BONE’S

DISEASE/DISORDER
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 INTRODUCTION:

● Metabolic bone disease, any of several

diseases that cause various abnormalities or
deformities of bone. Examples of metabolic
bone diseases include osteoporosis, rickets,
osteomalacia, osteogenesis imperfecta,
marble bone disease (osteopetrosis), Paget
disease of bone, and fibrous dysplasia.
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 Osteoporosis

● disease characterized by the thinning of bones, with a

consequent tendency to sustain fractures from minor
stresses. Osteoporosis is the most common 
metabolic bone disease, and its name literally means
“porous bone.” The disorder is most common in 
postmenopausal women over age 50. It is estimated that
approximately one-fourth of the world’s population of
women over age 60 have some degree of osteoporosis. For
these women, fracture is a leading cause of morbidity and
mortality.
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 Rickets

● disease of infancy and childhood

characterized by softening of the 
bones, leading to abnormal bone
growth and caused by a lack of 
vitamin D in the body. When the
disorder occurs in adults, it is
known as osteomalacia.
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 Osteomyelitis

● infection of bone tissue. The condition is most commonly caused by

the infectious organism Staphylococcus aureus, which reaches the
bone via the bloodstream or by extension from a local injury; 
inflammation follows with destruction of the cancellous (porous)
bone and marrow, loss of blood supply, and bone death. Living bone
grows around the infected area and walls in the dead tissue, forming
an involucrum, the contents of which are gradually resorbed as the
lesion is repaired.
● Osteomyelitis may occur as a complication of many diseases, such
as typhoid, syphilis, tuberculosis, or sickle cell anemia. In the
middle-aged, spinal osteomyelitis may be associated with urinary 
bladder infection. Intravenous drug use may also cause
osteomyelitis.
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 Arthritis

● inflammation of the joints and its effects. Arthritis is a general

term, derived from the Greek words arthro-, meaning “joint,”
and -itis, meaning “inflammation.” Arthritis can be a major
cause of disability.
● Osteoarthritis, also known as degenerative joint disease, is the
most common form of arthritis, affecting nearly one-third of
people over age 65. It is characterized by joint pain and mild
inflammation due to deterioration of the articular cartilage that
normally cushions joints. Joint pain is gradual in onset,
occurring after prolonged activity, and is typically deep and
achy in nature. One or multiple joints may be affected,
predominantly involving the knee, hips, spine, and fingers.
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 Bone cancer

● Bone cancer is when unusual cells grow out of

control in your bone. It destroys normal bone tissue.
It may start in your bone or spread there from other
parts of your body (called metastasis).
● Bone cancer is rare. Most bone tumors are benign,
which means they aren’t cancer and don’t spread to
other areas of your body. But they may still weaken
your bones and lead to broken bones or other
problems.
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 Osteopetrosis (marble bone disease)

● is a clinical syndrome characterized by the failure of

osteoclasts to resorb bone. As a consequence, bone
modeling and remodeling are impaired. The defect in
bone turnover characteristically results in skeletal
fragility despite increased bone mass, and it may also
cause hematopoietic insufficiency, disturbed tooth
eruption, nerve entrapment syndromes, and growth
impairment.
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 Paget disease of bone

● Paget's (PAJ-its) disease of bone

interferes with your body's normal
recycling process, in which new bone
tissue gradually replaces old bone
tissue. Over time, bones can become
fragile and misshapen. The pelvis,
skull, spine and legs are most
commonly affected.
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 Fibrous dysplasia

● Fibrous dysplasia is an uncommon bone disorder in

which scar-like (fibrous) tissue develops in place of
normal bone. This irregular tissue can weaken the
affected bone and cause it to deform or fracture.
● In most cases, fibrous dysplasia occurs at a single site
in one bone, but can occur at multiple sites in
multiple bones. Single bone involvement usually
occurs in adolescents and young adults. People who
have more than one affected bone typically develop
symptoms before the age of 10.
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 ETIOLOGY:

● From bone fractures (bone breaks) to crippling arthritis,

disorders that affect your bones come in many forms. Any
number of bone diseases can lead to abnormalities in bones
and joints, increase your risk for fractures, and cause chronic
pain and disability.
 
