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Medical and Nursing management of patients with osteoporosis
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- 2. OSTEOPOROSIS; By Nighat Gowhar (Faculty Islamic University Of science and technology Awantipora)
- 3. Introduction Bone mineral densityis defined as the amount of mineral per square centimeter of bones. One way to assess the quality of bone is to assess the microarchitecture of bone which is related to the mechanical strength of the bone and hence its greater or lesser risk of fracture. Bone loss is accompanied by deterioration of the bone microarchitecture resulted in decreased no of trabeculae , intertrabecular distances and loss of connective tissue of the trabecular meshwork. Resulting in formation of porous bone
- 4. KEY TERMS: Calcaneus: Is a bone of the tarsus of the foot which constitute the heel Osteopenia: is also called preosteoporosis, is a bone loss not as severe as osteoporosis. Ulnar styloid: Is a process of ulna found at the distal end of the forearm.
- 5. Hip protectors:Pads located over the trochanters(Bony extrusions of the hip region Bisphosphonates: Class of drugs used to treat osteoporosis Corsets: Is a garment worn to hold the torso into a desired shape for aesthetic and medical purposes.
- 6. Definition Osteoporosis ("porousbones", from Greek: ostoun meaning "bone" and /poros meaning "pore") is a progressive bone disease that is characterized by a decrease in bone mass and density which can lead to an increased risk of fracture. Osteoporosis is defined by the World Health Organization (WHO) as a bone mineral density of 2.5 standard deviations or more below the mean peak bone mass (average of young, healthy adults) as measured by dual-energy X-ray absorptiometry;
- 8. Classification : . Primary type1 osteoporosis: Primary type 2 osteoporosis; Secondary osteoporosis:
- 9. Primary type1osteoporosis:The form of osteoporosis most common in women after menopause is referred to as primary type.
- 10. Primary type2 osteoporosis; occurs after age 75 and is seen in both females and males at a ratio of 2:1.
- 11. Secondary osteoporosis:may arise at any age and affect men and women equally; this form results from chronic predisposing medical problems or disease, or prolonged use of medications such as gluco-corticoids,.
- 12. ETIOLOGY ANDRISK FACTORS: .
- 13. No modifiablerisk factors Age and gender: Race: Heredity: Build Early onset of menopause
- 14. Potentially modifiable Excessconsumption of alcohol: Vitamin D deficiency Prolonged immobilization Tobacco smoking. Malnutrition: Medication
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- 20. . Conventionalradiography Conventional radiography is useful, both by itself and in conjunction with CT or MRI, for detecting complications of osteopenia (reduced bone mass; preosteoporosis), such as fractures;
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- 22. Dual-energy X-ray: Dual-energy X-ray absorptiometry (DEXA) is considered the gold standard for the diagnosis of osteoporosis. Osteoporosis is diagnosed when the bone mineral density is less than or equal to 2.5 standard deviations below that of a young (30–40-year-old, healthy adult women reference population
- 23. Calcaneal ultrasonography Usuallytests calcaneus only Reflects other aspects of bone quality More portable test No radiation
- 24. Quantitative CT: ◦Usually tests spine and hip ◦ High radiation
- 25. Lab tests ◦phosphate, ESR, TSH/T4 ◦ Testosterone/ Estrogen ◦ 24 hour urine for calcium and creatinine ◦ ◦ 25-OH Vit. D ◦ Intact PTH ◦ ◦
- 26. Prevention: Exercise:- Weight bearing exercises such as walking, running is necessary for maintaining bone mass because disuse results in bone loss. In addition to maintaining bone mass by loading the bones, exercise leads to improved muscle fitness, which is associated with improved muscle strength, stability, reaction time, balance and coordination. Fall prevention can help prevent osteoporosis complications. At least 30 minutes of any physical activity should be incorporated into daily schedules.
