Osteoporosis
NUR 211 Unit 2 Study Guide Revised
=chronic condition that results in deterioration of bone tissue and density, increasing a patient’s risk for fractures. It is the most common bone disease in humans and creates a major public health concern for the future.
=”Silent Di...
bone remodeling the constant replacing of older bone with newer bone
a calcitonin thyroid hormone – decreases bone resorption by inhibiting osteoclast activity
b estrogen replac
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NUR 211 Unit 2 Study Guide Revised
Osteoporosis
=chronic condition that results in deterioration of bone tissue and density, increasing a patient’s risk
for fractures. It is the most common bone disease in humans and creates a major public health
concern for the future.
=”Silent Disease”
Bone remodeling = the constant replacing of older bone with newer bone
Osteoclasts = break down bone by adhering to the surface of bone and secreting acids and enzymes
directly into the bone cavity Osteoblasts = rebuild bone by synthesis and mineralization of the new
bony matrix within the bone cavity
Osteopenia = bone loss; bone resorption is greater than bone rebuilding in a decreased bone mineral densit
before osteoporosis
Medical
Management
Diagnosis
A. Annual height measurement
B. Bone Mineral Density (BMD) testing
1. Women over 65 or men over 70 years
2. Postmenopausal women and men 50-69 with high risk factors
a. DEXA = dual-energy x-ray absorptiometry ; precise measurements; highlight areas for future
fracture risk
Normal BMD within 1 SD of young normal adult,
T-score
-1.0 or higher
Low bone mass or osteopenia BMD between 1 and 2.5 SD’s lower than
that of a
young normal adult. T-score between 1.0
and -2.5
Osteoporosis BMD more than 2.5 SD’s lower than that
, of a young
normal adult, T-score -2.5 or lower
b. Quantitative computed tomography (QCT) = measures volumetric bone density of
the spine and hip and can identify cortical and trabecular bones distinctly. Used for
research and diagnostic management -NOT screening
c. Biochemical Markers = bone-specific alkaline phosphate, osteocalcin, N-telopeptide
and C-telopeptide, serum & urine calcium, Vit D, phosphorous, hematocrit, ESR,
d. FRAX = calculates a 10 year probability for hip and any one of four major osteoporotic fractur
bet 40-89 years.
Treatment
A. Prevention and early screening
B. Weight loss
C. Muscle-strengthening exercises and weight-bearing exercises
D. Avoid smoking and excessive alcohol intake
E. Calcium + Vitamin D supplements
Calcium 1,200 mg /day Vitamin D 800-1000 international units /
-give with food in divided doses with 6-8 oz of day
water -Toxicity can occur: weakness,
-can cause GI upset fatigue, nausea, constipation,
-monitor for constipation & hypercalcemia kidney stones
Milk and milk products Fortified milk & cereals
Figs Egg yoks
Fish with bones Saltwater fish
Greens Liver
Red and white beans Sunlight 15 min /day
Medications
A. Bisphosphonates
, 1. Fosamax (alendronate) = admin daily or weekly on an empty stomach 30 min
before food or meds and remain sitting up for 30 minutes after admin as risk
for esophagitis and esophageal ulcers can occur
2. Boniva (ibandronate) = monthly tablet or IV infusion every 3 months –
admin on empty stomach and remain sitting up for 30 minutes after admin
as risk for esophagitis and esophageal ulcers can occur
Manifestations
Dowager’s hump (kyphosis) Fear of falling
Loss of height (2-3 in) Previous fractures
Back pain BMD more than 2.5 SD’s (standard deviations)
lower than that
of a young adult
Pain with activity – relief with rest T-score -2.5 or lower
Restriction of movement
Hormonal Influences
A. Calcitonin (thyroid hormone) – decreases bone resorption by inhibiting osteoclast activity
B. Estrogen - replaces estrogen lost due to menopause or surgical removal of ovaries and should
be given with progesterone in clients who sill have their uterus.
1. Estrace = assists with bone remodeling and osteoclastic activity; varies methods of admin;
risk for MI, stroke, breast and endometrial cancers, PE, DVT. Perform monthly breast
exams
C. Parathyroid hormone
Diet
A. Dietary sources such as Vitamin D fortified milk, cereals, egg yolks, saltwater fish, liver, and kale
B. Sunlight for 15 min / day
C. Supplements of calcium and vitamin D
Nursing Diagnosis
A. Risk for trauma
B. Impaired physical mobility
, C. Acute / chronic pain
D. Nutrition, imbalance: less than body requirements
Interventions
A. Admin meds
B. Encourage activity for ADL’s and exercise: walking is effective
C. Assistive devices as applicable
D. Safety measures
E. Encourage weight reduction
F. Vitamin D and calcium supplements
Fibromyalgia
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