 When used for Paget’s dse, biphosphonates slow the accelerated bone turnover by attaching to the surface of the

he bone and
inhibiting osteoclast activity. Bone pain is relieved, and the incidence of pathologic fractures is reduced. Cardiac and vascular
manifestations of the dse improve.
 Nursing Resp.:
 dilute the prescribed dose of pamidronate in 1000ml of D5W or normal saline; infuse over at least 4hrs.
 do not add to calcium containing solutions such as Ringer’s solution or LRS
 monitor the IV site for thrombophlebitis.
 Assess the client for signs of elelctrolyte imbalance or other adverse responses such as drug fever.

OSTEOMALACIA (ADULT RICKETS)

 A metabolic bone disorder characterized by inadequate or delayed mineralization of bone matrix in mature compact and
spongy bone.
 Primary cause: Vitamin D deficiency and hypophosphatemia
 Osteomalacia can be corrected w/ treatment

Risk Factors

 Vitamin D Deficiency
 inadequate dietary intake
 lack of sun exposure
 Malabsorption from intestines: gastrectomy, small bowel d/o, gall bladder dse, chronic pancreatic insufficiency
 Renal or liver d/o
 Drug effects: isoniazid, rifampin, anticonvulsants

 Phosphate Depletion
 Inadequate intake
 Impaired absorption due to chronic antacid use
 Impaired tubular reabsorption due to either acquired or genetic d/o

 Systemic acidosis
 Renal tubular acidosis
 Ureterosigmoidostomy

 Bone Mineralization Inhibitors

 Hypophosphatasia
 Sodium fluoride or disodium etidronate (Didronel)
 Aluminum intoxication

 Chronic renal Failure

 Calcium Malabsorption

Disease Process

 Insufficient Calcium absorption n the intestine due to lack of calcium or resistance to the action of Vit. D.
 Increased losses of phosphorus through the urine

Inactive Vit D
↓
Vit D and its metabolites is transported in the blood to the liver
↓
Vit D is converted to Calcidiol
↓
Calcidiol is transported to the kidney
↓
Calcidiol is convereted to an active form calcitriol
↓
Optimal absorption of calcium and phosphorus is achieved
 Calcium and phosphorus is transported to the bones via active form of Vit D
↓
If Vit D is decreased, calcium and phosphorus are not absorbed from the intestine
↓
Serum calcium and phosphorus falls
↓
Parathyroid glands is activated
↓
Activates osteoclast
↓
Release of bone minerals
↓
Disruption of bone mineralization
↓
Osteoid continues to be produced but is not mineralized

Signs and Symptoms

 Bone pain
 Difficulty changing from lying to sitting position, sitting to standing position
 Muscle weakness
 Waddling gait
 kyphosis
 Pathologic fractures

Diagnostic/Laboratory Findings

 X-rays
 Demonstrate the effects of generalized bone demineralization

 Serum Calcium levels

 May be normal or low depending on the cause of the disease

 Serum parathyroid hormone

 Serum alkaline phosphatase

Medications

 Vit D therapy
 Calcium and phosphate supplements