest or
balloon-like device is used to limb rest as indicated.
provide space for the Provide support of
procedure before injecting joints above and below
specific cement into your the fracture site,
vertebrae (balloon especially when moving
vertebroplasty). Kyphoplasty and turning.
can increase the height of a Provides stability,
damaged vertebra and may reducing the possibility of
also be pain-relieving. disturbing alignment and
muscle spasms, which
enhances healing.
2. Secure a bed board

under the mattress or
place the patient on the
orthopedic bed.
A soft or sagging mattress
may deform a wet (green)
plaster cast, crack a dry
cast, or interfere with
traction pull.
3. Support fracture site

with pillows or folded
blankets. Maintain a
neutral position of the
affected part with
sandbags, splints,
trochanter roll,
footboard.
Prevents unnecessary
movement and disruption
of alignment. Proper
placement of pillows also
can prevent pressure
deformities in the drying
cast.
4. Use sufficient
personnel when turning.
Avoid using an
abduction bar when
turning a patient with a
spica cast.
Hip, body, or multiple
casts can be extremely
heavy and cumbersome.
Failure to properly
support limbs in casts
may cause the cast to
break.
5. Observe and evaluate

splinted extremity for
resolution of edema.
Coaptation splint
(Jones-Sugar tong) may
be used to immobilize
fracture while excessive
tissue swelling is present.
As edema subsides,
readjustment of splint or
application of plaster or
fiberglass cast may be
required for continued
alignment of the fracture.
6. Maintain position or
integrity of traction.
Traction permits pulling
on the fractured bone’s
long axis and overcoming
muscle tension or
shortening to facilitate
alignment and union.
Skeletal traction (pins,
wires, tongs) permits
greater weight for traction
pull than can be applied
to skin tissues.
7. Ascertain that all

clamps are functional.
Lubricate pulleys and
check ropes for fraying.
Secure and wrap knots
with adhesive tape.
Ensures that traction
setup is functioning
properly to avoid
interruption of fracture
approximation.
VIII. NURSING MANAGEMENT
A. Nursing Theory
Nursing theories give a fundamental grasp of care principles, enabling nurses to

rationalize actions and expound on what they do for patients. These theories exist to
determine the bounds of both general and specialized nursing practices by offering
rationales for making decisions for the betterment of the patient's health.
NOLA PENDER’S HEALTH PROMOTION THEORY
Nola J. Pender is a retired University of Michigan nursing professor. She

developed the Health Promotion Model. According to the Health Promotion Model,
each person has unique personal characteristics and experiences that influence future
behaviors. The Health Promotion Model's targeted behavioral objective and goal is
health-promoting behavior. Health-promoting behaviors should result in improved
health, enhanced functional ability, and a superior quality of life at all levels of
development. The immediate contrasting need and decisions influence the final
behavioral need, potentially disrupting intended health-promoting activities.
According to health promotion theory, health is a positive dynamic situation as

contrasted to the absence of disease. The goal of health promotion is to increase the
entire well-being of a patient. The health promotion model emphasizes individuals'
complex personalities as they interact with their surroundings in order to attain health.
Its purpose is to assist nurses understand and comprehend the key causes of health
behaviors so that they can help patients by utilizing behavioral therapy to promote
happiness and a healthy lifestyle. The model focuses on the three specified areas: (1)
Individual Attributes and Experiences. These are the patient's personal circumstances
and previous relevant behavior. (2) Behavior-Specific Cognitions and Affect. These are
the anticipated advantages of physical activity, perceived barriers to action, perceived
self-efficacy, activity-related mood, interpersonal consequences, and environmental
implications. (3) Behavioral Outcomes. This relates to adhering to a plan of action,
balancing conflicting wants and priorities in the short term, and engaging in
health-promoting activity.
The individuals who commit and adhere to a particular action plan, the more
probable health-promoting behaviors must be maintained over time. Thus, we can
encourage osteoporotic patients to change their habits to promote health, reduce the
risk of exacerbating the condition, and enhance their overall quality of life by utilizing
Health Promotion theory. If patients continue to engage in these health-promoting
habits, their conditions may improve over time. and prevent further damage.
HILDEGARD PEPLAU’S INTERPERSONAL RELATIONS THEORY
The Theory of Interpersonal Interactions by Hildegard Peplau was released in

