ms gayatin part 3 midterm PERCEPTION AND COORDINATION

osteoporosis

is a metabolic imbalance. Think of it as a bank account where withdrawals exceed deposits.

• Osteoblasts (The Builders): Stimulated by Calcitonin. They take calcium from the blood and "lock" it into the bone matrix.

• Osteoclasts (The Crushers): Stimulated by Parathyroid Hormone (PTH). They dissolve bone to release calcium into the bloodstream for vital functions like muscle contraction and nerve signaling.

• Kyphosis (Dowager’s Hump): Resulting from gradual vertebral compression fractures. This can lead to a "stooped" posture and even respiratory compromise in severe cases.

• Colles' Fracture: A specific type of distal radius fracture (wrist) that typically occurs when a patient tries to break a fall with an outstretched hand (FOOSH).

• Loss of Height: Patients may lose 2–3 inches over time due to the compression of the spinal column.

Manifestations to Watch For osteoporosis

1. DEXA Scan (Dual-Energy X-ray Absorptiometry)

This is the Gold Standard. It measures Bone Mineral Density (BMD), usually at the hip or lumbar spine.

• T-Score: Compares the patient's BMD to a healthy 30-year-old.

  • 0 to -1.0: Normal.

  • -1.0 to -2.5: Osteopenia (the "warning" zone).

  • Below -2.5: Osteoporosis.

• Z-Score: Compares the patient to someone of their own age/gender (useful for identifying secondary causes).

Gold Standard osteoporosis

FRAX Tool

• An algorithm that calculates a patient's 10-year probability of a major osteoporotic fracture.

• It combines DEXA results with clinical risk factors (age, smoking, alcohol, steroid use).

• Serum Calcium & Phosphorus: Usually normal in primary osteoporosis but checked to rule out malnutrition.

• Vitamin D (25-hydroxyvitamin D): To check for deficiency.

• Thyroid/Parathyroid Panels: To check for hyperparathyroidism (high PTH).

Laboratory osteoporosis

Bisphosphonates (The Gold Standard)

• Examples: Alendronate (Fosamax), Ibandronate (Boniva), Risedronate (Actonel).

• Mechanism: Inhibits osteoclasts to stop bone resorption.

• Critical Nursing Teaching:

  • Take with a full glass of water.

  • Take on an empty stomach (first thing in the morning).

  • Stay upright for 30–60 minutes to prevent esophageal erosion or severe heartburn.

osteoporosis Medical Management (The Gold Standard)

1. Bisphosphonates (The Gold Standard)

• Examples: Alendronate (Fosamax), Ibandronate (Boniva), Risedronate (Actonel).

• Mechanism: Inhibits osteoclasts to stop bone resorption.

• Critical Nursing Teaching:

  • Take with a full glass of water.

  • Take on an empty stomach (first thing in the morning).

  • Stay upright for 30–60 minutes to prevent esophageal erosion or severe heartburn.

2. Estrogen Agonists (SERMs)

• Example: Raloxifene (Evista).

• Benefit: Provides the bone-saving benefits of estrogen without the increased risk of breast/uterine cancer.

3. RANKL Inhibitors

• Example: Denosumab (Prolia).

• Use: Often an injection given every 6 months for those at high risk of fracture.

osteoporosis Medical Management

Percutaneous Vertebroplasty

Surgical Interventions osteoporosis

Bone cement is injected into the fractured vertebra to stabilize it.

Kyphoplasty

Surgical Interventions osteoporosis

small balloon is inflated first to "re-expand" the height of the bone, then cement is added. This is better for restoring height and reducing the "Dowager’s Hump."

LOW BACK PAIN

is a symptom, not a disease, and has many causes.

• It is generally described as pain between the costal margin and the gluteal folds

• Characterized by an uncomfortable or acute pain in the lumbosacral area associated with severe spasm of the paraspinal muscles, usually with pain radiating to the lower back

trapezius

Low back pain can be felt commonly on the muscle called .

Disc Herniation

Low back pain Structural & Mechanical Causes

The "jelly" inside the intervertebral disc leaks out, pressing on nerves.

Radiculopathy (Sciatica)

Low back pain Structural & Mechanical Causes

Nerve root compression causing pain, tingling, or numbness radiating down the leg.

Spinal Stenosis:

Low back pain Structural & Mechanical Causes

• Narrowing of the spinal canal (common in the elderly), often causing pain that improves when leaning forward (the "shopping cart sign").

Scoliosis

Low back pain Structural & Mechanical Causes

Abnormal lateral curvature causing unequal weight distribution.

Unequal Leg Length

Low back pain Structural & Mechanical Causes

This tilts the pelvis, forcing the lower back muscles to overwork to keep the spine straight.

Condition	Clinical Clue
Abdominal Aortic Aneurysm (AAA)	Severe, "tearing" back pain; may have a pulsating mass in the abdomen. Medical Emergency.
Kidney Disorders	Pain is usually in the flank (Costovertebral Angle) and associated with fever or urinary changes.
Retroperitoneal Tumors	Constant, deep pain that doesn't change with movement or rest.

Non-Musculoskeletal causes of back pain

dextroscoliosis

Scoliosis (curvature to the right)

levoscoliosis

Scoliosis (curvature to the left) –

Test	Best Used For...	Nursing/Clinical Note
X-Ray	Bone only (Fractures, Scoliosis).	Cannot see "slipping" discs or nerves.
MRI	Soft Tissue (Discs, Nerves, Ligaments).	Gold Standard for herniated discs. Check for metal/pacemakers!
CT Scan	Bony detail & Calcifications.	Better for complex fractures or arthritis than X-ray.
Myelography	Nerve root/Spinal cord compression.	Involves injecting contrast into the spinal subarachnoid space.
EMG	Nerve function/damage.	Uses tiny needles to measure muscle electrical activity. Helps distinguish nerve vs. muscle issues.
Bone Scan	High metabolic activity.	Used mostly to find cancer (metastasis) or occult infections.

Diagnostic Imaging lower back pain

Cauda Equina Syndrome:

This occurs when the nerve roots at the base of the spinal cord are severely compressed.

• Signs: "Saddle anesthesia" (numbness where you'd touch a saddle), new bowel or bladder incontinence, and sudden leg weakness.

• Action: Immediate notification of the provider; this requires surgery within hours to prevent permanent paralysis.

NSAIDs (Ibuprofen, Naproxen)

lower back pain medicaton

First-line treatment. They reduce the inflammation that irritates the nerves.

Muscle Relaxants (Cyclobenzaprine)

lower back pain medicaton

used for acute spasms. Nursing Note: These cause significant drowsiness—safety/fall risk!

Anticonvulsants (Gabapentin/Pregabalin):

lower back pain medicaton

Specifically for Radiculopathy (nerve pain). They "quiet down" overactive pain signals from compressed nerves.

Antidepressants (Duloxetine/TCAs):

lower back pain medicaton

• Also used for chronic nerve pain and to help the patient cope with the psychological toll of chronic LBP.

Opioids

lower back pain medicaton

Used strictly for acute, severe pain. We avoid long-term use due to the risk of addiction and constipation.