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Melanie Gurski

on 15 November 2013

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Transcript of Osteoporosis

And All the Bones About It!
Objectives for YOU to know!
1) To understand the pathophysiology & risk factors of Osteoporosis.

2) To understand the genetics behind the disease process.

3) To understand Pharmacologic/Non-Pharmacologic treatment options and prevention methods.
How to Prevent Osteoporosis!
How to Treat Osteoporosis
Ackley, B. J., & Ladwig, G. B. (2011). Nursing diagnosis handbook: An evidence-based guide to planning care. St. Louis, Mo: Mosby.
Anatomy of a Fracture as a Result of Systemic Bone Loss. (n.d.). YouTube. Retrieved from
Banu, J., Varela, E., & Fernandes, G. (2012). Alternative therapies for the prevention and treatment of osteoporosis. Nutrition Reviews, 70(1), 22-40. doi:http://dx.doi.org.dax.lib.unf.edu/10.1111/j.1753-4887.2011.00451.x
Cow Cartoon #2416 ANDERTOONS COW CARTOONS. (n.d.). Cartoons: Purchase Business & Family Cartoons - ANDERTOONS. Retrieved from http://www.andertoons.com/cow/cartoon/2416/i-think-we-can-rule-out-osteoporosis/
DEXA and Bone Density Scans - Lexington Diagnostic Center. (n.d.). YouTube. Retrieved from

Heuther, S.E., & McCance, K.L. (2012). Alterations of musculoskeletal function. Understanding Pathophysiology, (5th ed.) (pp. 979-1021). St. Louis, MO: Elsevier.
Kanis, M. (n.d.). Frax: Who fracture risk assessment tool. Retrieved from http://www.shef.ac.uk/FRAX/

LeMone, P., Burke, K., & Bauldoff, G. (2011). Nursing care of patient with musculoskeletal disorders. Medical-surgical nursing: critical thinking in patient care (5th ed., pp. 1337-1400). Upper Saddle River, N.J.: Pearson.
Lilley, L. L., Savoca, D., & Lilley, L. L. (2011). Women's Health Drugs. In Pharmacology and the nursing process (6th ed., pp. 527-528). Maryland Heights, MO: Mosby.

Marieb, E. N., & Hoehn, K. (2011). Anatomy & physiology (4th ed., pp. 150-170). Upper Saddle River, NJ: Pearson/Benjamin Cummings.
Osteoporosis. (n.d.). Florida Department of Health. Retrieved from http://www.doh.state.fl.us/family/osteo/
Osteoporosis Support Group - DailyStrength. (n.d.). Online Support Groups and Forums at DailyStrength. Retrieved from http://www.dailystrength.org/c/Osteoporosis/support-group

Potter, P. A. (2013). Fundamentals of nursing (8th ed., p. 552). St. Louis, Mo: Mosby.
Silvestri, L. A. (2011). Saunders comprehensive review for the NCLEX-RN examination (pp. 995-996). St. Louis, Mo: Elsevier/Saunders.
The national osteoporosis foundation. (2012). Retrieved from http://www.nof.org/articles/8
The national osteoporosis foundation. (n.d.). Retrieved from http://www.nof.org/articles/743
The Price is Right 1972 Extended Theme. (n.d.). YouTube. Retrieved from
By: Amanda, Melanie, Shanna, Tamara, & Tanisha

What is Osteoporosis?
Diagnostic Testing
Pharmacologic & Non-Pharmacologic
Weight Bearing Exercise.
Abdominal exercises
Plant Products (Article)
Adults over age 25 should consume 1000-1500 mg/day
Vitamin D is required for absorption of Calcium from food, and is ingested or produced by the skin.
*Vitamin D is required for the absorption of Calcium into the cells and thus, promotes bone growth.

*Need 0.01 mg/day

* Found in dairy products & egg yolk.

*Made in the skin by the presence of sunlight.

Need 3-4 mg/day
Found in fluoridated water, tea, & seafood.
Article) Alternative Therapies for the Prevention & Treatment of Osteoporosis
Found many components of plants have anti-reabsorptive properties for bone (
Other plant compounds decrease inflammatory cytokienes associated with bone loss (
Plants from the family Fabaceae contain phytoestrogens that perform estrogen-like activities; part of estrogen replacement therapies: have high effect on bone maintenance & low side effects. Ex)
Soy beans
Plan of Care
Nursing Diagnosis (NANDA)
Central Dual Energy X-ray Absorptiometry (Central DXA Scan)
Normal Bone Density= -1 or Above
Low Bone Density= Between -1 & -2.5
Osteoporosis= -2.5 or Below
Understanding Bone Denstiy Scores
The FRAX Tool
WHO Fracture Risk Assessment Tool
Online resource that is useful to both patients & clinicians in taking information about bone density & risk factors for bone fracture to estimate your 10-yr probability of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture).
http://www.shef.ac.uk/FRAX/ (website for FRAX)
The Wonder of
Plan of Care Progression
Disorder characterized by abnormal resorption of bone; Literally means "porous bone".

Old bone is resorbed faster then new bone is made, but pathophysiology is unclear: known to involve imbalance of activity of osteoblasts and osteoclasts.