1952. Under Interpersonal Relations Theory, the nurse-client connection was
emphasized as the foundation of nursing practice. Nursing, she stated, is an
interpersonal interaction of therapeutic engagements among an in need of health-care
individual as well as a nurse who is sufficiently prepared to act upon the need for
assistance. The therapeutic process is guided by purpose, wherein the nurse and client
respect one another as individuals. The Nursing Practice and Interpersonal Relations
Theory are progressively interrelated and concentrate on the therapeutic relationship by
implementing problem-solving methods that help the nurse as well as the patient
achieve the client's needs, with observation, communication, and documentation
serving as fundamental nursing tools.
This can be readily understood by nurses in order to promote the growth of their
clients and avert limiting their choices available to those that nurses offer because
communication and active listening remain fundamental nursing tools and the nurse
and the patient can communicate, emphasizing that the therapeutic communication
makes it possible for both the patient and the nurse to mature. The concept included
four phases of the therapeutic nurse-patient connection: orientation, identification,
exploitation, and resolution, which can help to first establish a basis for both the client
and the nurse to further develop each time the relationship is strengthened.
Overall, subsequent nurse theorists and practitioners have derived these seven
nursing roles, which portray the dynamic character roles observed in practical nursing,
rely significantly on Peplau's theory to establish more comprehensive and therapeutic
nursing treatments. This indicates that a nurse's work description covers not only
providing care for patients, but also every action that may affect their health. Individuals
suffering from osteoporosis seek supportive and sympathetic healthcare practitioners,
an individual who can openly discuss any aspect of life and as to how to treat the health
issue, therefore their communication style must be open and compassionate.
B. Nursing Care Plans
CLUSTERING OF CUES
CUES NURSING DIAGNOSIS PRIORITIZATIO

N
HEALTH PERCEPTION - HEALTH

MANAGEMENT PATTERN
● Smokes from teenage years up Risk-prone health LOW PRIORITY -

to 70 years of age. behavior 3
● Used to be a heavy Domain 1 • Class 2 •
alcohol-drinker; now: drinks Diagnosis Code 00188
occasionally
NUTRITIONAL - METABOLIC Imbalanced nutrition: MEDIUM

PATTERN less than body PRIORITY - 1
requirements
Objective: Domain 2 • Class 1 •
● Dry Skin Diagnosis Code 00002
● Low Hemoglobin: 119 g/L (N:
140-180 g/L) Risk for impaired skin LOW PRIORITY -
● Low RBC: 4.22 10^12/L (N:4.5 integrity 2
- 5.0 10^12/L) Domain 11 • Class 2 •
Diagnosis Code 00047
ACTIVITY-EXERCISE PATTERN
Objective: Impaired Physical HIGH PRIORITY

Mobility - 2
● Weakness at both hands and Domain 4 • Class 2 •
feet Diagnosis Code 00085
● Limited range of motion
● Chest Pain
● TEMP: 37.4°C Activity Intolerance MEDIUM
● BP: 120/80 mmHg Domain 4 • Class 4 • PRIORITY - 2
● CR: 82 Diagnosis Code 00092
● PR: 78
● RR: 24
● Low Calcium: 1.00 mmol/L (N:
1.13 - 1.32 mmol/L)
● Decrease height of T12, L1-L3
COGNITIVE – PERCEPTUAL
PATTERN
Subjective: Acute pain HIGH PRIORITY

● The patient stated that Domain 12 • Class 1 • -1
whenever he experiences joint Diagnosis Code 00132
pain, it would last from an hour
or more.
● The patient also stated that it Impaired Comfort
also occurs randomly with a Domain 12 • Class 1 •
pain scale of 10 out of 10. Diagnosis Code 00214
● Joint pain, specifically at left
knee
● Severe back pain
Objective:
● Weakness at both hands and
feet
● Facial grimace
● 3rd year highschool -
educational attainment
● The left eye has some opacity,
which may be due to cataract.
SAFETY/PROTECTION Risk for poisoning MEDIUM

Domain 11 • Class 4 • PRIORITY - 4
● Polypharmacy due to
Diagnosis Code 00037
numerous drugs: Alendronate,
Risedronate, Zoledronic Acid,
Impaired tissue integrity
Ibandronate, Denosumab,
Domain 11 • Class 2 • MEDIUM
Abaloparatide, Teriparatide,
Diagnosis Code 00044 PRIORITY - 3
and Romosozumab
● On complete best rest without
Risk for adult pressure
bathroom privileges
injury
Domain 11 • Class 2 • LOW PRIORITY -
Diagnosis Code 00304 1
ACUTE PAIN
Name of Patient: S. M. Age/Sex: 80/M Ward: St. Catherine Room #: 436