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 ETIOLOGY
Genetics, age, hormones, occupation, activity levels, lifestyle, and environmental factors all play
a role in the development of bone disease. Here is what you need to know about the common
causes and risk factors of various bone diseases.

There are many different types of bone diseases. Some of these conditions affect mostly adults
The most common causes of bone disease are: 
● Genetics
● Age
● Sex
● Ethnicity
● Occupation
● Environmental factors
● Bacteria
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● Injury and overuse

 Etiology
● Genetics
Many diseases of the skeletal system are considered congenital because they are either evident at birth or manifest soon after birth
● Age
Changes to bone health are common as you age. Osteoporosis, a condition in which bones become weak and brittle, is often
diagnosed in older adults because of reduced bone density causing bones to break more easily.
● Ethnicity and Race
There are differences in bone diseases between ethnic groups. Many of these are related to body size and composition.
● Sex
It seems women have a higher risk of inflammatory arthritis diseases, osteoarthritis, and osteoporosis.
● Occupation
Occupational bone diseases are rare although osteoarthritis has some occupational risk associated with it.
● Environmental Factors
Exposure to certain toxins can affect bone health.
● Bacteria and Infections
Infectious bone diseases—like osteomyelitis—are caused by bacteria. Common bacteria associated with bone infections are
Staphylococcus bacteria.
● Inflammatory Arthritis
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Some types of inflammatory arthritis can contribute to the development of other bone conditions, including osteoarthritis,
osteoporosis, and osteopenia.
 Diagnosis:
Along with a complete medical history and physical exam, other tests to diagnose bone disorders include:
● Lab tests on blood, urine, and other body fluids
● X-ray. An X-ray can show injuries, such as fractures, infections, arthritis, and other changes.
● Computed tomography scan (also called a CT or CAT scan). This is an imaging test that uses X-rays and a computer
to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs. CT scans are more
detailed than general X-rays.
● Magnetic resonance imaging (MRI). An MRI scan provides detailed images of soft tissue, the bone marrow cavity, and
bone tumors.
● Bone densitometry. Bone densitometry is often used to find osteoporosis. The test measures bone mass in the spine,
hips, and arms. These are the areas most likely to fracture when bone mass is low.
● Radionuclide bone scan. The bone scan is used to pinpoint the location of bone tumors. It is also used to find any
spread to other bones. It's also used to diagnose stress fractures or tiny cracks in the bones
● Biopsy. Tissue samples are removed and examined under a microscope. It's done to determine if cancer or other
abnormal cells are present. Two types of biopsy, including:

○ Needle biopsy. A needle is inserted into the bone to obtain tissue.

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○ Open biopsy. A surgical procedure in which an incision is made through the skin to allow a sample of tissue to be
cut or scraped away.
 Signs and Symptoms
. Paget's Disease of
Osteoporosis Bone.
Bone Cancer Rickets Osteogenesis

● Bone pain ● Delayed growth ● Imperfecta. ● Back pain, caused by ● Fractures due to brittle
● Swelling and ● bones that break with a fractured or bone.
● Delayed motor
tenderness near the no known cause or collapsed vertebra ● Deformity of bone,
skills
affected area from very minor ● Loss of height over including bowing of
● Weakened bone, ● Pain in the spine, trauma time the affected bone.
leading to fracture pelvis and legs ● bone pain ● A stooped posture ● Advanced arthritis in
● Fatigue ● Muscle weakness ● bone deformity (such ● A bone that breaks joints near the affected
● Unintended weight as scoliosis or much more easily than bone.
loss bowlegs) expected ● Compression on
● Bone Density. ● a shorter stature neighboring nerves
● Back pain, caused by ● brittle teeth (called from enlarged bones,
a fractured or dentinogenesis leading to a loss of
collapsed vertebra imperfecta) sensation or
● Loss of height over ● a blue, purple, or gray movement.
time tint to the sclera (the
● A stooped posture whites of the eyes)
● A bone that breaks ● triangular face shape
much more easily than ● hearing loss in
expected
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adulthood
● loose joints
 Medical Treatment

