Osteoporosis - Coggle Diagram
A condition where there is higher breakdown of bone in comparison of the formation of new bone which results in porous bones, meaning a decrease in bone density to the point of potential fracture.
2 common types of osteoporosis:
- When the osteoclasts breaks down the bone faster than the osteoblasts can rebuild, it results in lowering the bone mass and lead to osteoporosis.
- Decreasing amount trabeculae, thinning of the cortical bone, and widening of the haversian canals.
- Postmenopausal osteoporosis: Due to the decreased estrogen levels lead to increased bone resorption.
- Senile osteoporosis: Osteoblasts just gradually lose the ability to form bone, while the osteoclasts keep on promoting bone resorption. So, bone resorption usually overtakes bone formation around the 8th decade of life.
Age: >30 yrs old; after menopause - Women's level of estrogen decreasing sharply at the time of menopause.
Height & Weight: >170cm, <57kg - Small body frames, less body masses to draw from.
Sex hormone level: Lower level of sex hormone tend to weaken bones. Estrogen responsible to protect the bones therefore lower level of estrogen will weaken the bones.
Low calcium intake in diet: Will diminished bone density, early bone loss and an increase risk of fractures. Calcium is important to maintain bone mass to support skeleton
Medical problems: diminished bone density, early bone loss and an increase risk of fractures. Calcium is important to maintain bone mass to support skeleton
Lifestyle: Sedentary lifestyles, excessive alcohol consumption, smoking.
- Fracture: Vertebral fractures/compression fractures; occurs when one or more bones in the spine weaken & shatter.
- Vertebral fractures can cause back pain, height loss and a hunched posture.
- Femoral neck fractures and distal radius fractures can also occur; often associated with postmenopausal osteoporosis.
1. Susceptible to bone fractures
a) Spine fractures (common)
- fracture to vertebrae which make up the spine
- series of fractures to the vertebrae can lead to spinal compression fractures --->Severe pain, Kyphosis.
b) Hip fractures
- fracture in the top quarter of the thighbone
- can damage surrounding muscles, ligaments, tendons, blood vessels, & nerves.
- could affect the level of ability (prolonged immobility) which can lead to other complications such as: Blood clots in legs/lungs, prolonged immobility >>> blood clots formed in the deep veins of the legs >>> travels to the lungs >>> pulmonary embolism, bedsores & loss of muscle mass.
- Osteoporosis affects their body images (e.g. Kyphosis) >>> low self esteem.
- Stop doing things that are enjoyable to them because of fear of fall and might injure themselves.
- Biophosphonates: For both men & women at increased risk of fractures.
- Alendronate (Binosto, Fosamax)
- Risedronate (Actonel, Atelvia)
- Ibandronate (Boniva)
- Zoledronic acid (Reclast, Zometa)
- abdominal pain
- heart-burn like symptoms
- Monoclonal antibody medications
- Denosumab (Prolia, Xgeva) produces similar or better bone density results and reduces the chance of all types of fractures.
- delivered via shot under the skin every 6 months.
- very rare complications of biophosphanate & denosumab: crack/break in the middle of thighbone, delayed healing of the jawbone (osteonecrosis of the jaw). This can occur after an invasive dental procedure such as removing a tooth.
3. Hormone-related therapy
- Estrogen can help maintain bone density, however, increase the risk of blood clots, endometrial cancer, breast cancer & heart disease.
- Raloxifene (Evista) - reduce the risk of breast cancer.
- Teriparatide (Forteo)
- similar to parathyroid hormone & stimulates new bone growth.
- Abaloparatide (Tymlos)
- similar to parathyroid hormone
- Romosozumab (Evenity)
- newest bone-building medication to treat osteoporosis.
- a small incision is made in the back then a small tube is placed through it.
- creates a path through the back into the fractured area.
- surgeon uses x-rays to insert a below into the vertebrae then inflates it.
- inflation of the balloon returns the fractured pieces to a more appropriate position, relieving pain and creating a cavity.
- after the balloon is removed,the doctor fills the cavity with a material that hardens and stabilizes the bone.
-minimally invasive procedure involves inserting low viscosity cement directly into the collapsed vertebral body to stabilize the fracture.
- prevent further deformity, such as spine curvature or loss of height.
- different from kyphoplasty because it does not typically involve manipulation before the injection.
Priority nursing care
ND: Impaired physical mobility related to limitation to independent as evidenced by diagnosed osteoporosis.
- Assess patient mobility & functioning to prevent any risk for injury to the patient.
- Provide a good environment to the patient to the patient to prevent any hazard that can cause injury to the patient.
- Assist patient in repositioning to prevent skin breakdown & assist patient with mobility.
- Provide & assist patient in range of motion to promote good body mechanics to the patient.
- Encourage patient to take low salt diet & take recommended amounts of calcium & vitamin D from food or supplements to get stronger bones.
- Educate patient on lifestyle & such as avoid smoking & limit intake of alcohol to decrease rate of bone loss & to prevent risk for fall.
- Patient need to know healthy diet intake to prevent osteoporosis become worst. High calcium and vitamin D intake really recommended to prevent and decrease bone loss to the patient. Avoid from taking alcohol because can increase risk of fracture.
- Promote patient to do more exercise to improve balance and to strengthen muscle.
- Advice to avoid or stop smoking to increase bone health and it will decrease risk of fracture.
- Antiresorptive agents:
- inhibit action of bone cells that degrade bones
- eg; Biphosphonates, Selective-estrogen receptors modulators (SERMs), Calcium.
- Anabolic agents:
- promote bone formation
- eg; TeriparitidePharmacotherapeutics: Calcuim carbonate
- Alendronate sodium (Fosamax; Merck), Risedronate sodium, (Actonel; Procter & Gamble/Aventis)
- first line therapy medications and most commonly used
- increase bone mineral density (BMD) & decrease the incidence of first and future fractures.
- Raloxifene hydrochloride
- demonstrate estrogen agonist activity at the bone and liver and antagonist activity at the breast and uterus.
- increase BMD and reduce fracture risk without promoting breast or endometrial cancer.
- Calcium carbonate has the most elemental calcium (40%), but it should be taken with food to enhance absorption.
- Calcium citrate is absorbed in a nonacidic environment, can be taken without regard to food
- increases BMD & reduces the risk of vertebral and nonvertebral fractures
- not recommended for use for >2 years.
- eg. Fosamax