Chief Complaint: Body weakness Diagnosis: Osteoporosis
Physician: Dr. Acosta
Date/ Cues Need Nursing Diagnosis Patient Nursing Intervention Implem Evaluation
Time Outcome entation
F Subjective: C Acute Pain related to Within 1 hour of Assess and check for 1 February 28, 2023
E The patient stated O compression of nursing reports of pain, noting @ 5 pm
B that whenever he G spinal nerves as interventions, the locations and
R experiences joint N evidenced by severe the patient will intensity (scale of GOAL MET
U pain, it would last I back pain and be able to 0–10). Note the verbal
A from an hour or T reports of joint pain, report feelings and nonverbal pain After 1 hour of giving
R more. I rating pain a 10 on a of comfort and cues. nursing
Y V scale of 1/10. relief from pain interventions, the
The patient also E as evidenced Rationale: This is to patient was able to
2 stated that it also - by lowered pain create a baseline set show signs of
8, occurs randomly P Rationale: scale (1-2) and of observations for the comfortability and
with a pain scale E Pain may be related nonverbal pain patient. The scale of pain relief, as
2 of 10 out of 10. R to vertebral relief cues. 0-10 points is globally evidenced by pain
0 C compression on recognized and scale of 2/10, and
2 E spinal nerve, accepted as an absence of facial
3 Objective: P muscles, and accurate and effective grimace.
● Weakness T ligaments; pain rating tool.
@ at both U spontaneous
hands and A fractures, possibly Check and obtain the 2
4 feet L evidenced by verbal list of medications in
P ● Joint pain reports, guarding or the patient’s chart that
M ● Severe P distraction the client is taking or
back pain A behaviors, self has taken.
● Facial T focus, and changes
grimace T in sleep pattern. Rationale: This can
E serve as a guide in
R the treatment that can
N References: prevent errors
Doenges, M., associated with Marielle Ayn A. Ines,
Moorhouse, M., & incorrect medications, St.N
Murr, A. (2019). dosages, drug-drug
Nurse's Pocket interactions, and
Guide: Diagnoses, toxicity that may
Prioritized happen with a
Interventions, and combination of
Rationales (15th incompatible drugs.
ed.). Philadelphia,
Pennsylvania: F.A. Determine any factors 3
Davis Company. in the lifestyle of the
patient which includes
alcohol or other drug
use or abuse.
Rationale: Unhealthy
lifestyle of the patient
may affect their
response to
analgesics.
Combination of
alcohol and drugs
such as aspirin may
cause stomach or
intestinal bleeding.
Hence, this is done to
lessen the side and
adverse effects that
may happen during
the drug therapy.
Administer analgesics 4
as prescribed by the
physician.
Rationale: This is to
relieve the pain that
the patient is
experiencing.
Provide 5
nonpharmacological
management to the
patient such as:
● quiet, peaceful,
and calm
environment
● relaxation
exercises like
focused
breathing and
activities like
socializing with
significant
others such as
the family.
Rationale: This
helps in alleviating the
pain that the patient is
experiencing.
Monitor the vital signs 6

of the patient.
check for the overall
body status of the
patient. Thus, vital
signs are usually
altered in an event of
pain.
Do pain assessment 7
each time the patient
reports a complaint of
pain. Document and
observe for any
unusualities or
complications.
evaluate the
effectiveness of the
interventions used to
manage the pain and
check if there are any
improvements with
the patient’s condition.
Reinforce the 8
importance of
applying warm
compresses to the
affected joints. Check
the temperature of the
water first, to avoid
any burns.
Rationale: Heat
promotes muscle
relaxation and
mobility, decreases
pain, and relieves
morning stiffness.
Encourage patient to 9
take rest.
Rationale: Having
adequate rest allows
the body to recover
fast and this prevents
fatigue that may
hinder the ability to
manage pain.
Instruct patient to 10
report if pain reoccurs
immediately.
Rationale: Quick and

timely intervention
helps in relieving the
pain.
IMPAIRED PHYSICAL MOBILITY
Name of Patient: S. M. Age/Sex: 80/M Ward: St. Catherine Room #: 436

