Osteoporosi

s
Josh Labang

Is a progressive bone disease that is characterized by a

decrease in bone mass and density which can lead to an
increased risk of fracture.[1] In osteoporosis, the bone
mineral density (BMD) is reduced, bone microarchitecture
deteriorates, and the amount and variety of proteins in
bone are altered. Osteoporosis is defined by the World
Health Organization (WHO) as a bone mineral density of
2.5 standard deviations or more below the mean peak
bone mass (average of young, healthy adults) as measured
by dual-energy X-ray absorptiometry; the term "established
osteoporosis" includes the presence of a fragility fracture.

Types:
A. Primary osteoporosis
is the most common type of osteoporosis. It is more
common in women than men. A person reaches
peak bone mass (density) at about age 30. After
that, the rate of bone loss slowly increases, while
the rate of bone building decreases. Whether a
person develops osteoporosis depends on the
thickness of the bones in early life as well as health,
diet, and physical activity at all ages.
In women, accelerated bone loss usually begins
after monthly menstrual periods stop. This happens
when a woman's production of estrogen slows down
(usually between the ages of 45 and 55). In men,
gradual bone thinning typically starts at about 45 to
50 years of age, when a man's production of
testosterone slows down. Osteoporosis usually does
not have an effect on people until they are 60 or
older. Women are usually affected at an earlier age
than men, because they start out with lower bone
mass.

B. Secondary Osteoporosis
Has the same symptom as primary osteoporosis.
But it occurs as a result of having certain medical
conditions, such as hyperparathyroidism,
hyperthyroidism, or leukemia. It may also occur as a
result of taking medicines known to cause bone
breakdown, such as oral or high-dose inhaled
corticosteroids (if used for more than 6 months), too
high a dose of thyroid replacement, or aromatase
inhibitors (used to treat breast cancer). Secondary
osteoporosis can occur at any age.

C. Osteogenesis imperfecta
Is a rare form of osteoporosis that is present at birth.
Osteogenesis imperfecta causes bones to break for no
apparent reason.
Idiopathic juvenile osteoporosis
Idiopathic juvenile osteoporosis is rare. It occurs in
children between the ages of 8 and 14 or during times
of rapid growth. There is no known cause for this type
of osteoporosis, in which there is too little bone
formation or excessive bone loss. This condition
increases the risk of fractures.

C. Causes
Bone is made up mostly of minerals such as calcium.
The bones in our bodies are constantly being broken
down and replaced with new bones. This bone-building
cycle takes about 100 days and is influenced by the
hormones produced in our bodies (such as estrogen in
women) as well as by the levels of calcium and vitamin
D.
Osteoporosis occurs when bone tissue and minerals
are lost faster than the bone is replaced
Other factors that may lead to osteoporosis
.drop in estrogen after menopause:
family history and body type:
lifestyle factors and health conditions:
lack of exercise:
lack of calcium:

D.
Pathophysiology
The balance between bone resorption and bone deposition is
determined by the activities of two principle cell types,
osteoclasts and osteoblasts, which are from two different
origins. Osteoclasts are endowed with highly active ion
channels in the cell membrane that pump protons into the
extracellular space, thus lowering the pH in their own
microenvironment.
This drop in pH dissolves the bone mineral. Osteoblasts,
through an as yet poorly characterized mechanism, lay
down new bone mineral. The balance between the activities
of these two cell types governs whether bone is made,
maintained, or lost. The activities of these cells are also
intimately intertwined. In a typical bone remodeling cycle,
osteoclasts are activated first, leading to bone resorption.
Then, after a brief reversal phase, during which the
resorption pit is occupied by osteoblasts precursors, bone
formation begins as progressive waves of osteoblasts form
and lay down fresh bone matrix. Because the bone
formation phase typically takes much longer than the
resorption phase, any increase in remodeling activity tends
to result in a net loss of bone. At various stages throughout
this process, the precursors, osteoclasts, and osteoblasts

E. Clinical
manifestations
Osteoporosis generally does not become clinically apparent
until a fracture occurs. Two thirds of vertebral fractures are
painless.
Typical findings in patients with painful vertebral
fractures may include the following:
The episode of acute pain may follow a fall or minor
trauma
Pain is localized to a specific, identifiable, vertebral
level in the midthoracic to lower thoracic or upper
lumbar spine.
The pain is described variably as sharp, nagging, or
dull; movement may exacerbate pain; in some cases,
pain radiates to the abdomen.
Pain is often accompanied by paravertebral muscle
spasms exacerbated by activity and decreased by
lying supine
Patients often remain motionless in bed because of
fear of causing an exacerbation of pain.
Acute pain usually resolves after 4-6 weeks; in the
setting of multiple fractures with severe kyphosis, the
pain may become chronic

F. Diagnostic
tests
On physical examination, patients with vertebral compression
fractures may demonstrate the following:
With acute vertebral fractures, point tenderness over
the involved vertebra.
Thoracic kyphosis with an exaggerated cervical lordosis
(dowager hump)
Subsequent loss of lumbar lordosis
A decrease in height of 2-3 cm after each vertebral
compression fracture and progressive kyphosis
Baseline laboratory studies include the following:
Complete blood count: May reveal anemia or raise
suspicion of alcoholism
Serum chemistry levels: Usually normal in persons with
primary osteoporosis
Serum iron and ferritin levels: Helpful when
malabsorption or hemochromatosis is suspected
Liver function tests: Elevations may indicate alcoholism
Thyroid-stimulating hormone level: Thyroid dysfunction
has been associated with osteoporosis

