Arianne June P.

Labis BSN 2C

Osteoporosis is a metabolic bone disorder in which the rate bone resorption accelerates while the rate of bone formation slows, causing a loss of bone mass. Bones affected by this disease lose calcium and phosphate salts and become porous, brittle and abnormally vulnerable to fractures. Osteoporosis may be primary or secondary to an underlying disease, such as Cushings syndrome or hyperthyroidism. It primarily affects the weight-bearing vertebrae.

Only when the condition is advanced or severe, as in secondary disease, do similar changes occur in the skull, ribs and long bones. Usually, the femoral heads and pelvic acetabula are selectively affected. Osteoporosis is more common in women who are white and who have a family history of osteoporosis. Primary osteoporosis is commonly called postmenopausal osteoporosis because it develops in postmenopausal women.

The cause of primary osteoporosis is unknown, but contributing factors include: Declining gonodal and adrenal function Faulty protein metabolism due to relative or progressive estrogen deficiency Mild but prolonged negative calcium balance due to inadequate dietary intake of calcium Sedentary lifestyle

The many causes of secondary osteoporosis include: Alcoholism Cigarette smoking Endocrine disorders Lactose intolerance Malabsorption Malnutrition Osteogenesis imperfecta Prolonged therapy with steroids or heparin Scurvy Sudecks atrophy Total immobilization or disuse of a bone

In normal bone, the rates of bone formation and resorption are constant; replacement follows resorption immediately, and the amount of bone replaced equals the amount of bone resorbed. Osteoporosis develops when the remodeling cycle is interrupted and new bone formation falls behind resorption. When bone is resorbed faster than it forms, the bone become less dense. Men have approximately 30% greater bone mass than women, which may explain why osteoporosis develops later in men.

Possible complications of osteoporosis include spontaneous fractures as the bones lose volume and become brittle and weak, and shock, hemorrhage, or fat embolism.

Osteoporosis is typically discovered suddenly, such as when: A postmenopausal woman bends to lift something, hears a snapping sound, and then feels a sudden pain in her lowerback Vertebral collapse causes back pain that radiates around the trunk and is aggravated b movement or jarring.

In another common pattern, osteoporosis can develop insidiously, showing: Increasing deformity, kyphosis, loss of height, decreased exercise tolerance, and a markedly aged appearance. Spontaneous wedge fractures, pathologic fractures of the neck and femur, Colles fractures of the distal radius after a minor fall, and hip fractures

Treatment to control bone loss, prevent fractures, and control pain may include: Physical therapy emphasizing gentle exercise and activity and regular, moderate weight-bearing exercise to slow bone loss and possibly reverse demineralization Supportive devices such as a back brace Surgery, if indicated Hormone replacement therapy with estrogen and progesterone to slow bone loss and prevent occurrence of fractures Analgesics and local heat to relieve pain

Other medications include: Biphosphonates to increase bone density and restore bone lost. Calcium and vitamin D supplements to support normal bone metabolism Reloxifene to decrease bone loss and decrease the risk of spinal fractures Vitamin C, calcium and protein to support skeletal metabolim

Other measures include: Early mobilization after surgery or trauma Decreased alcohol and tobacco consumption Careful observation for signs of malabsorption Prompt, effective treatment of the underlying disorder

 Check the patients skin daily for redness, warmth, and new sites of pain, which may indicate new fractures. Encourage activity; help the patient walk several times daily. As appropriate, perform passive range-of-motion exercises or encourage the patient to perform active exercises. Make sure the patient regularly attends scheduled physical therapy sessions.

 Impose safety precautions. Keep the side rails of the patients bed in a raised position. Move the patent gently and carefully at all times. Explain to the patients family and ancillary health care personnel how easily an osteoporotic patients bones can fracture. Make sure the patient and her family clearly understand the prescribed drug regimen. Tell them how to recognize significant adverse effects and to report them immediately.

 Tell the patient to report any new pain sites immediately, especially after trauma, no matter how slight. Advise the patient to sleep on a firm mattress and to avoid excessive bed rest. Thoroughly explain osteoporosis to the patient and her family. Teach the patient good body mechanics.