Chief Complaint: Body weakness Diagnosis: Osteoporosis
Physician: Dr. Acosta
Date/ Cues Need Nursing Diagnosis Patient Nursing Intervention Implem Evaluation
Time Outcome entation
F Objective: A Impaired Physical Within 2 days Ensure the patient’s 1 March 01, 2023
E ● Weakness C Mobility related to of nursing safety before doing @ 11 pm
B at both T decreased bone intervention, any interventions.
R hands and I density as the patient will GOAL PARTIALLY
U feet V evidenced by be able to show Rationale: Since it is MET
A ● Limited I inability to ambulate an increase in the top priority and to
R range of T and limited range of strength and lessen any risks of After 2 days of
Y motion Y motion. function of legs complications or giving nursing
- as evidenced injuries. interventions, the
2 E Rationale: by patient was able to
8, X Physical inactivity demonstration Observe any pain, 2 show an increase in
E can lead to an of effective and make sure to strength and
2 R increased incidence passive range treat pain with function of legs as
0 C of bone loss. They of motion. massage, heat pack, evidenced by
2 I also result in poor or medication demonstration of
3 S physical shape, prescribed by the effective passive
E which raises the doctor before letting range of motion but
@ likelihood of falling the patient engage in with assistance.
P and fracturing a assisted activities.
4 A bone. Furthermore,
P T physical inactivity Rationale: As this
M T along with would maximize the
E compromised potential of the patient
R neuromuscular for mobility and
N function (e.g., function.
decreased muscle
strength, altered gait Turn and position the 3
Sittie Maliejah H.
and balance), are patient every 2 hours
Ampatuan, St.N
associated with the or as needed.
development of
fragility fractures, Rationale: Position
which can impair changes optimize
and interfere circulation to all
physical mobility tissues, relieve
(Tański, pressure, maintain
Kosiorowska, & body alignment,
Szymańska-Chabow preventing bed sores
ska, 2021). and contractures.
References: Provide adequate rest 4

Tański, W., periods and a relaxing
Kosiorowska, J., & environment to the
Szymańska-Chabow patient.
ska, A. (2021).
Osteoporosis-risk Rationale: This
factors, promotes fast
pharmaceutical and recovery and can help
non-pharmaceutical in conserving energy
treatment. Eur Rev of the patient.
Med Pharmacol Sci,
25(9), 3557-66. Advice the patient to 5
utilize side rails,
Doenges, M., walker, or cane during
Moorhouse, M., & position changing and
Murr, A. (2019). transferring. Also,
Nurse's Pocket lower the bed and put
Guide: Diagnoses, the necessary things
Prioritized needed by the patient
Interventions, and close to him.
Rationales (15th
ed.). Philadelphia, Rationale: This helps
Pennsylvania: F.A. in facilitating a safe
Davis Company. activity for the patient.
Thus, these
precautionary
measures give a
secured environment
for the patient, and it
lowers the risk of
falling.
If tolerated and 6
advised by the doctor,
maintain muscle
strength and joint
mobility by engaging
in a passive range of
motion exercises such
as stretching.
Rationale: It
enhances muscle
strength, improves
joint motion,
maintains joint
function, prevents
deformity, promotes
circulation, develops
endurance, and helps
relaxation.
Monitor the vital signs 7

of the patient,
especially the blood
pressure (BP) during
the course of activity.
Note reports of
dizziness.
Rationale: Since
postural hypotension
is a common problem
after a prolonged bed
rest.
Use pillows, rolled 8

blankets, and foam to
support the affected
body part.
Rationale: This
helps in prevention of
musculoskeletal
deformities and
complications such as
contractures, foot
drop, thus,
maintaining a
functional position of
extremities.
Encourage the patient 9

to have enough intake
of nutritious foods
such as food rich in
calcium and vitamin
D, and fluid.
provide energy that
would help the patient
in activities. Also,
calcium and vitamin D
are essential for bone
health.
Let the patient do his 10

daily activities with his
pace as he should not
be hurried in doing so.
Rationale: Since
when patients are
rushed and ordered to
do more than what he
can do, this may
result in slow recovery
and may reduce their
participation in
treatment.
Collaborate with a 11
physical therapist, if
necessary, when
providing exercises
and activities to the
patient.
create an exercise
and mobility program
suitable and
appropriate for the
condition of the
patient and to lessen
the effects and
complications of
immobility.
C. Discharge Planning
HEALTH TEACHINGS RATIONALE
1. Encourage the patient to Since the body does not

