msk

osteoporosis

• chronic, progressive metabolic bone disease; deterioration of bone tissue & low bone mass

• leads to ⬆ bone fragility

• ⬆ risk for fracture hip, wrist and spine

• causes significant morbidity & mortality

osteoporosis pathophysiology

• bone resorption is greater than bone being deposited → bones become fragile & prone to fractures

osteoporosis

• spontaneous fractures or fractures from minimal trauma

• back pain

• loss of height & kyphosis

osteoporosis risk factors

• diseases: IBD, malabsorption, renal disease, RA, hyperthyroidism, liver cirrhosis, hypogonadism, DM, menopause, hyperparathyroidism

• meds: corticosteroids, anticonvulsants, antacids with aluminum, heparin, certain CA treatments

• low body weight (<60 kg) or major weight loss

• high ETOH use

OP management (nutritional, lifestyle & prevention)

nutritional support:

• adequate calcium intake (1000-12000 mg daily)

• adequate vitamin D production/intake (sun exposure, supplements 400-2000 IU daily)

lifestyle actions:

• weight bearing exercise for 30 mins at least 3x/week

• smoking and ETOH cessation

fracture prevention:

• strength training

• fall prevention

• protective interventions in LTC

OP meds

• hormone replacement therapy

• calcitonin (ex: calcimar)

• bisphosphates (ex: alendronate [fosamax])

• selective estrogen receptor modulators (ex: raloxifene)

• monoclonal antibody (ex: denosumab)

• recombinant human parathyroid hormone (ex: teriparatide)

hip fracture

• fracture of the proximal third of the femur

• 70-90% of hip fracture are d/t OP

• associated with high mortality

• types:

  • instracapsular: capital, subcapital or transcervical

  • extracapsular: intertrochanteric or subtrochanteric

hip fracture clinical manifestations

• severe pain & tenderness near fracture site

• external rotation of the affected leg

• shortening of the affected leg

• muscle spasms

the vast majority of hip fractures are treated _______. best practice is for surgery to happen ______ after the fracture to _________.

surgically, <48 hours, decrease mortality

hip fracture pre-op care

• standard pre-op VS (q4h)

• neurovascular assessments q4h

• pain assessments

• assess for clinical manifestations

• bed rest, keep affected leg stabilized

• analgesics and/or muscle relaxants prn

• foley catheter

• pre-op teaching on DB&C, PT exercises

hip fracture post-op care

• standard post-op VS

• neurovascular assessments

• pain assessment

• assess incision site for bleeding & infection

• monitor I&O until stable

• DB&C q1h when awake

• analgesics prn