- 27. Avoid Alcohol andtobacco:- As tobacco smoking and high alcohol intake have been linked with osteoporosis, Smoking cessation and moderation of alcohol intake are commonly recommended as ways to help prevent it. If a women quits smoking she reduces her risk of hip fractures by 40 %. Excessive alcohol intake reduces bone density and increases the risk of falls. Modern alcohol intake has no negative effects on BMD.
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- 29. Pharmaceutical preventionand treatment of osteoporosis :- Bisphosphonates risedronate or etidronate Alendronate Teriparatide strontium ranelate Hormone replacement therapy, Raloxifene Denosumab. Calcitonin
- 30. Non pharmaceuticalprevention of osteoporosis:- Hip protectors : These undergarments have protective shields or pads sewn into the area over the greater trochanter on each side.
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- 32. Promoting healingafter fracture:- The goals of treatment after fracture are to manage pain, regarding mobility and strength, promote healing, reduce bone loss and prevent further fracture. Furthermore, treatment is directed towards limiting the disability associated with existing fractures
- 33. Managing pain:- . Non opioid analgesics may be needed for 1 to 2 weeks to aid in pain reduction. If NSAIDs are used, protect the client from gastric ulceration by administering medications with foods or antiacids.
- 34. Flexible corsets with adjustable self- fastening tape may help to relieve back pain and fatigue, however these corsets cannot correct the underlying problem of bone loss and spinal deformity.
- 35. Physical therapy: is of utmost importance in the long term treatment of back pain. Often chronic back pain is associated with decreased range of motion, weakness, muscle spasm, postural change, muscle tenderness and decreased endurance. Physical therapy should be started during the period of bed rest with range of motion exercises and mild resistive exercises of the extremities in bed.
- 36. Regaining mobilityand strength:- After acute pain subsides, the clients should carry out exercises specifically prescribed for them, such as stretching and strengthening. A long term physical activity programme should include weight bearing and aerobic exercises in addition to strengthening and flexibility exercises.
- 37. Nursing managementof osteoporosis: Assessment: Health promotion, identification of people at risk for osteoporosis and recognition of problems associated with osteoporosis form the basis for nursing intervention. .
- 38. Nursing diagnosis: : Deficient knowledge about the osteoporotic process and treatment regimen. Acute pain related to fracture and muscle spasm. Risk for constipation related to immobility or development of ileus. Risk for injury : additional fractures related to osteoporosis.
- 39. Planning andgoals The major goal for the patient may include: knowledge about osteoporosis and treatment regimen relief of pain, improved bowl elimination and absence of additional fractures
- 40. Nursing interventions: Promoting understanding of osteoporosis and treatment regimen: Patient teaching focuses on factors influencing the development of osteoporosis, interventions to arrest or slow the process and measures to relieve symptoms.
- 41. Relieving pain: Relief of back pain resulting from compression fracture may be accomplished by resting in bed in supine or side lying position several times a day. . The nurse encourages good posture and teaches body mechanics. When the patient is assisted out of the bed, a lumbosacral corset may be worn for temporary support and immobilization, although such a device is frequently uncomfortable and is poorly tolerate. Improving bowl elimination: Constipation is a problem related to immobility and medications. Early institution of high-fiber diet, increased fluids and use of stool softeners helps to prevent and minimize constipation.
- 42. Preventing injury: Physical activity is essential to strength muscles, improve balance, prevent disuse atrophy and retard progressive bone demineralization.
- 43. Promoting homeand community based care: Teaching the patient self-care: . The nurse encourages the patient to participate actively in personal care and to use assistive devices safely. The nurse must assist the patient in identifying areas of self-care deficit and in developing the strategies to achieve independence in activities of daily living. The patient’s participation in planning and accomplishing activities of daily living is an important of aspect of self- care.
- 44. Conclusion Socreating awareness regarding osteoporosis is important because there many risk factors associated with osteoporosis which can be modified so as to prevent occurance of osteoporosis.
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