Osteoporosis_Osteoarthrititis_ DJD (holistics)

what is Osteoporosis?

-Loss of bone mass

- Increased bone fragility

-Increased risk of fracture

( a Metabolic skeletal bone disorder)

what is the sequence of the disease process during Osteoporosis?

bone remodeling --> bone loss --> bone replacement--> reduced bone mineral density.

what population will have a bone fracture due to osteoporosis?

half of all women and men over the age of 50.

when bone resorption outpaces bone replacement... what can happen ?

bone loss and osteoporosis occur

Bone remodeling is affected by:

-Vitamin D

-Calcium levels

- Stress on bones caused by gravity and muscle action

-Tobacco smoking

-Alcohol consumption

-Hormones ( low in estrogen and Testosterone)

what is Cathepsin K ?

a product of osteoclasts that causes a breakdown of bone

what are the types of Osteoporosis (primary) ?

Primary:

type 1: associated with menopause

-linked to estrogen deficiency resulting in increased calcium reabsorption from bone

Type 2 - associated with decrease in bone formation that accompanies the aging process

- results from kidneys losing ability to process vitamin D--> decreased Calcium absorption

what is the "secondary" causes of Osteoporosis?

Result of disease process, deficiency, or effect of drug i.e. hyperparathyroidism

what are the Unmodifiable risk factors of Osteoporosis?

-Family history

-Age and sex

-Ethnicity

-Previous fractures

-Menopause

-Hysterectomy

- Other chronic disease

what are Modifiable risk factors ?

-poor nutrition

-Body weight

-Substance abuse

-Smoking

-Sedentary lifestyle

what are the common Clinical Manifestations of osteoporosis ?

Fractures, back pain, loss of height, stooped posture

what are the " fragility fracture" associated with osteoporosis

-common early manifestation

- Wrist, hip, and vertebrae

what can vertebral fracture cause ?

-Loss of height, back pain, functional limitations, spinal deformity

Causes dorsal kyphosis and cervical lordosis

what can hip fractures cause ?

Pain in the hip or groin, local swelling, bruising

what are the Diagnostic testing for osteoporosis?

DEXA and FRAX -->(fracture risk assessment tool)

what are management methods for Activity for osteoporosis?

Physical therapy & occupational therapy

what are the dietary methods for osteoporosis ?

-Healthy diet rich in calcium and vitamin D

- Limit intake of foods that affect bone strength like Caffeine and alcohol

what are Pharmacologic therapy methods?

Antiresorptive treatment

-Bisphosphonates, RANKL inhibitors, selective estrogen receptor modulators (SERMs)

- Anabolic tx

- Calcium and vitamin D supplements

- Calcitonin hormones

to block action of PTH

- Estrogen derivative drugs

-Parathyroid hormone analogs

what are the lifespan considerations in children ? ( think chronic issues )

-Diagnosed with spina bifida or cerebral palsy

- Those with Turner syndrome, growth hormone deficiency, osteogenesis imperfecta, juvenile rheumatoid arthritis, diabetes

what are the lifespan considerations in children ? ( think immobilization issues )

by casting or bracing

what are the lifespan considerations in children ? ( think sport issues )

-children who are very lean

-Adolescent female athletes at risk for female athlete triad -->

( Low bone mass• Disordered eating• Amenorrhea)

lifespan considerations for pregnancy: what factors can cause lost of bone mass ?

-fetus draws calcium from the mother's bone (only if the mother's diet is deficient in calcium)

- breastfeeding

lifespan considerations for pregnancy: "If a pregnant women has lost of bone mass, she will continue the same symptoms after pregnancy ? "

True or false ?

False. usually restored after few months

Lifespan considerations in older adults: cause an increase risk of ____?

fracture

what are other symptoms of old age that increase the risk of fractures ?

-Visual impairment

-Loss of balance

-Neuromuscular dysfunction

-Dementia

-Immobilization

-Use of sleeping pills

what are Prevention strategies of osteoporsis ?

-Adequate nutrition

-Weight-bearing and muscle-strengthening exercises

-Lifestyle modification: no smoking, weight reduction

- Medication and Supplements: bisphosphonate, hormone replacement

therapy, Calcium and vitamin K supplements

Fall and injury prevention

what is Degenerative Joint Disease (JDJ)

gradual deterioration of cartilage in the joints leading to pain, stiffness and reduced joint function

what is the most common form of arthritis?

