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OSTEOPOROSIS

Case
An elderly woman 67 years old came to the Hospital, based on the
history the woman tripped over the carpet about 2 hours ago, when
she would move on sitting position to standing, unfortunately she
turned sitting on the chair. She attempted to stand up, she felt pain in
left hip, but she still able to hold enough on the left leg. Several times
later, the pain is more severe, the left leg feels heavy to be moved, let
hip feels stiff and sore, however the woman cant stand up and resting
on the left hip. Patient admitted that she had no menstrual period
since 25 years ago, not smoking experience, not drunk, not taking drug
anti-allergy, not to do exercise regularly and most activity is watching
TV. Doctor diagnosed hip fracture e.c Osteoporosis
Questions?
What is Osteoporosis?
Definition
Osteoporosis means "porous bones" causes bones to become weak
and brittle so brittle that even mild stresses like bending over,
lifting a vacuum cleaner or coughing can cause a fracture.
In most cases, bones weaken when low levels of calcium,
phosphorus and other minerals in the bones and results as low
bone density.
A common result of osteoporosis is fractures of the spine, hip or
wrist.
Although it's often thought of as a women's disease, osteoporosis
also affects many men
Normal bone has the appearance of a honeycomb
matrix (left). Under a microscope, osteoporotic bone
(right) looks more porous.
Classification
1. Primary osteoporosis
Divide into two types :
Type 1 : Occur in women after menopause
Type 2 : Occurs in older adult ( men and women )

2. Secondary osteoporosis
Caused by errosive bone disease such as multiple myeloma,
hypertiroidism, hyperparatiroidism and also caused by drug
which has tixical effect to bone such as glucocorticoid
Cont...
3. Idiopatic osteoporosis
Ostepoporosis which the cause is unknown
Childhood age
Adolescence age
Pra menopause women
Middle age people
Sign and Symptoms
It might have signs and symptoms
that include:
Back pain, caused by a fractured
or collapsed vertebra
Loss of height over time
A bone fracture that occurs
much more easily than expected
McConkey sign : protuberansia
abdoment, paravertebral muscle
spasm, thin skin.
Causes
The strength of the bones depends on their size and density; bone
density depends in part on the amount of calcium, phosphorus and
other minerals bones contain.
When the bones contain fewer minerals than normal, they're less
strong and eventually lose their internal supporting structure.
Etiology
Osteoporosis caused by glucocorticoid which disturb calsium
absorbance in the intestine and increasing calsium extraction through
renal. It can cause, hipocalcemia, secondary hyperparatiroidism and
increase osteoclase acivity. Glucocorticoid will disturb osteoblas also
that will cause decrease bone formation. Increasing bone resorption
by osteoclas and decreasing bone formation by osteoblas will cause
progressive osteoporosis
Pathways
Risk Factor
Age, usually happen in the older Early menopause ( < 50 years old )
adult Nutritional status ( lack of protein
Race, white skin people have and calcium in teenage)
highest risk for osteoporosis Hormonal ( low level of estrogen )
Genetic, someone who has family Corticisteroid drug
history on osteoporosis will have
higher risk that who has no family Bone damage due to tiredness
history in that Women have 3 times risk than men
Weak bone and skoliosis vertebra
Lack of physical activity
Never give birth a baby
Diagnostic Test

The best screening test is Dual energy X-ray Absorptiometry (DEXA) -


measures the density of bones in the spine, hip and wrist and it's

used to accurately follow changes in these bones over time.

Ultrasound
Quantitative CT scanning
Indiction
Older than age 65, regardless of risk factors.

Postmenopausal and have at least one risk factor for osteoporosis, including having fractured a bone.

Having vertebral abnormality.

Use medications, such as prednisone, that can cause osteoporosis.

Type 1 diabetes, liver disease, kidney disease, thyroid disease or a family history of osteoporosis.

Experienced early menopause.


COMPLICATIONS
Fractures are the most frequent and serious complication of
osteoporosis.
Often occurs in spine or hips bones that directly support your
weight.
Hip fractures and wrist fractures from falls are common.
Compression fractures can cause severe pain and require a long
recovery. If many such fractures, can lose several inches of height as
the posture becomes stooped.
Prevention
Do exercise such as walking, running, skipping rope, jogging
regularly.
Add soy in diet plant estrogens found in soy helps to maintain
bone density and reduce the risk of fractures.
Avoid smoking, it can reduce the levels of estrogen and increase
bones Loss.
Avoid excessive alcohol.
Avoid caffeine, which is very harmful.
Consider hormone therapy.
ESTIMATED DAILY CALCIUM INTAKES

RECOMMENDED DAILY INTAKE OF VITAMIN D


Nursing Process
Demoghrapy : Sex, Age, Race.
Genetic
Physical activity
ObsGyn : hormonal, menopause, history of partus
Using corticosteroid drug
Nursing Diagnostic
Accute pain related to biological injury agent (fracture)
Physical mobility obstacle related to musculoskeletal disturbance
Knowledges deficiency related to osteoporosis process dan program
of therapy
Anxiety related to changes of health status
Risk for fall related to decrease activity and muscle strength
Intervention