osteomalacia osteoporosis

OSTEOPOROSIS

METABOLIC

BONE DISEA

SE

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OSTEOPOROSISCharacterized by low bone mass and structural

deterioration

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Normal homeostatic bone remodeling is altered – the rate of bone resorption is greater than the rate of bone formation.

OSTEOPOROSISChronic, progressive metabolic bone disease characterized by

Porous bone ___ ____ ____ Structural deterioration of bone tissue Increased bone fragility

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OSTEOPOROSIS

Eight times more common in women than men for several reasons

1. Lower calcium intake than men2. Less bone mass because of smaller frame3. Bone resorption begins earlier and

accelerates after menopause4. Pregnancy and breastfeeding deplete

woman’s skeletal reserve of calcium5. Longevity increases likelihood of

osteoporosis; women live longer than men

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ETIOLOGY

Risk factors (non-modifiable) Female gender Increasing age Family history White or Asian ethnicity Small stature Early menopause

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ETIOLOGY

Risk factors (cont’d) Excess alcohol intake Cigarette smoking Anorexia Oophorectomy Sedentary lifestyle Insufficient calcium intake Low testosterone levels (hypogonadism in men)

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ETIOLOGY AND PATHOPHYSIOLOGYPeak bone mass is achieved before age 20

Bone loss after midlife is inevitable but rate of loss is variable Bone resorption exceeds bone deposition Bones become weakened and prone to fracture, loss of height, and kyphosis.

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ETIOLOGY AND PATHOPHYSIOLOGY

Diseases associated with osteoporosisIntestinal malabsorptionKidney diseaseRheumatoid arthritisHyperthyroidismChronic alcoholismCirrhosis of the liverHypergonadismDiabetes mellitus

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OSTEOPOROSISDIAGNOSTIC STUDIES

Clinical Manifestations Known as silent disease

Diagnosis Bone Mineral Density (BMD) Dual-energy x-ray absorptiometry (DEXA) History and physical Quantitative ultrasound

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OSTEOPOROSIS

Can the disease be prevented?

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TREATMENT AND NURSING CAREDiet Therapy

Weight bearing Exercises

Decrease Risk Factors Quit smoking and decrease consumption of alcohol

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DRUG TREATMENT OF OSTEOPOROSISEstrogen Replacement Therapy

Calcium & Vitamin D supplementsCalcitoninBiphosphonates (Fosamax, Didronel, Actonel, Boniva, Aredia, Bonefos, Skelid)Selective Estrogen receptor modulator – EvistaTeriparatide (Forteo)

Portion of parathyroid hormoneFirst drug to stimulate new bone formation

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MEDICATIONS USED IN TREATMENT OF OSTEOPOROSISHormone Replacement Therapy – Estrogen Controversy over use. Should discuss with health care

provider

CalciumThere are a variety of calcium supplements available (See Table 64-16, p. 1689).

They should be taken with _______ _ to aid in absorption. Also if taking large doses i.e. 1000 mg. / day – take in divided doses of 500mg BID for better absorption

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MEDICATIONS USED IN TREATMENT OF OSTEOPOROSISCalcitonin

If calcitonin inhibits bone resorption by opposing the effects of parathyroid hormone, how does that affect serum calcium levels?

What is needed to counter that effect?

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MEDICATIONS USED IN TREATMENT OF OSTEOPOROSISBisphosphenates – (Fosamax) Inhibit osteoclast-mediated bone resorption thereby

increasing BMD and total bone mass. Side effects – anorexia, weight loss, gastritis Patient Teaching

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MEDICATIONS USED IN TREATMENT OF OSTEOPOROSISSelective Estrogen Receptor

Modulators Mimic effect of estrogen on bone by reducing bone resorption without

stimulating the breasts or uterus.

Side effects

Leg crampsHot flashes

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OSTEOMALA

CIAMETA

BOLIC BONE D

ISEASE

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OSTEOMALACIADecalcification and softening of the bone

Caused mainly by: vitamin D deficiency **Vitamin D is required for the absorption of calcium from the intestine and calcium is responsible for mineralization of bone

Etiology Lack of exposure to __________ ____ GI malabsorption, extensive burns, chronic diarrhea, pregnancy, drugs such as Dilantin.

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OSTEOMALACIA SIGNS & SYMPTOMS

Most Common ____ ____ Difficulty rising from a chair Difficulty walking

Additional Signs and Symptoms Low back pain, muscle weakness Weight loss, progressive deformities

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DIAGNOSISBlood work

Decreased serum calcium or phosphorus Decreased serum 25-hydroxyvitamin D Elevated alkaline phosphatase

X-Rays Show loose’rs transformation zone – ribbons of decalcification in bone

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OSTEOMALACIATREATMENT AND NURSING CAREDrug Therapy

Diet Therapy Milk, yogurt, cheese Dark green leafy vegetables, okra, broccoli Fish and seafood Almonds

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PAGET

’S

DISEASE

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PAGET’S DISEASEExcessive bone resorption followed by replacement of normal marrow by vascular, fibrous connective tissue. The new bone is ______, ____________,

___ ______Most often affect the pelvis, long bones, spine,ribs, sternum, and cranium

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CLINICAL MANIFESTATIONSIn milder form, noneCommon early symptom--FatigueWaddling gaitLoss of heightIncreased head size

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COMPLICATIONS

Pathological fractures (may be a first sign of disease)

Bone tumors

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PAGET’S DISEASEDiagnosis

Elevated serum alkaline phosphatase

X-ray will show increase in bone size

Bone scan shows increased uptake in affected bones

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DRUG TREATMENT FOR PAGET’SDrug Therapy

Calcitonin-salmon (Miacalcin)Bone is in a constant state of remodeling, whereby old bone is removed by osteoclasts, and new bone is laid down by osteoblasts. Calcitonin inhibits bone removal by osteoclasts, and promotes bone formation by osteoblasts.

NSAIDSBisphosphonates

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PAGET’S DISEASE

Other treatments and Nursing Care

Back support by firm mattress Teaching about use of splints or braces to support bones and joints

and help prevent weakened bones - skin care, circulation, etc. Teach how to correctly use canes or walkers Physical therapy Diet high in…what?

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