Med-Surg: Osteoporosis and Osteomyelitis

What is osteoporosis? 

Low bone mass and deterioration of bone tissue 

• Fragile bone 

• Have an increased risk for fractures, vertebral deformity, hip fracture, Colle’s fracture 

What are some physical deformities of osteoporosis that one may experience?

• Dowager’s hump (kyphosis)

• Loss of height

• Back pain

Some risk factors for osteoporosis?

• Women: over the age of 65, low body weight, smoking and vitamin D deficiency, alcohol

• Medications: long term steroids, thyroid, heparin, anti-seizure

• Diseases: IBD, malabsorption, kidney diease, RA, cirrhosis, diabetes

Why is bone loss a major thing with osteoporosis? 

The breakdown is greater than the build up 

Clinical manifestations for osteoporosis?

• The spine ,hips and wrist are impacted

• Back pain and spontaneous fractures

• Vertebral fractures (loss of height and kyphosis)

How do you diagnose osteoporosis?

• Annual height measurement 

• Bone Mineral Density (GMD) measurements (grams of mineral per unit volume) 

Based on the t-score test what is a normal bone density? 

-1 to +2

Based on the t-score test what is considered osteopenia or low bone mass? 

-1 to -2.5

Based on the t-score test what is considered osteoporosis? 

-2.5 to -4

What is the z-score compared too?

Same age, gender and ethnic group

What is examined in a quantitative ultrasound (QUS)? 

Heel, kneecap and skin 

Management of care for osteoporosis?

• Proper nutrition 

• Weight loss and muscle strength 

• Weight bearing exercise

• Avoid smoking cessation and excessive alcohol intake 

• Medications  

Proper nutrition for osteoporosis?

Calcium and vitamin D

Why is weight loss and muscle strength important for care? 

Reduce falls and fractures 

Types of weight bearing activities?

Walking, hiking, stair climbing

Types of medication to take?

• Calcium (1200 mg /day via diet and supplement)
- Milk, yogurt, cottage cheese, sardines, spinach
- Supplements in divided doses with meals
• Vitamin D (800 to 1000 mg/day), 20 minutes of
sunlight/day
• Bisphosphonates (Fosamax, Boniva)
• Calcitonin (nasal spray, SQ), estrogen,
parathyroid hormone

What is osteomyelitis?

Infection of bone, bone marrow and surround soft tissue

What is the most common infection? 

Staphylococcus aureus

Which infection of osteomyelitis do children experience? 

Hematogenous (endogenous)

• Spread via bloodstream from another part of the body 

What infection of osteomyelitis do adults experience? 

Nonhematogenous (exogenous)

• From open fracture/trauma to bone 

• Implanted surgical devices

• Puncture wound 

Clinical manifestations for acute (less than a month) osteomyelitis? 

Constant pain (worsens with
activity, unrelieved by rest),
swelling, tenderness, warmth,
restricted movement, fever, night
sweats, chills, nausea, malaise

Clinical manifestations for chronic (greater than a month) osteomyelitis?

Bone pain, swelling, warmth, granulation → avascular scar tissue

What complication can arise from osteomyelitis?

• Septicemia

• Septic arthritis

• Pathologic fractures 

• Amyloidosis 

What is the gold standard diagnosis?

Bone and soft tissue biopsy

What blood cultures and tests can be done?

Look for

• Increase in WBC count 

• Increase in erythrocyte sedimentation rate (ESR)

• Increase in C-reactive protein (CRP)

All of these will be increased in the first 7 days 

When should you make sure to get an x-ray by before it becomes inconclusive? 

Before the 2 week mark because after that it becomes not detectable

What does a CT and MRI show us?

A CT shows the extent of infection and an MRI shows any bone marrow edema 

Interprofessional Care for how to care for osteomyelitis?

• Prolonged antibiotic therapy (before bone ischemia)

• Chronic infection 

• Remove prothesis 

• Muscle flaps/ skin grafts/ bone grafts

• Amputation 

What do you want to do for prolonged antibiotic therapy (before bone ischemia)?

• Cultures / biopsy before antibiotics started
• Broad spectrum until culture results are available
• IV ABX infusions (CVAD) for 4-6 weeks
- Oxacillin, nafcillin, clindamycin, vancomycin, ceftriaxone, ciprofloxacin, linezolid

How should a nurse treat a chronic infection?

• Debridement & wound vac
• Ciprofloxacin (PO) 6-8 weeks after IV ABX is completed
• Implanted antibiotic beads
• Hyperbaric O2 → new blood growth & healing

What nursing interventions can be done to help treat this?

• Administer IV antibioics

• Splint/Traction

• Administer analgesics

• Administer muscle relaxants

• Handle limb gently/carefully

• Have contact precautions

• Thermal therapy

• ROM to joints above and below the site

• Assistive devices for safety

• Nutritional support 

• Home health for home infusion antibiotic therapy 

• Bedrest 

What should we do when administering IV antibiotics?

• Teach pt about adverse effects 

• Monitor the peak and trough levels 

What should the nurse do when a pt has a splint or traction on? 

Do a neurovascular exam- check for proper blood flow and perfusion 

Why is it important to administer analgesics?

To preserve function

Why do we want to administer muscle relaxants? 

To treat muscle spasms 

How does thermal therapy benefit the patient?

Treats the pain and improves function

Why is it important to make sure to do ROM to joints above and below the site? 

To prevent contractures 

What is involved with nutritional support and diet?

• High protein diet

• Vitamin C, zinc. iron, thiamine, folic acid, multivitamin

Why is bedrest important?

• Maintain alignment

• Prevent flexion contractures