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Slide 1 - Osteoporosis Metabolic Bone Disease
Slide 2 - Osteoporosis Characterized by low bone mass and structural deterioration Normal homeostatic bone remodeling is altered – the rate of bone resorption is greater than the rate of bone formation.
Slide 3 - Osteoporosis Chronic, progressive metabolic bone disease characterized by Porous bone ___ ____ ____ Structural deterioration of bone tissue Increased bone fragility
Slide 4 - Osteoporosis Eight times more common in women than men for several reasons Lower calcium intake than men Less bone mass because of smaller frame Bone resorption begins earlier and accelerates after menopause Pregnancy and breastfeeding deplete woman’s skeletal reserve of calcium Longevity increases likelihood of osteoporosis; women live longer than men
Slide 5 - Etiology Risk factors (non-modifiable) Female gender Increasing age Family history White or Asian ethnicity Small stature Early menopause
Slide 6 - Etiology Risk factors (cont’d) Excess alcohol intake Cigarette smoking Anorexia Oophorectomy Sedentary lifestyle Insufficient calcium intake Low testosterone levels (hypogonadism in men)
Slide 7 - Etiology and Pathophysiology Peak bone mass is achieved before age 20 Bone loss after midlife is inevitable but rate of loss is variable Bone resorption exceeds bone deposition Bones become weakened and prone to fracture, loss of height, and kyphosis.
Slide 8 - Etiology and Pathophysiology Diseases associated with osteoporosis Intestinal malabsorption Kidney disease Rheumatoid arthritis Hyperthyroidism Chronic alcoholism Cirrhosis of the liver Hypergonadism Diabetes mellitus
Slide 9 - OsteoporosisDiagnostic Studies Clinical Manifestations Known as silent disease Diagnosis Bone Mineral Density (BMD) Dual-energy x-ray absorptiometry (DEXA) History and physical Quantitative ultrasound
Slide 10 - Osteoporosis Can the disease be prevented?
Slide 11 - Treatment and Nursing Care Diet Therapy Weight bearing Exercises Decrease Risk Factors Quit smoking and decrease consumption of alcohol
Slide 12 - Drug Treatment of Osteoporosis Estrogen Replacement Therapy Calcium & Vitamin D supplements Calcitonin Biphosphonates (Fosamax, Didronel, Actonel, Boniva, Aredia, Bonefos, Skelid) Selective Estrogen receptor modulator – Evista Teriparatide (Forteo) Portion of parathyroid hormone First drug to stimulate new bone formation
Slide 13 - Medications Used in Treatment of Osteoporosis Hormone Replacement Therapy – Estrogen Controversy over use. Should discuss with health care provider Calcium There are a variety of calcium supplements available (See Table 64-16, p. 1689). They should be taken with _______ _ to aid in absorption. Also if taking large doses i.e. 1000 mg. / day – take in divided doses of 500mg BID for better absorption
Slide 14 - Medications Used in Treatment of Osteoporosis Calcitonin If calcitonin inhibits bone resorption by opposing the effects of parathyroid hormone, how does that affect serum calcium levels? What is needed to counter that effect?
Slide 15 - Medications Used in Treatment of Osteoporosis Bisphosphenates – (Fosamax) Inhibit osteoclast-mediated bone resorption thereby increasing BMD and total bone mass. Side effects – anorexia, weight loss, gastritis Patient Teaching
Slide 16 - Medications Used in Treatment of Osteoporosis Selective Estrogen Receptor Modulators Mimic effect of estrogen on bone by reducing bone resorption without stimulating the breasts or uterus. Side effects Leg cramps Hot flashes
Slide 17 - Osteomalacia Metabolic Bone Disease
Slide 18 - Osteomalacia Decalcification and softening of the bone Caused mainly by: vitamin D deficiency **Vitamin D is required for the absorption of calcium from the intestine and calcium is responsible for mineralization of bone Etiology Lack of exposure to __________ ____ GI malabsorption, extensive burns, chronic diarrhea, pregnancy, drugs such as Dilantin.
Slide 19 - Osteomalacia Signs & Symptoms Most Common ____ ____ Difficulty rising from a chair Difficulty walking Additional Signs and Symptoms Low back pain, muscle weakness Weight loss, progressive deformities
Slide 20 - Diagnosis Blood work Decreased serum calcium or phosphorus Decreased serum 25-hydroxyvitamin D Elevated alkaline phosphatase X-Rays Show loose’rs transformation zone – ribbons of decalcification in bone
Slide 21 - OsteomalaciaTreatment and Nursing Care Drug Therapy Diet Therapy Milk, yogurt, cheese Dark green leafy vegetables, okra, broccoli Fish and seafood Almonds
Slide 22 - Paget’s Disease
Slide 23 - Paget’s Disease Excessive bone resorption followed by replacement of normal marrow by vascular, fibrous connective tissue. The new bone is ______, ____________, ___ ______ Most often affect the pelvis, long bones, spine, ribs, sternum, and cranium
Slide 24 - Clinical Manifestations In milder form, none Common early symptom-- Fatigue Waddling gait Loss of height Increased head size
Slide 25 - Complications Pathological fractures (may be a first sign of disease) Bone tumors
Slide 26 - Paget’s Disease Diagnosis Elevated serum alkaline phosphatase X-ray will show increase in bone size Bone scan shows increased uptake in affected bones
Slide 27 - Drug Treatment for Paget’s Drug Therapy Calcitonin-salmon (Miacalcin) Bone is in a constant state of remodeling, whereby old bone is removed by osteoclasts, and new bone is laid down by osteoblasts. Calcitonin inhibits bone removal by osteoclasts, and promotes bone formation by osteoblasts. NSAIDS Bisphosphonates
Slide 28 - Paget’s Disease Other treatments and Nursing Care Back support by firm mattress Teaching about use of splints or braces to support bones and joints and help prevent weakened bones - skin care, circulation, etc. Teach how to correctly use canes or walkers Physical therapy Diet high in…what?