Osteoporosis

What is it?
What are results of having it?
What can be done about it?

Mary J. Aigner, RN, MSN, FNPC

 What is it?
 Osteoporosis means “porous bone”

 Bones that used to be strong gradually

grow weak and thin

 This puts bones at risk for fractures

– Most commonly: spine, hip, and wrist
Osteopenia may be
found first
 Abnormally
decreased bone
density
– Indicates weakening
bones

 May progress into

osteoporosis
 Who is affected?

 10 million
Americans

 80% are women

Osteoporosis

A woman in
her upper
80’s with
Advanced
osteoporosis.
 Why mostly women?
 Bones lighter and less dense already
 Hormonal changes (post-menopause,

or post-ovary removal) increase risk

 Uncommon in men until after 70

 Most commonly before age 70, men

get it secondary to other problems

Comparison by Race and Gender
Race/Gender Osteoporosis LowBoneMass
NonHispWhite or 20% 52%
Asian >50 Women
NonHispBlack 5% 35%
>50 Women
Hispanic 10% 49%
>50 Women
NonHispwhite or 7% 35%
Asian >50 Men
NonHispBlack 4% 19%
>50 Men
Hispanic 3% 23%
>50 Men
 Bone loss progression

Bone loss in women occurs

most rapidly during first 5-
7 years after menopause,
then slows again.

This is related to the sharp

drop in estrogen levels …
estrogen seems to help
keep calcium in the bones.
Other risk factors
 Amenorrhea
 Personal hx fx

>50yrs
 Anorexia nervosa

 Liver disease

 Chronic renal

failure
 Malabsorption

syndromes
 Some at higher risk
 Thin or small framed women
 Smoking, drinking (excessively), or
living a sedentary lifestyle
 Family history

 Ovaries removed before age 40

 White and Asian women

 Current concern about today’s children

with low dairy intakes (low calcium)
 What about men?
 2 million men over 65
yrs. in U.S. (w/osteop)

 3.5 million at risk

 By age 90, 1 in 6 men

will have a hip fracture
– 1/3 less than women
Common causes for
men

 Delayed puberty
 Smoking
 Alcohol (excess)
 Calcium intake
 Physical activity
and strength
 Genetic factors
 Male hormones
 Decreasing
testosterone can lead
to osteoporosis
– May occur with aging
– May occur with some
medications

 Increased estogen
production
Secondary
Osteoporosis

 Another illness or
a medication

 Causes osteoporosis

 Equals same results as primary o.

 Some disorders that
can lead to 2nd osteop.
Endocrine Disorders  Medications
– Corticosteroids
– Anticonvulsants
Autoimmune Diseases
– thyroid

Chronic Illnesses  Nutritional

deficiencies
Bone marrow or
malignant disorders  Lifestyle factors
What can happen?
 Fractures possibe
 Vertebral fractures
– 2004 – estimated 700,000 occurred

 Hip/femoral neck fractures

– 2000 – estimated 340,000 annually

 Both have higher mortality rates in the

1-5 years after fracture
Vertebral fractures
 Pain

 Loss of height

 Stooped/curved
posture
Curved spine
compresses organs
 Respiratory

– Hard to breathe

– Can’t take as deep

of breaths

– Higher risk
pneumonia/infections
Compression affects
digestive system
 Unable to eat as
much (at one time)
– Decreases sense of
hunger
– Weight loss results

 Slower movement in
colon
– Possibly narrowed
– Constipation results
Skin problems
 A stooped posture
can lead to folds of
skin around the
abdomen

 Rashes and other

skin irritation can
occur

 Pressure Areas
Other problems from a
bent posture
 Back pain

 Poor balance
– Which then
decreases mobility

 Fatigue and muscle

weakness

 Loss of Height
Hip fractures also
common
Hip fracture problems
 Hip fractures:
– Delirium/confusion
may occur