Characterized by loss of bone mass, increased bone fragility, and risk of fractures.
Who is at Risk?
Non-Modifiable Modifiable
Family History
Female Gender
Increased Aged
Small Stature
Diet- low Calcium & Vitamin D
Excessive caffeine intake
Sedentary lifestyle
Excessive alcohol consumption
•1 in 3 women over 50 & 1 in 5 men will have a fracture due to osteoporosis.

•Approximately 1.6 million hip fractures occur each year worldwide; the incidence is set to increase to 6.3 million by 2050.

•34 million Americans have low bone density & more than 10 million Americans have osteoporosis.

•In 2002, the estimated costs of medical care for fractures due to osteoporosis was $12.2-$17.9 billion.

•Hip fractures are responsible for 72% of fracture costs.

•According to the National Osteoporosis Foundation, 24% of people with hip fractures die within the first year.
ONLY test that can diagnose Osteoporosis: measures bone density in the Lumbar spine or Hip, due to the greater chance of breakage.

Results: Low bone density, greater risk of bone fracture.

Results are called T-scores; compares bone density to that of a healthy, 30 year old adult.
It's time to introduce you to our patient, M.S.!
Community Resources
National Osteoporosis Foundation
Florida Department of Health
Daily Strength – Online support group
Nursing Interventions & Activities
Assess client's surroundings to prevent injury.
Move the client gently if repositioning
Educate and perform range of motion exercises with the client.
Educate the client on good body mechanics, weight bearing exercises, nutritious food rich in calcium and vitamin D, importance of avoiding alcohol, and maintaining proper fluid intake to prevent kidney stones.
General Nursing Care
Client Will...
Nursing Diagnosis (NANDA)
Deficient knowledge r/t diet, exercise, and need to abstain from nicotine, secondary to osteoporosis aeb admitting she needs to “quit smoking, lose some weight, and start exercising,” and “smoked 1-2 packs of cigarettes per day since she was age 17.”
Nursing Interventions & Activities
Involve older clients in setting their own goals & participating in the decision-making process.

Allowing senior clients to set goals that are meaningful to them and are realisitc have demonstrated positive clinical outcomes (Ackley, 2011)
Discuss healthy lifestyle changes that promote wellness for the older adult.
Greater efforts must be made both to improve preventive health care & enhance quality of life interventions for older people (Ackley, 2011)
Client will...
Explain disease state, recognize need for medications, and understand treatments.
Incorporate knowledge of health regimen into lifestyle.
Calcium & Vitamin D Supplements
Hormone (estrogen) Replacement Therapy
(Alendronate) Fosamax
Calcitonin Hormone
•Family history of osteoporosis –history often reveals that the patient’s mother had the disease.

•White and Asian race –most common among these races.

•Female gender –declining levels of estradiol and androgen associated with menopause.

•Increased age –old bone is being resorbed faster than new bone is being made, causing loss of bone density.
1.) Consume Calcium & Vitamin D while bones are still growing. Limit excessive amounts of protein

2.) Drink fluoridated water to harden skeletal bones and teeth.

3.) Limit carbonated beverages in your diet. (Phosphorous & Calcium have an inverse relationship!)

4.) Don't smoke!

5.) Integrate weight bearing exercise into your lifestyle.
Acute pain r/t vertebral compression aeb self-report of “pain in my upper back,” and “six on a 0 to 10 point scale.”
i.Assess the client for pain presence routinely at frequent intervals, often at the same time as vital signs are taken, and during activity and rest. Also assess for pain with interventions or procedures likley to cause pain.
Rationale: Acute pain should be reliably assessed both at rest (important for comfort) and during movement (important for function and decreased client risk of cardiopulmonary and thromboembolic events (Ackley, 2011).

ii.In addition to administering analgesics, support the clien'ts use of nonpharmacological methods to help control pain, such as distraction, imagery, relaxation, and application of heat and cold.

Cognitive-behavioral strategies can restore the client's sense of self-control, personal efficacy, and active participation in his or her own care (Ackley, 2011).
Use a self-report pain tool to identify current pain level and establish a comfort-function goal.
Describe nonpharmacological methods that can be used to help achieve comfort-function goal.
Impress Us!:)
1.) Which of the following patient statements regarding osteoporosis prevention would indicate that more education is needed.

a.“I will quit smoking to reduce my risk”
b.“I will consume a large amount of protein to help my bones stay strong”
c.“Vitamin D is needed for calcium absorption”
d.“I will limit my alcohol consumption”
2.) A nurse is conducting health screening for osteoporosis. Which of the following clients is at greatest risk of developing this disorder?

a.A 25 year old woman who jogs
b.A 36 year old man who as asthma
c.A 70 year old man who consumes excess alcohol
d.A sedentary 65 year old woman who smokes cigarettes
3.) The most important vitamin required for bone reabsorption and modeling is ____.

c. C
4.) Which modifiable risk factor places a young woman at the greatest risk of developing osteoporosis?

a.Small stature
b.Caucasian race
c.Sedentary lifestyle
d.Family history of osteoporosis
5.) Which test would lead to a diagnosis of osteoporosis?

a.FRAX tool
b.Central DXA scan
Time to Have Some Fun!
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