METABOLIC BONE DISEASE Normal Bone with

OSTEOPOROSIS
bone Osteoporosis
OSTEOMALACIA
PAGET's DISEASE

dstbots Osteoclast DEFINITION

Function: Maintain Function: Bone
mineral resorption Osteoporosis is a chronic, progressive
concentration of Location: Bone
matrix
surfaces and sites
at
metabolic bone disease marked by low bone
Location BONE CELLs of old, injured, or
Entrapped In matrix unneeded bone mass and deterioration of bone tissue, leading
to increased bone fragility.
Osteogenic
Osteoblast cell

Function: Bone
Function: Develop
formation into osteoblasts
Location: Growing
portion of bone, Location: Deep
layers of the
including periosteum and the
periosteum and
marrow
endosteum
 Incidence
estimated that
I n India it is
million adults have
60
with 2.3
osteoporosis
million added annually.
OSTEOPOROSIS
of women over 60
25% SEVERE

of develop NORMAL oSTEOPOROSISs

years age BONE
OSTEOPOROSS

vertebral fractures due to

osteoporosis.
Osteoporosis is known as a
silent thief because it
slowly robs the skeleton so
fragile that they cannot
withstand normal
mechanical stress.

of
TheTop Causes
Classifications
Primary: post menopausal osteoporosis
age related osteoporosis
Secondary: prolonged use of drugs like
corticosteroids
.Other:idiopathic
Juvenile osteoporosis
osteogenesis imperfecta -inherited
disorder characterized by fragile bones that
easily breaks. Caused by defective gene.
 10STEOPOROSIS K
COMMON RISK FACTORS
RISK FACTORS Cont...
testosterone in
Advancing age (>65) Low
men
Female gender
term use of
Low body weight Long
corticosteroids
White or Asian ethnicity Excessive use of alcohol
Sedentary lifestyle
Estrogen deficiency in women

Family history
Diet low in calcium or vitamin D deficiency

shutterst'ck

Cont
PATHOPHYSIOLOGY
by loss
Cancellous bone is lost first-followed
a
risk factors
D u e to etiological and of compact bone

bone
R a t e of bone reabsorption is greater than Outer cortex of bone thins
and fracture of bone

formation occurs e v e n with minimum stress

Irreversible bone loss that makes the inside of

metaphysis of bone
Primarily affects diaphysis and bone porous and weaker

thinning of outer osteoporosis

Increase in bone diameter and
supporting cortex
 Symptoms ODf
Osteoporosis
Signs & Symptoms of Osteoporosls
Bone pain or Bone pain or tenderness
Tenderness

Fractures with little or no

Fractures with ittle trauma
Dr no trauma

Loss af he:ght
Loss of height over time
Cve time

Neck or lower back pain due

to fractures
Neck or low
Stooped posture
MKaovYourRone

Stages of osteoporosis
is follows:
OSTEOPOROSIS STAGES T h e scoring per stage
as

T-score between +1
Stage 1: A person with a
in the typical range.
and-1 has a bone density
with a T-score
between -1.0
Stage 2: Someone
and-2.5 indicates osteopenia. .
-2.5 below can
Stage 3: A T-score of
or

indicate osteoporosis.
HEALTHY OSTEOPENA OSTEOPOROSIs SEVERE
OSTEOPOROSIs
Stage 4: severe osteoporosis
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 MANAGEMENT
DIAGNOSTIC STUDY Adequate dietary calcium

History collection and Calcium supplements( 1000mg/day)

physical examination S u n exposure or vitamin D supplements

Duel energy x- ray absortiometry Exercise programn
Serum calcium test Drug therapy:
X- ray Bisphosphonates eg: alendronate

Bone mineral density (BMD) Salmon calcitonin

Ct scan Selective estrogen receptor modulator eg:
.MRI raloxifene

Surgical management
Foods high in calcium include milk, yogurt, .Vertebroplasty
turnip, cottage cheese, ice cream, spinach
kyphoplasty
Regular physical activity is important to build
and maintain bone mass.
Best exercise are weight bearing exercise
include walking, tennis, dancing, and hiking.
Gait aid to walk safely
 Osteomalacia
Osteomalacia is caused by vitamin D deficiency
a
that causes bone to lose calcium and become soft.
I t is the same disorder as rickets in children.
Insuffficient vitamin D intake can interfere with
normal bone mineralization, with little or no
calcification, bones become soft.

