Osteoporosis has been called “silent disease” because bone mass is lost over many years with no sings or symptoms.

1. Osteoporosis
Doneby:
Hani abu dieh

2. OUTLINE
 Definition.
 Pathophysiology.
 Risk factor.
 Causes.
 Signs and symptoms.
 Diagnostic procedure.
 Prevention and medical management.
 Nursing process.

3. What is it?
• metabolic skeletal disease characterized by
low bone density and microarchitectural
deterioration of bone tissue which results in
increased bone fragility and susceptibility to
fracture.
• The vertebrae ,wrists ,and hips are
the most common sites of fractures.

5. Pathophysiology
•Result of prolonged imbalance of Bone Remodeling;
- Bone remodeling occurs throughout an individual’s lifetime.
- In normal adults, the activity of osteoclasts (bone resorption) is
balanced by that of osteoblasts (bone formation).
- normal bone remodeling in the adult result in gradually increase
bone mass until the early 30s.
* with ageing the peak bone mass is gradually decrease and
1.Calicitonin which inhibit bone resorption and promote
bone formation. (decrease)
2.Estrogen which inhibit bone breakdown. (decrease)
3.PTH increase bone turnover and resorption. (increase)

6. Puberty
Peak Bone Mass
Menopause
Old age
0 40 50 60 7020 3010
Age in years
Bone Mineral Density
Bone Remodeling

7. Risk Factors
-female more than male.
-increase age.
-inadequate intake of calcium and vit D.
-estrogen deficiency or menopause.
-family history.
- Lack of physical activity .
-Smoking , alcohol consumbtion
-medication. (corticosteroids, antiseizure )
- low weight and body mass index.
-caucasian, asian.

8. 8
Causes of Osteoporosis:
(A) Idiopathic age-related osteoporosis (most
common):
(1) Young adults
(2) Postmenopausal (type I)
(3) Senile (type II)

9. 9
(B) Osteoporosis secondary to disease states:
1. Metabolic conditions
e.g calc. deficiency, vit. D deficiency, malnutrition, scurvy.
2. Endocrine conditions
e.g, Hyperparathyroidism.
3. Renal disease.
4. Gastrointestinal-liver disease.
5.Bone marrow infiltration
e.g, leukemia.

10. 10
7. Drugs
e.g Phenobarbital, Thyroid hormones, Corticosteroid.
8. Life style
e.g Nutnition, alcohol, smoking, inactivity,
immobilization, excessive caffeine
9. Miscellaneous
e.g Rh. arthritis ..

11. Signs and symptoms
• Osteoporosis has been called “silent disease”
because bone mass is lost over many years
with no sings or symptoms.
•CM:
1.Loss of height.
2.Back pain.
3. vertebrae collapse. (dowager’s hump)

13. Diagnosing Osteoporosis
1.x-ray studies: determine bone density.
2. radiographic: bone mass. (osteopenia).
3.ultrasonography:determine bone density.
4. Dual-energy x-ray absorptiometry (DEXA) is
the preferred modality for measuring bone
mineral density (BMD).

14. Prevention and medical managment
• The main goal of treatment
is to prevent development
of osteoporosis and to
stabilize remaining bone
mass.

15. (1) A calc. rich diet esp. in childhood.
• adolescents may need 1200mg and postmenopausal women
may need 1500mg daily.
• Milk, cheese and yogurt are rich in calcium.
• Elderly should be advised to take 400-800 units of Vit. D daily
Comes (from 2 sources : the sun and Fortified dairy products, egg yolks, saltwater fish, and liver)
(2) Never Smoking

16. (3) Exercise
• Exercising regularly in childhood and adolescence can
ensure that you will reach peak bone density.
(4) Alcohol , caffeine intake should be avoided.
(5) Women with low body w.t (those with eating
disorders) should receive appropriate evaluation, Rx
and dietary counseling.

17. DRUG THERAPY
1.calcitonin: a synthetic thyroid hormone usually prescribe
as a daily nasal spray to reduce factors that cause loss of
calcium and increase reabsorption of calcium in the
gastrointestinal tract.
2. Selective Estrogen Receptor Modulators.
3. Hormone Replacement Therapy: to increase serum
estrogen levels, which in turn decrease the rate of bone resorption.

18. Nursing process
assessment
• Profile: Age & gender
• Risk factor
• Secondary causes
• Symptoms related
• Past medical Hx
• Family Hx
• Social Hx
History:

19. 19
Physical Exam:
• General:
- decreasing height greater > 1.5inches
- dorsal kyphosis
- exaggerated cervical lordoisis
- low body weight.
• Assessed for:
- localized pain
- muscle spasm
- neurologic deficit (risk of spinal cord compression)
- loss of strength
- range of motion in the affected area
• Fractures most commonly occur in the vertebral bodies,
wrist, humerus, hip. rib and pelvis (in that order).

20. Nursing diagnosis:
• acute pain
• Impaired physical mobility
• self-care deficit (Dressing or grooming)
• Imbalanced nutrition: Less than body
requirements
• Risk for impaired skin integrity
• Risk for injury
• Risk for constipation RT immobility
• Deficient knowledge about the
osteoporosic process and treatment
regimen.

21. Goals:
-relieving pain
-improve self-care.
-improve nutritional status.
-improve physical mobility.
-prevent injury. (no new fracture)
-improving bowel elimination.
-promoting understanding of osteoporosis and
the treatment regimen.

22. Intervention
-consumes adequate dietary calcium and vit D.
-encourage to increase level of exercise.
-modify lifestyle choices: avoid smoking, alcohol,
carbonated beverages.
-maintain optimal body wt.
-creates safe home environment.
-adheres to prescribe screening and monitoring
prcedures.
-take prescribed medication as instruction.

23. Reference:
• Brunner & suddarth’s Textbook of medical-
surgical nursing.11th edition.
• Web site:
-www.nursing4all.com
-www.nursingcaste.com

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