Osteoarthritis

what happens to the joints in Osteoarthritis?

-Develops as wear, tear breaks down cartilage in joint

-Causes bone to rub on bone

OA the most common cause of disability for older adults? Y/N?

Yes

what does cartilage do for the joints ?

allows them to glide over each other without friction

Absorbs shock from physical movement

As a person ages, cartilage starts to break down, becomes rough, wears away.... what can happen ?

allows bone to rub on bone

what bones are usually effected by OA?

-Weight-bearing joints of hips, knees

-Digits of hand, big toe

-Cervical and lumbar spine

Does OA have an actually cause?

No. Believed to be caused by mechanical, molecular factors

what does the term "Localized OA" mean

effecting 1 or 2 joints

what does the term " Generalized OA" mean

effecting greater than or equal to 3 joints

what is the Secondary cause of OA ?

-Caused by underlying condition

-Injury

-Congenital malformation

-Metabolic, endocrine, or neuropathic disease

What are the risk factors for OA?

older age, sex, obesity, certain medical conditions, Fx

60% of people with OA are _____

women

where is OA typically seen in males?

hips, knees, and spine

where is OA typically seen in Females?

hipes, knees, hands

what are the specific medical conditions for OA ?

-Malformed joints or defective cartilage

-Diabetes, hypothyroid, gout, Paget disease

-Joint injuries from sports, accidents, repetitive use.

individuals with family member who has OA have higher risk of developing OA?

True or false?

true

what are prevention methods for OA?

-Maintain ideal body weight

-Participate regularly in moderate exercise program

-Inactivity and excessive exercise -->premature degeneration of cartilage

-Use good posture, proper body mechanics

-Avoid repetitive stress on joints

what are the clinical manifestations for OA?

-joint pain

-pain, stiffness

-Tenderness to touch

-Swelling related to excess fluid in joint

-Crepitus of joint

-Bone spurs

-Decreased range of motion (ROM)

-unsteady gait

-decrease ability to perform ADL = depression

what are the OA required for interprofessional care from:

-primary care provider

- Rheumatologist

-Physical therapist (PT) and occupational therapist(OT)

-Orthopedics

is there any cures for OA?

No

what are the Diagnostic test ?

x-ray, MRI, Ultrasounds, joint fluid analysis

- blood test to rule out other causes

Surgical Management: what is the term "Arthroscopy"

remove of Debridement

what is Joint resurfacing ?

Small amount of bone removed, metal replacement is fitted over end of bone• Often used instead of total joint replacement in younger patients

what is joint irrigation ?

fluid injected in joint• May be combined with arthroscopy

what is osteotomy ?

-Surgical removal of wedge of bone above or below joint

-To realign affected joint

-To shift weight away from damaged part of joint

what is joint fusion (arthrodesis) ?

Permanent fusion of two or more bones at a joint using pins, plates, screws, rods.

-owth at site• Used for badly damaged smaller joints in spine, wrist, ankle, fingers, toes

what is Arthroplasty?

Total joint replacement• Damaged joint is removed with plastic, metal, or ceramic

older adults are best candidates for artificial joints bc....

they usually last for 15-20 years

what are complications of Arthroplasty?

infection, blood clots, long-term breakdown of artificial joint

what are pharmacological managements for OA ?

Acetaminophen ( first line of defense)

NSAIDs

Opioids ( if severe )

Topical creams

Corticosteroid injections

what are Nonpharmacological management methods ?

Use of assistive technology• Weight reduction• Adequate rest• Sleep• Resting of joint• Education about the disease• Exercise• Coping techniques

what are lifespan considerations for Children & adolescents?

Juvenile OA• Secondary to a congenital abnormality, genetic condition, or joint injury• Typically occurs in only one or two joints• May be outgrown as child ages

Children with joint abnormalities who do not develop OA in childhood are at increased risk for OA later in life? True or false

true

lifespan considerations in pregnant women?

increased weight of pregnancy --> increases OA-related pain.

In older adults what should you administer ?

Acetaminophen: first-line medication

Narcotics safer than NSAID

what are the nursing inventions focus on:

-Reducing pain

-Maintaining mobility and function

-Helping patient learn to use assistive devices

-Preoperative, postoperative care

- Encouraging overweight or obese patient to begin weight-loss program