Bone Cement Market

OSTEOMALACIA
Normal Bones
Osteomalacia CAUSES OF OSTEOMALACIA
Lock
of vitamin D synthesis
.Gl malabsorption
-celiac disease
Extensive burns
Chronic diarrhea
Pregnancy
Kidney disease -kidney failure
Use of drugs such as
phenytoin
Inadequate sun exposure
Physical activity and poor diet
 Cont..
s0FTENNGwEAKENINGPSCOOFMGTURES
DONES
L
.Intestine disease ARDON

.Phosphate binding antacids and sedative

Muscles relaxants may decrease calcium and
vit D absorption CAVSES D1AGNOSIS
VIND oCHCIONCY EDIM STTRY 3 17K TXAM
b02n TEST

DNEY DISCASE TRCATMCNT

DI TKY CHIGS- uLCNINTS
10R KCEY JILUE MC

PATHOPHYSIOLOGY Activate parathyroid gland

Due to etiological factors Results in continuous loss o calcium and phosphorus

from bone
Decreased level of vitamin D
Impaired mineralization in spongy or compact bones
Decreased absorption of calcium & phosphorus
Deformity of long bone, apine, pelvic and skull
from intestines

Bone become soft and unable to bear stress and

Serum level of calcium and phosphorus decreases weight

osteomalacia
 Symptoms of osteomalacia
CLINICAL MANIFESTATIONS
hips
Bone pain especiallyin the
MoOd changes
Bone loss
Difficult walkinge to vertebral collapse
Leg and lower back pain due
in the pelvic girdle
Muscle w e a k n e s s especially

Bone & joint Weight loss bones

pain
Muscle P r o g r e s s i v e deformity of weight bearingbone
cramps indicate delayed
common
Fracture are

healing.

Fatigue

L A B O R A T O R Y FINDINGS
Cont.. alkaline
investigations elevated serum
Blood
Difficulty in changing position -

lying to sitting phosphatase

position
X-rays
Enlargement wrists and angles Bone demineralization
Pigeon breast ( protruding ribs and sternum) MRI
Numbness around the mouth CT scan
and creatinine
Numbness of the arms and legs U r i n e test to detect calcium
Spasms of the hands or feet Bone biopsy
test
ALP (alkaline phosphatase
) isoenzyme
 MANAGEMENT PAGET's DISEASE
.Vitamin D eg: cholecalciferol,
ergocalciferol Paget's disease, also called osteitis deformans, is
supplements are used. a slowly progressive metabolic bone disease
Encourage dietary intake of egg meat and oil characterized by enhanced resorption of bone as
a result of over activity of osteoclasts.
fish, cereals.
Excessive bone resorption occurs followed by
Exposure to sunlight excessive bone formation.
.Patients who have bariatric This process results in a disorganized ,mosaic
surgery to treat pattern of woven and lamellar bone that is
obesity. associated with increase vascularity, marrow
fibrosis and mechanical weakness.

Causes
Cont.
Idiopathic
This metabolic disorder results from excessive
Infection
metabolic activity in bone, affected bones
Benign and malignant bone tumors
become thickened and their structure Vitamin D deficiency
disorganized Auto immune disease -which the body's
immune system attacks healthy cells.
Estrogen deficiency -hormonal imbalance
Vascular disorder and abnormal growth of tissu
neoplasm- new
a part of the body.
 have highly
vasculariation and and weak
Bones
structure
PATHOPHYSIOLOGY
Due to etiological factors
deformities
bowing offemur and ti i:
Skeletal of skull
and e n l a r g e m e n t
Increase in number, size and activity of osteoclasts
remodeling
bowing of bone-
bone
Osteoclasts secrete acid and enzyme that dissolve Disorganized nerve endings
stimulate nociceptive
the mineralized bone and matrix

Paget's disease
Increased osteoclasts activity results in
disorganized new bone formation

CLINICAL MANIFESTATION Cont.

Most people with paget's disease have no of
movement due to impingeding
symptoms Impaired sensor
spinal card or
Pain and tenderness abnormal bone on the
of bone
nerve root.
Fracture of brittle bone
Browning of femur and tibia Cranial enlargement over frontal and occipit
areas and possible headache.
Enlargement of the skull or hips motor
Curved back bone Sensory abnormalities and impaired
function
Waddling gait
 Kyphosis spinal curvature due to
compression fractures of vertebrae Barrel chest

Normal
splne Kyphottc
spine

ADAM

DIAGNOSTIC EVALUATIONI
Biopsy
DEKneedle
History collection
Physical examination
X-rays
CT scan and MRI
.Radionuclide bone scan
Bone biopsy
Small piece
of bone
removed

O AboutKidsHealth c.
 MEDICAAL MANAGEMENT Surgical management
Pain controlled with
analgesics such as aspirin or 1. help fracture heal
NSAID .2. Replace joints damaged by severe arthriitis
Acetaminophen- pain bone
Didronel- given orally or iv intravenously (this 3. realign deformed
drug reduce normal and abnormal bone 4 . reduce presure
on n e r v e s
resorption and secondarily
arthritis require total replacement
Antibiotics- mthramycin .5. severe

Calcitonin
use physiotherapy
Physical therapy - improves mobility

Nursing management
Assess the pain location & intensity of pain
Advise the patients to take analgesics
Ensure correct use of prescribed brace or
corset
Advice heat therapy and massage
Encourage
mechanism
the patient to practice good body
Weight controlling to reduce the stress on
affected bones
Advice the patient to take diet rich in calcium
and vitamin D.