Treatment of Other Bone Diseases Primary

hyperparathyroidism

● ~ Removal of parathyroid adenoma(s) by -Special diets

surgery if signs or symptoms meet
guidelines
● ~ Hormone therapy or bisphosphonates may
be helpful Renal osteodystrophy (bone
disease from kidney failure)
● ~ Treatment of kidney problem (dialysis,
transplantation)
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~ Calcitriol Paget’s disease of bone
~ Bisphosphonates (alendronate, risedronate,
tiludronate, etidronate) Multiple myeloma
~ Chemotherapy
~ Stem cell transplantation
~ Bisphosphonates Osteogenesis imperfecta
~ Rehabilitation
~ Physical therapy
~ Bisphosphonates
 Medical Treatment

● There are some treatments available to treat bone metastases caused by cancers. Bisphosphonates,
which are potent inhibitors of bone resorption, significantly reduce skeletal morbidity in patients with
advanced breast cancer and can reduce metastasis to bone by human breast cancer cells in an
experimental model (Cancer Supplement 2003). Pamidronate, a second generation bisphosphonate, has
recently been approved by the FDA for treatment of breast cancer osteolysis. Zoledronic acid, a third-
generation bisphosphonate, has also been approved for treatment of cancer patients. Another inhibitor of
bone resorption, the protein osteoprotegerin, has also been shown to be effective in reducing bone
metastases in animal models of breast and prostate cancer and in reducing bone pain in patients
(Cancer Supplement 2003). Although bisphosphonates significantly reduce skeletal morbidity associated
with solid tumor metastases to bone, most studies indicate no improvement in survival (Cancer
Supplement 2003). Thus, in order to improve therapy and ultimately prevent bone metastases, a more
precise understanding of the pathophysiology of bone metastases is necessary, as the level of current
understanding is very limited (Cancer Supplement 2003).
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 Nursing Care Management

● Nursing care of a patient with fracture include: The nurse should instruct the patient
regarding proper methods to control edema and pain. It is important to teach exercises
to maintain the health of the unaffected muscles and to increase the strength of muscles
needed for transferring and for using assistive devices.

● Medical management of osteoporosis aims at slowing down or preventing further bone

loss, controlling pain and avoiding additional fractures. A nurse's care plan should focus
on the patient's fragility, stressing careful positioning, ambulation, and prescribed
exercises.
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 Home Care Management

● Include plenty of calcium in your diet- For adults ages 19 to 50

and men ages 51 to 70, the Recommended Dietary Allowance
(RDA) is 1,000 milligrams (mg) of calcium a day. The
recommendation increases to 1,200 mg a day for women age 51
and older and for men age 71 and older. Good sources of calcium
include dairy products, almonds, broccoli, kale, canned salmon
with bones, sardines and soy products, such as tofu. If you find it
difficult to get enough calcium from your diet, ask your doctor
about supplements.
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 Home Care Management

Sources of calcium
• Tofu (calcium fortified).
• Soy milk (calcium fortified).
• Green leafy vegetables (e.g., broccoli, brussels sprouts, mustard greens, kale).
• Chinese cabbage or bok choy.
• Beans/legumes.
• Tortillas.
• Sardines/salmon with edible bones.
• Shrimp.
• Orange juice (calcium fortified).
• Pizza.
• Bread.
• Nuts/almonds.
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• Dairy products (e.g., milk, cheese, yogurt).

 Home Care Management

● Pay attention to vitamin D- Your body needs vitamin D to absorb calcium. For adults ages 19 to 70, the RDA of vitamin D is
600 international units (IUs) a day. The recommendation increases to 800 IUs a day for adults age 71 and older. Good sources of
vitamin D include oily fish, such as salmon, trout, whitefish and tuna. Additionally, mushrooms, eggs and fortified foods, such as
milk and cereals, are good sources of vitamin D. Sunlight also contributes to the body's production of vitamin D. If you're
worried about getting enough vitamin D, ask your doctor about supplements.

• Include physical activity in your daily routine- Weight-bearing exercises, such as walking, jogging, and
climbing stairs, can help you build strong bones and slow bone loss.

• Prevent falls- Falling down can cause a bone to break, especially in someone with osteoporosis. But most falls
can be prevented. Check your home for dangers like loose rugs and poor lighting. Have your vision checked
regularly. Increase your balance and strength by walking every day and taking classes

• Avoid substance abuse- Don't smoke. If you are a woman, avoid drinking more than one alcoholic drink each day.
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If you are a man, avoid drinking more than two alcoholic drinks a day.
Thank you!
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