take calcium supplements produce calcium, a person
as needed. Even though must get it through other
diet is the best way to get sources such as the calcium
calcium, calcium supplements that are
supplements can also be considered as a standard
given if diet is not enough. treatment and prevention of
The two main forms of osteoporosis.
calcium supplements
include calcium carbonate
and citrate.
2. Instruct the patient to It is important to take the

take the medication medication correctly at the
correctly as prescribed by right time, right dose, right
the doctor following the right route, and right frequency as
time, dose, and route. prescribed by the doctor to
help the body keep healthy
and manage medical issues.
MEDICATION
3. Remind the patient to not Since missing a dose can
miss a dose or overdose the have a major impact on the
medication. overall health and it would not
be as effective as it supposed
to be. Moreover, drug
overdose can put the life of an
individual at risk and may lead
to serious, long-term
consequences.
4. Advise the patient to It is important to keep the

place the medications in a medications in their proper
clean area and free from place (medicine cabinet) since
any contaminants or some medications are easily
bacteria. damaged by heat and
moisture that may cause them
to be less potent. In addition,
placing them in a clean and
organized place may prevent
any contaminations.
5. Inform the patient about Discussing with patients the

the expected side effects of possible side effects of the
the medications and teach medication will allow them to
them how it can be assess whether the
managed. medication is effective, on the
other hand, teaching them
how to manage it will improve
their health outcomes at
home.
1. Let the patient be Being comfortable leads to

comfortable, have enough better satisfaction and
sleep, and rest properly. improves health outcomes.
Also, having adequate rest
and sleep allows the body to
promote overall health and
fast recovery.
2. Engage in exercising These can help build and
regularly as advised by the strengthen bone as well as
physician. It is these types of exercise work
recommended to have a directly on the bones in the
weight bearing exercise for legs, hips, and lower spine to
EXERCISE 30 minutes, 3 times a week. slow mineral loss.
Examples include walking,
dancing, low-impact
aerobics, stair climbing and
gardening.
3. Advice the patient to limit Because having osteoporosis

and lessen activities that causes the bones to become
are more high-risk. To take weak, brittle, and more likely
a temporary or long-term to fracture while doing
break from activities that activities.
involve aggressive
movement or twisting of
your body.
TREATMENT 1. Remind the patient to This will help the patient to

comply with the prescribed manage the disease or illness,
medication. obtain overall long-term health
and wellbeing, and prevent
life-threatening complications.
1. Emphasize the Practicing hygiene is a great

importance of proper way to protect the self from
hygiene (hand washing, oral infectious diseases, decrease
hygiene, taking a bath) to the number of germs and
the patient. bacteria in the body, and help
prevent any infection.
2. Instruct the patient to This is because nicotine and
avoid smoking, and other chemicals in cigarettes
consuming alcohol and and cigars have the possibility
caffeine. to speed up bone loss and
decrease bone mineral
density. Also, alcohol can
increase the risk of fracture.
3. At home, tell the patient Having osteoporosis, even

and the family members to minor injuries and falls can
keep the surroundings or have a major effect on health.
environment clean and Since falling greatly increases
organized. This can be the risk of osteoporotic
done by organizing or fractures especially in older
storing loose items in the adults and implementing
house and remove anything measures to prevent falls can
HYGIENE
that is not needed, cover reduce the risk of fractures.
slippery surfaces, wear Also, disorganized things or
supportive shoes, make clutter is a significant factor for
sure that there is enough concern, making an individual
light at home especially in stumble over scattered
the stairs, have handrails on objects.
staircases, put grab bars in
different areas of the house,
and put a rubber bath mat
to avoid falls. Also, some
people with osteoporosis
may use mobility aids, such
as a cane, walker, or
wheelchair for support.
Also, avoid leaving anything
unnecessarily on the floor
even if it’s just dirty clothes
or grocery bags which may
cause a person to be
tripped over, injured, and
fall.
1. Instruct the patient to Follow-up visits to the doctor

make a follow-up are important to ensure that
appointment as ordered by the patient is doing good, and
the doctor. the prescribed medication is
being complied by the patient
and effective. Also, this
promotes safety, more positive
health outcome.
2. Advise the patient to work Since a physical therapist

with a physical therapist as teaches and demonstrates
directed. different exercises to help
OUT-PATIENT
improve movement and
muscle strength, they can help
design an exercise plan that
meets the patient’s needs.
3. Inform the patient to seek Since people with

