Osteoporosis. Osteoporosis ADD PICTURE
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1 OSTEOPOROSIS The Silent Thief Chronic, progressive metabolic bone disease marked by Low bone mass Deteriora?on of bone?ssue Leads to increased bone fragility ADD PICTURE Osteoporosis Over 54 million people in the United States One in 2 women and 1 in 4 men over 50 will sustain an osteoporosis- related fracture Why more common in women? Lower calcium intake Less bone mass Bone resorp?on begins earlier and becomes more rapid at menopause Pregnancy and breasqeeding Longevity Osteoporosis Screening guidelines Ini?al bone density test in women over age 65 Repeat in 15 years if normal Earlier and more frequent if high risk Currently no evidence of benefit for screening in men
2 Risk factors Advancing age (>65 yr) Female gender Low body weight White or Asian Current cigareye smoking Prior fracture Sedentary lifestyle Estrogen deficiency Family history Diet low in calcium/vitamin D deficiency Excessive use of alcohol (>2 drinks/day) Low testosterone in men Specific diseases Certain drugs Preven?ve factors Regular weight- bearing exercise Fluoride Calcium Vitamin D (Why?) Peak bone mass (by age 20) determined by heredity, nutri?on, exercise, and hormone func?on Bone loss a]er age inevitable, rate of loss variable Rapid bone loss for women at menopause
3 Remodeling Osteoblasts deposit bone Osteoclasts resorb bone In osteoporosis, bone resorp?on exceeds bone deposi?on Clinical Manifesta4ons Occurs most commonly in spine, hips, and wrists Back pain Spontaneous fractures Gradual loss of height Kyphosis or dowager s hump Diagnos?c Studies History and physical exam X- ray and lab studies not diagnos?c Bone mineral density (BMD) Quan?ta?ve ultrasound (QUS) Dual- energy x- ray absorp?ometry (DXA)
4 Focus on 1. Proper nutri?on 2. Calcium supplements 3. Exercise 4. Preven?on of fractures 5. Drug therapy Adequate calcium intake 1000 mg/day for women ages years Men ages years 1200 mg/day for Women 51 years or older Men 71 years or older Good sources of calcium Milk Yogurt Turnip greens CoYage cheese Ice cream Sardines Spinach Supplemental calcium Take in divided doses Calcium carbonate 40% elemental calcium Take with meals Calcium citrate 20% elemental calcium Less dependent on stomach acid
5 Vitamin D necessary for calcium absorp?on/ func?on; bone forma?on Sunlight for 20 minutes adequate Supplemental ( IU/day) Postmenopausal Older adults Homebound/long- term care Minimal sun exposure Weight- bearing exercise Build up and maintain bone mass Increase strength, coordina?on, balance Walking, hiking, weight training, stair climbing, tennis, dancing Quit smoking Decrease alcohol intake Drug Therapy Bisphosphonates Inhibit bone resorp?on Side effects: anorexia, weight loss, gastri?s Proper administra?on Take with full glass of water Take 30 minutes before food or other meds Remain upright for at least 30 minutes
6 Drug Therapy Calcitonin Inhibits bone resorp?on Give IM form at night to minimize side effects Alternate nostrils when using nasal form Calcium supplementa?on is needed Drug Therapy Selec?ve estrogen receptor modulators Raloxifene (Evista) Reduces bone resorp?on Audience Response Question Alendronate (Fosamax) is prescribed for a pa?ent with osteoporosis. The nurse teaches the pa?ent that a. the drug must be taken with food to prevent GI side effects. b. bisphosphonates prevent calcium from being taken from the bones. c. lying down a]er taking the drug prevents light- headedness and dizziness. d. taking the drug with milk enhances the absorp?on of calcium from the bowel.
7 Audience Response Question Which pa?ent would be at greatest risk for developing osteoporosis? a. A 73- year- old man who has five alcoholic drinks per week and limits sun exposure to prevent recurrence of skin cancer. b. An 84- year- old man who has recently been diagnosed with hypothyroidism and is prescribed levothyroxine (Synthroid). c. A 69- year- old woman who had a renal transplant 5 years ago and has been taking prednisone to prevent organ rejec?on. d. A 55- year- old woman who recently had a hysterectomy with bilateral salpingo- oophorectomy and refuses estrogen therapy.
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