NURS 308 - Osteoporosis

more common in women because:

- women tend to have lower calcium intake

- women have smaller frames, therefore less bone mass

- bone resorption begins at an earlier age in women and becomes more rapid at menopause

- pregnancy and breastfeeding depletes a woman’s reserves

- longevity increases the likelihood of osteoporosis, and women tend to live longer than men

is osteoporosis more common in men or women? why?

adequate dietary calcium intake

the body stops building bone at around 30 years of life, and we must maintain the bone mass that we have for the rest of our life. how can we maintain our bone mass?

bone remodeling

the process of bone being continuously deposited by osteoblasts and resorbed by osteoclasts in the body

bone deposition

the formation of new bone by osteoblasts

bone resorption

the breakdown of bone by osteoclasts

bone loss

when osteoclast activity exceeds osteoblast activity, _____ results

age ≥ 65 - women - ↓ body weight - white or asian - smoking - sedentary lifestyle - postmenopausal - family hx - diet ↓ in Ca or vitamin D - excess alcohol - ↓ testosterone - long-term use of corticosteroids, thyroid replacement hormone, heparin, long-acting sedatives, or anti-seizure medications

risk factors of osteoporosis:

low body weight: bone is built by stress being placed on bones. the less a person weights, the less stress the bones get through normal everyday activity

is osteoporosis more common in patients with higher or lower body weight? why?

women in menopause have an estrogen deficiency. estrogen contributes to osteoblast activity, therefore bone is not being built as much with an estrogen deficiency

*testosterone also contributes to osteoblast activity, therefore bone is not being built as much with a testosterone deficiency

why is osteoporosis more common in post-menopausal women?

corticosteroids

thyroid replacement hormone

heparin

long-acting sedatives

anti-seizure medications

what types of medications can lead to osteoporosis?

spine

hips

wrists

osteoporosis occurs most commonly in the bones of the:

back pain and spontaneous fractures

common early manifestations of osteoporosis:

back pain

spontaneous fractures

loss of height

dowager's hump or kyphosis

clinical manifestations of osteoporosis:

bone mineral density test: dual-energy x-ray absorptiometry (DXA)

the gold standard for diagnosis of osteoporosis

age ≥ 65 or younger if high risk

*high risk example: woman has a complete hysterectomy and goes into surgical menopause at 30 years old

when should patients begin bone density testing?

milk

cheese

almonds

icecream

seafood

yogurt

patients should eat foods high in calcium for prevention of osteoporosis. what are some examples of foods high in calcium?

calcium and vitamin D

*nurses cannot recommend a calcium or vitamin D supplement to a patient; but, we can recommend that they talk to their provider about whether they should take a supplement

most patients who are at risk for or have osteoporosis will have prescribed _____ supplements

vertebroplasty, kyphoplasty

procedures to repair spinal fractures usually occurring as a result of osteoporosis: a catheter is inserted into the spinal column to inject a foam-type substance that gets in between the vertebrae and shapes them back into anatomical alignment, providing support for the patient

bisphosphonates (weekly tablet)

the most common drug given for osteoporosis

must be given on an empty stomach with a full glass of water, and the patient must remain in an upright position for 30 minutes after taking the pill - no food, drink, or any other medications can be taken for 1 hour before to 1 hour after administration

*bisphosphonates can cause erosion in the esophagus

how should bisphosphonates be administered for a patient with osteoporosis?

raloxifene (daily tablet)

medication taken for osteoporosis that changes the effects of estrogen on bone to maintain or build the bone (has an estrogen-antagonistic effect on bone receptors); however, also blocks the effects of estrogen on other organs, like the ovaries, so the patient still has menopause-like symptoms (e.g., hot flashes), and increases their risk for thrombosis formation

non-opioid: do not manage osteoporosis pain with opioids because this is a chronic, long-term disease

should osteoporosis pain be managed with opioids or non-opioids?

weight-bearing and low impact

what type of exercise plan should a patient with osteoporosis have?

remain ambulatory, promote safety

what is the main focus for a patient with osteoporosis?

prioritize prevention of falls and injury: put on non-slip socks, get them a walking aid, order a PT consult, etc.

how does a patient's history of osteoporosis affect your plan of care as a nurse?

ask your provider about taking calcium supplements, but you should increase your dietary intake of calcium

your patient with osteoporosis asks if they should be taking a calcium supplement. how will you respond?