immediate care or go to the osteoporosis have a higher
hospital right away if they risk of falls due to muscle
have difficulty or pain in the weakness and lesser postural
body when doing daily control. Also, this is for the
activities and if they have medical professionals to
an accident such as falling. provide medical treatment
needed by the patient.
1. Teach the patient to eat Since the body needs calcium
healthy foods that are high to support bone health, build
in calcium. Milk, cheese, and maintain strong bones,
broccoli, tofu, almonds, and and helps regulate muscle
canned salmon and contractions.
sardines are good sources
of calcium.
2. Advise the patient to Vitamin D helps the body

increase intake of vitamin D absorb calcium and
such as salmon, swordfish, phosphorus from the food that
tuna fish, orange juice a person eats. That is why this
fortified with vitamin D, dairy nutrient is important for people
and plant milks fortified with with osteoporosis. In addition,
vitamin D, sardines, beef studies have shown that
liver, spinach, okra, calcium and vitamin D
soybeans, and white beans. together can build stronger
bones, decrease bone loss
and lower the risk of fracture,
especially in people with older
DIET
age. Also, low vitamin D levels
can increase the risk of
osteoporosis and broken
bones, and since not getting
enough vitamin D from
sunlight or from diet may
cause a deficiency which can
potentially harm the bones.
3. Drink more liquids Since alcohol or caffeine may
(2000–3000 mL) as directed decrease bone mineral
and do not have alcohol or density, which can weaken the
caffeine. bones.
4. Encourage the patient to It is important to drink the

drink more water. Older recommended amount of
people should drink the water per day to have better
recommended amount of bone health because water
water daily (at least 2L/day). lubricates joints and helps
Also, the capability to bring calcium and other
recognize thirst diminishes nutrients to the bones. In
as a person grows older, addition, the amount of water
which can lead to a person drinks helps keep
dehydration that may not be bones and bone marrow
noticed or observed functioning properly.
immediately.
IX. PROGNOSIS
Osteoporosis is a health condition which makes the bone so weak to the point
that it can be easily broken. It is also known as a "silent disease" because individuals
with this condition might not notice any symptoms until a bone breaks, typically a bone
in the hip, spine, or wrist. As we all know, bones protect the vital organs and support the
body, while osteoporosis weakens the inside of the bone by causing the "holes" in the
"sponge" to enlarge and proliferate. People suffering from osteoporosis have reduced
quality of life and a shorter life expectancy. Anyone, regardless of race, can develop
osteoporosis, white and Asian women, particularly older women who have passed
menopause are at highest risk (MayoClinic, 2021).
There is a good prognosis if the bone loss is identified in the early stages and
appropriate treatment is received by the patient. However, if the condition is left
untreated, it can lead to complications such as limited mobility, fractures in the spine
(vertebrae), hips, and distal radius, that can result in extended bed rest, posture
changes (kyphosis), disability, deep vein thrombosis, pressure ulcer, pulmonary
embolism, sepsis, and even death. Even with severe osteoporosis, bone density may
normally be improved or stabilized. If proper therapy is undertaken and maintained by a
patient with mild osteoporosis, he/she can expect a good prognosis. If a fracture
happens, the affected bone will usually heal normally, and the pain will usually go away
within a few weeks. Moreover, there are four stages of osteoporosis, the first stage
which occurs during early 20s to 30s, the bone growth and breakdown at equal pace
with no symptoms, second stage begins between the age of 25 and 35, the bone loss
begins to surpass bone rebuilding with no symptoms, third stage begins between the
age of 45 and 55, the bone loss surpasses bone rebuilding with symptoms that may
remain undetected but there is an increased risk of fractures and breakages, and lastly,
the fourth stage which occurs anytime after the age of 45, with significant bone loss
along with a severe reduction or lack of bone growth and there is high risk of fractures
and breakages and symptoms such as a spinal curve from soft and fragile spinal bones
begins to appear (Bottaro, 2023).
In addition, through engaging in regular exercise, eating a diet high in calcium,

and taking the appropriate anti-osteoporotic medications such as bisphosphonates,
patients can improve their bone mineral density (BMD) and reduce their risk of fracture.
Patients can also minimize their risk of falling and complications by taking part in a
holistic approach that includes rehabilitation treatment and environmental changes.
Providing appropriate pain management and orthotic devices can prevent the
worsening of condition (Elam, 2023).
Furthermore, postmenopausal women are at high risk of suffering from a hip

