Osteoporosis Debilitating disease in which bones become fragile and are more likely to break. It affects more than 28 million Americans, 80% of whom are women. Risk factors: Gender- women are more likely to develop than men due to thinner, lighter bones & the decrease in estrogen production that occurs during menopause. Age- the longer you live, the greater the likelihood of developing.

Osteoporosis Family history-is due part to heredity. Ethnicity-Caucasian & Asian women are at highest risk;African-American & Hispanic women at lower but significant risk. Body size- low body weight (< 127 lbs.) & a small-boned frame place at increased risk. Lifestyle- a diet low in CA, inadequate vitamin D, little or no exercise, current cigarette smoking or excessive use of alcohol are all risk factors.

Osteoporosis Assessment: Assess for backache with pain radiating around trunk Evaluate for skeletal deformities. Assess for pathologic fractures. Evaluate lab finding: 1. Serum CA, phosphorus & alkaline phosphatase are usually normal. 2. Parathyroid hormone may be elevated.

Osteoporosis Diagnostic tests: 1. Routine x-ray when there is 25 to 45% demineralization. 2. Single-photon absorptionmetry identifies degree of bone in wrist. 3. Dual-photon absorptionmetry identifies bone loss at hip or spine

Osteoporosis Nursing Diagnoses: 1. Risk for injury-altered mobility, minimal trauma, falls, advanced age, previous fall. 2. Impaired physical mobility- decreased bone mass, decreased strength, musculoskeletal impairment, pain. 3. Situational low self-esteem- chronic illness,anxiety, loss of usual role, body changes, limitation in mobility, chronic pain, loss of independence.

Osteoporosis Prevention- by age 20, the average woman has acquired 98% of her skeletal mass. Building strong bones during childhood & adolescence can be the best defense against developing osteoporosis. 1. Balanced diet rich in CA & Vitamin D. 2. Weight-bearing exercises 3. A healthy lifestyle with no smoking & limited alcohol intake. 4. Bone density testing & medication when appropriate.

Osteoporosis Prevent fractures: 1. Instruct in safety factors-watch steps, avoid use of scatter rugs. 2. Keep side rails up to prevent falls. 3. Move gently when turning & positioning. 4. Assist with ambulation if unsteady on feet. Provide pain control. Instruct in good use of body mechanics. Provide diet high in protein, vit. D; avoid excessive use of alcohol & coffee.

Osteoporosis Administer medications: 1.Estrogen & progesterone-decrease rate of bone reabsorption at menopause. 2. Calcium& vitamin D-support bone metabolism. Instruct in regular exercise program. 1. ROM exercise 2. Ambulation several times per day.

Osteomalacia (adult rickets) Metabolic bone disorder characterized by inadequate mineralization of bone matrix. Bone mineralization requires adequate calcium & phosphate ions in extracellular fluid. When either of these ions are insufficient because (1) inadequate CA intake or decreased CA absorption from intestines d/t insufficient Vit. D or (2) increased renal losses or decreased intestinal absorption of phosphate the bony matrix is not mineralized & thus unable to sustain weight bearing. Marked deformities of wt. Bearing bone & pathological fractures occur. Can be corrected with treatment.

Osteomalacia Incidence: Health problem in cultures which tend to be deficient in calcium & vitamin D. Almost non existent in the U.S.-many foods are fortified with Vitamin D. Increased incidence in elders, very low birth weight infants, strict vegetarian. Primary Causes in U.S.- Vitamin D deficiency- decreased intake, absorption, impaired renal tubular reabsorption d/t acquired or genetic disorders-most common cause alcohol abuse.

Osteomalacia Assessment: 1. Bone pain- vague & generalized first, becoming more intense with activity as the disease progresses, occurs most frequently in the pelvis, long bones of extremities, spine & ribs. 2. Difficulty changing from lying to sitting position, sitting to standing. 3. Muscle weakness, waddling gait, dorsal kyphosis (severe), pathological fractures.

Osteomalacia Assessment: 1. X-rays- effects of generalized bony demineralization-trabecular bone loss, cyst formation, compression fracture, bowing & bending deformities of the long bones, osteoid defosits (vertebral bodies/pelvis). Looser’s lines or zones-pseudofractures-they represent stress fx. that have not mineralized. They often appear symmetrically in the inner femora, ribs, & inferior pubic rami & may progress to complete fx. with minimal trauma.

Osteomalacia Serum calcium-normal or low depending on cause Serum phosphorus- typically is low may be up –renal failure. Serum parathyroid hormone (PTH)-elevated as a compensatory response to hypocalcemia in client with renal failure or vitamin D deficiency.

Differential Features of Osteoporosis & Osteomalacia Definition Decreased bone mass Demineralized bone Pathophysiology Lack of calcium Lack of Vitamin D Radiographic findings Osteopenia fractures Pseudofractures, looser’s zones, fractures Calcium level Normal Low or normal Phosphate level Parathyroid level High or normal Alkaline phosphatase High

Osteomalacia Pharmacology- Vitamin D therapy-only if not enough with diet- 10ug or 400 IU to 600-800 IU. Fortified milk. Nursing Diagnoses: 1. Alteration in nutrition < body requirements. 2. Risk for injury- evaluate home for hazards. PT consult-assistive devices. 3. Impaired physical mobility-conserve energy,gait devices, get brief exposure to sun.