Osteoporosis Lecture Notes

Pathophysiology

• Definition: Osteoporosis is a chronic metabolic bone disorder characterized by low bone density.
• Mechanism: Occurs when bone resorption (osteoclast activity) exceeds bone formation (osteoblast activity), resulting in fragile bones and risk of fractures.

Etiology of Osteoporosis

• Primary Causes:
  • Aging (>50 years old)
  • Ethnicity: Asian and White American
  • Sex: Female, especially post-menopause or after ovary removal (due to estrogen decline)
  • Nutritional factors: Low calcium and Vitamin D intake, high phosphorus, limited protein.
  • Lifestyle: Tobacco use
• Secondary Causes:
  • Chronic Kidney Disease
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Multiple Myeloma
  • Medications: Anticonvulsants (e.g., phenytoin), loop diuretics (e.g., furosemide)
  • Endocrine disorders: Hyperparathyroidism
  • Rheumatoid Arthritis
  • Malabsorption Syndromes

Assessment Findings (Signs and Symptoms)

• Reduced height (5 to 7.5 cm)
• Acute back pain after lifting/bending; worse with activity, relieved by rest
• Movement restriction and spinal deformity
• History of fractures (wrist, femur, thoracic spine)
• Thoracic kyphosis (humpback) of the dorsal spine
• Pain upon palpation over affected area

Diagnostic Procedures

• Radiography
• Dual-energy x-ray absorptiometry (DEXA)
• Peripheral Quantitative Ultrasound (pQUS)
• Quantitative Computed Tomography
• Magnetic Resonance Imaging (MRI)
• Magnetic Resonance Spectroscopy (MRS)

Laboratory Tests

• Blood tests: Calcium, Vitamin D, phosphorus, hematocrit, ESR, and alkaline phosphatase to rule out other bone diseases
• Regular checks for blood calcium and Vitamin D levels, especially for females at high risk and males over 50

Therapeutic Procedures

• Orthotic devices
• Joint repair or arthroplasty
• Vertebroplasty or Kyphoplasty

Nursing Management

• Encourage weight-bearing exercises
• Recommend calcium and Vitamin D supplements with food
• Promote Vitamin D exposure
• Assess home for safety
• Advise on dietary calcium sources

Client Education

• Limit caffeine, alcohol, and carbonated beverages
• Ensure adequate intake of protein, Vitamin K, magnesium, and trace minerals
• Avoid slippery surfaces, wear rubber-bottomed shoes
• Exercise: Isometric exercises, avoid jarring and strenuous activities

Pharmacology

Bisphosphonates

• Alendronate
• Ibandronate
• Risedronate
• Zoledronic Acid
• Pamidronate

Non-Pharmacological Interventions

• Vitamins: Calcium and Vitamin D

Osteoporosis Complications

• Fractures due to low mineral bone density
• Thoracic kyphosis of the dorsal spine

Lifestyle and Dietary Recommendations

• Rich in Vitamin D, protein, calcium
• Gerontologic concerns
• Exercise and weight training recommended 3x a week, including weight training exercises.

This summary provides an overview of the lecture on osteoporosis, covering the main points regarding its pathophysiology, etiology, symptoms, diagnostics, management, and treatment options.