fracture, which frequently requires extended recovery and nursing home care. Vertebral
fractures are also prevalent and are linked to an increased risk of pneumonia, kyphosis,
chronic pain, and respiratory impairment. Due to their inability to function well on a daily
basis, most patients with osteoporosis are unable to live independently (Porter &
Varacallo, 2022). According to Bottaro (2023), men who starts treatment before the age
of 60 and women who starts treatment before the age of 75 can live for at least 15
years or more after their diagnosis since the course of treatment and the patient's age
upon diagnosis determine how long the patients can live with osteoporosis.
Additionally, the most common cause for fractures in older people is

osteoporosis since 80% of all fractures in people 50 years of age and above are linked
to osteoporosis. Due to this, women aged 50 years have a lifetime fracture rate of about
50%. Also, hip fractures occur in approximately 33% of women who live up to 90 years
old, and they are associated with functional impairment, nursing home admission, and
death (Elam, 2023).
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Group-1 Osteoporosis

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A Case Analysis on

In Partial Fulfillment of the

Sittie Maliejah H. Ampatuan, St. N.

Earl Wayne E. Bangay, St. N.

Ela Carolane S. Brato, St. N.

Kyle Andrei A. Caballero, St. N.

Kim Zascney Guiang, St. N.

Marielle Ayn Ines, St. N.

Eloisah Maglinte, St. N.

BSN 3F - Group 2 - Subgroup 1

March 12, 2023

I. INTRODUCTION AND OBJECTIVES ……………………………………………… 2

Bone remodeling, a highly coordinated process of concurrent resorption and

About 10 million Americans over the age of 50 have osteoporosis, and an

According to the National Nutrition Health Survey (NNHeS), the general

19.8% of the post-menopausal participants in the current community-based

Specifically, the student nurses aim to achieve the following;

a) Present an overview of Osteoporosis, the patient and the rotation briefly;

II. DATA BASE

For the lumbosacral spine x-ray, there is a generalized decrease in osseous

D. Past Health History

E. History of Present Illness

III. PHYSICAL/NEURO ASSESSMENT

A physical assessment was done on patient S.M., an 80-year-old male, last

TEMPERATURE 37.4°C 35.6 to 37.5°C Normal

BLOOD 120/80 mmHg 110/70 - 130-90 Normal

CARDIAC RATE 82 60 to 100 bpm Normal

PULSE RATE 78 60 to 100 bpm Normal

RESPIRATORY 24 16-20 cpm Abnormal

PAIN 4/10 See Fig. 1 Moderate

Figure 1. Pain Intensity and Facial Grimace Scale

The patient has a normodynamic precordium and no abnormal sounds were

IV. DEFINITION OF DIAGNOSIS

Osteoporosis is a condition leading to loss of bone mass. The structure of the

V. ANATOMY & PHYSIOLOGY

The bone is a metabolically active connective tissue which provides

Cellular process of the bone remodelling begins when osteoblasts detect

The bone modelling-remodelling process initially starts during fetal life

Other hormones affecting the bone modelling-remodelling process are the

PREDISPOSING PRESENT RATIONALE

Age ✓ Bone loss accelerates with age, whereas

Gender ✓ A study conducted by Babhulkar & Seth

Race ✓ Women in white and Asian subjects had

Family history of 𝙓 A positive family history of osteoporosis, as

Hormonal changes 𝙓 There is a decreased estrogen production

II. Precipitating Factors

PRECIPITATING PRESENT RATIONALE

Low dietary calcium ✓ Calcium and vitamin D, which are

Low body mass index X According to the study of Cheraghi et al.

Eating disorders X Anorexia nervosa is a type of eating

Excessive alcohol ✓ The link between alcohol use and fracture

Prolonged tobacco use ✓ A study by Yang et al. (2021) stated that

Hypercalciuria X The calcium homeostasis is maintained

Androgen-deprivation X Prostate cancer is an

Long-term use of X Glucocorticoids are the most regularly

- Turner Women who have Turner syndrome are

- Hyperprolactine Antipsychotics may induce osteoporosis

- Klinefelter Osteoporosis is seen in up to 40% of

- Cushing's Cushing's syndrome causes a number of

- Diabetes Diabetes mellitus type 2 (T2DM) is a risk

SYMPTOMS PRESENT RATIONALE

Severe Back Pain ✓ Caused by fractures experienced