– Decreased mobility
may result

– Hardware problems
can occur
 Making the diagnosis
 Biochemical markers can help make
the diagnosis in conjunction with BMD
results
– Some are markers of bone resorption
– Others are markers of bone formation
– All are lab tests
– None are diagnostic by themselves
 Special Test: BMD
 Specialized tests called bone mineral density (BMD) tests can
measure bone density in various sites of the body. A BMD
test can:
 Detect osteoporosis before a fracture occurs
 Predict chances of fracturing in the future
 Determine rate of bone loss and/or monitor the effects of
treatment if a DXA BMD test is conducted at intervals of one
year or more
 Medicare reimburses for BMD testing every two years.
 An increase in BMD testing and osteoporosis treatment was
associated with a decrease in hip fracture incidence.
 Bone density is an important determinant of fracture risk even
in nursing home patients.
 There has been a five-fold increase in office visits for
osteoporosis (from 1.3 to 6.3 million) in the past 10 years.
Treatments/Repair
 Treatments once
diagnosed

 Medications
– Fosamax, Actonel
– Estrogen
– Evista
– Pain meds
– Calcium with
Vitamin D
 Osteoporosis
Medications
 Bisphosphonates
 Alendronate and alendronate plus vitamin D
(brand name Fosamax® and Fosamax®
plus D)
 Ibandronate (brand name Boniva®)
 Risedronate and risedronate with calcium
(brand name Actonel® and Actonel® with
Calcium)
 Calcitonin (brand name Miacalcin®)
What about Estrogen??
 Estrogen loss results
in an increase in
osteoclast activity
(bone loss) after
menopause

 Replacement therapy
controversial
 Medications/Estrogen
 Estrogen/Hormone Therapy
 Estrogens (brand names, such as Climara®, Estrace®, Estraderm®,
Estratab®, Ogen®, Ortho-Est®, Premarin®, Vivelle® and others)
 Estrogens and Progestins (brand names, such as Activella™,
FemHrt®, Premphase®, Prempro® and others)
 Parathyroid Hormone – Teriparatide (PTH (1-34) (brand name
Fortéo®)
 Selective Estrogen Receptor Modulators (SERMs)
 Raloxifene (brand name Evista®)
 Alendronate is approved as a treatment for osteoporosis in men and
is approved for treatment of glucocorticoid (steroid)-induced
osteoporosis in men and women. Risedronate is approved for
prevention and treatment of glucocorticoid-induced osteoporosis in
men and women.Parathyroid hormone is approved for the treatment
of osteoporosis in men who are at high risk of fracture.Treatments
under investigation include sodium fluoride, vitamin D metabolites,
and other bisphosphonates and selective estrogen receptor
Surgery or Radiology
may intervene

Vertebral fractures:
– Vertebroplasty
– Kyphoplasty

–Hip Fractures:
–Surgical Repair
–Type depends on
severity
Better than Treatment!
 Treatments?
Prevention Best
Most bone growth
before age 20
Encourage children
be active
consume Calcium
Don’t start smoking
Don’t drink excessive
alcohol
 Avoid Falls

 Use handrails on
stairs

 Remove clutter
– Clear walkways
Avoid throw rugs
– use nonskid mats

 Avoid floppy shoes or

slippers
Preventing

Osteoporosis
 Don’t smoke!
 Don’t drink too
much alcohol

 Both smoking and

alcohol intake
(excessive) have
been found to
decrease bone
strength
Exercise,
exercise
 Weight bearing
exercise will
strengthen bones

 Dance the night

away!

 Walking good too!

 Exercise Benefits

 Decreases fall risk

 Increases muscle
and bone mass

 Improves cognitive function (brain)

What foods are good to build
and keep strong bones?
 Calcium rich foods
 Low-fat or non-fat TIPS:
dairy products • Use low-fat yogurt to

make salad dressings

• Add extra dry milk
 Green leafy veggies when baking
– Also high in iron!
• Lactose intolerant? Try
 Saltwater fish lactose-free milk now
available.
 Calcium Intake
 1500 mg/day for men
and women over 65
years Calcium can cause:
 Divided doses are
absorbed better Constipation – divide doses,
 Calcium Citrate Add milk & yogurt to diet
absorbs better than
carbonate Gas, Bloating –
 Usually need Vitamin D Try Tums
as well
Vitamin D
 Sunlight

 Found in
– Milk
– Egg yolks
– Fish

 Usually 400 iu/day

What if I have had
kidney stones?
 1000 mg Ca Citrate
– Ask your doc/NP
 Urine Calcium will
need to be
measured
 May need HCTZ
– A water pill
 Avoid Vitamin D
supplements
Lower YOUR Risk
 Increase daily Calcium intake
 Exercise – weight bearing type

 Talk to you health care provider

about your risk factors
Remember . . .

Prevention needs
to
start

YOUNG!