 25-Hydroxyvitamin D level: Vitamin D insufficiency can

predispose to osteoporosis
Plain radiography features and recommendations are
as follows:
Obtain radiographs of the affected area in symptomatic
patients
Lateral spine radiography can be performed in
asymptomatic patients in whom vertebral fracture is
suspected; a scoliosis series is useful for detecting
occult vertebral fractures
Radiographic findings can suggest the presence of
osteopenia, or bone loss, but cannot be used to
diagnose osteoporosis
Radiographs may also show other conditions, such as
osteoarthritis, disk disease, or spondylolisthesis

G. Treatment
Bisphosphonates are the most common medications prescribed
for osteoporosis treatment. These include:
Alendronate (Fosamax)
Risedronate (Actonel)
Ibandronate (Boniva)
Zoledronic acid (Reclast)
Hormones, such as estrogen, and some hormone-like
medications approved for preventing and treating
osteoporosis, such as raloxifene (Evista), also play a role in
osteoporosis treatment. However, fewer women use
estrogen replacement therapy now because it may increase
the risk of heart attacks and some types of cancer.
Still, women who have reasons such as menopausal
symptoms to consider using hormones or who are
considering using Evista for breast cancer prevention, can
weigh the benefit of improved bone health into their
decision.
Denosumab (Prolia) is a newer medication shown to reduce
the risk of osteoporotic fracture in women and men.
Unrelated to bisphosphonates, denosumab might be used
in people who can't take a bisphosphonate, such as some
people with reduced kidney function.

How do most osteoporosis

medications work?
With the exception of teriparatide, osteoporosis
medications slow bone breakdown. Healthy
bones continuously break down and rebuild. As
you age and, for women, especially after
menopause, bones break down faster. Because
bone rebuilding cannot keep pace, bones
deteriorate and become weaker.
Osteoporosis medications basically put a brake
on the process. These drugs effectively maintain
bone density and decrease the risk of breaking a
bone as a result of osteoporosis.

H. Lifestyle
changes
Avoid Excessive consumption of alcohol:
correct Vitamin D deficiency:[17][18]
Tobacco smoking:
promote proper nutrition:
High dietary protein: Research has found an association
between diets high in animal protein and increased
urinary calcium, and have been linked to an increase in
fractures. However, the relevance of this observation to
bone density is unclear, since higher protein diets tend to
increase absorption of calcium from the diet and are
associated with higher bone density. Indeed, it has
recently been argued that low protein diets cause poor
bone health. No interventional trials have been performed
on dietary protein in the prevention and treatment of
osteoporosis.
Underweight/inactive: Bone remodeling occurs in
response to physical stress, so physical inactivity can lead
to significant bone loss. Weight bearing exercise can
increase peak bone mass achieved in adolescence, and a
highly significant correlation between bone strength and
muscle strength has been determined. The incidence of
osteoporosis is lower in overweight people.

 Endurance training: In female endurance athletes,

large volumes of training can lead to decreased bone
density and an increased risk of osteoporosis. This
effect might be caused by intense training
suppressing menstruation, producing amenorrhea,
and it is part of the female athlete triad. However,
for male athletes, the situation is less clear, and
although some studies have reported low bone
density in elite male endurance athletes, others
have instead seen increased leg bone density.
Avoid Soft drinks: Some studies indicate soft drinks
(many of which contain phosphoric acid) may
increase risk of osteoporosis.

I. Surgical interventions
Vertebroplasty- is a minimally invasive procedure used to
reinforce vertebrae with compression fractures, which are
common in patients with osteoporosis. Vertebroplasty involves
injecting an acrylic compound into the collapsed vertebra to
stabilize the weakened bone. The procedure is performed in
an operating room or radiology suite and treatment of each
affected vertebra takes approximately 1 hour.
Local anesthesia is injected into the vertebra, a small incision
is made, and a bone biopsy needle is inserted. Several small
syringes of the cementing material are then injected through
the needle into the vertebra. The cement hardens almost
immediately.
Approximately 7090% of patients experience pain relief after
vertebroplasty and most are released from the hospital the
same day. Anti-inflammatory medicine (e.g., Motrin) may be
used to relieve pain after the procedure.
Complications from the procedure are rare. Bone cement may
enter the lung, spinal cord, or epidural space surrounding the
vertebra. Other possible complications associated with
vertebroplasty include nerve irritation, punctured lung
(pneumothorax), and spinal cord injury.

 Kyphoplasty
Multiple spinal compression fractures caused by
osteoporosis may lead to height loss, kyphosis (extreme
curvature of the spine), and pain. Kyphoplasty, also
called balloon kyphoplasty, is a minimally invasive
procedure that is used to restore the height of the
vertebrae and stabilize weakened bone. Kyphoplasty
cannot correct established spine deformities and is used
in patients who have experienced recent fractures (within
24 months). The procedure is usually performed in the
hospital under local or general anesthesia and takes
approximately 1 hour for each affected vertebra. In
balloon kyphoplasty, a small incision is made and a
fluoroscope (device that consists of a screen and an x-ray
tube) is used to guide the insertion of a balloon catheter
into the vertebra. The balloon is inflated slowly to raise
the compressed vertebra, and then is deflated. An acrylic
compound (cementing material) is then injected into the
vertebra through a bone biopsy needle. The material
hardens almost immediately. Pain relief usually occurs
within 2 days.
Most patients are released from the hospital the day after
kyphoplasty and can resume daily activities upon
discharge. Strenuous activity, such as heavy lifting,
should be avoided for at least 6 weeks.

J. Nursing Interventions
Focus on careful positioning, ambulation, and prescribed
exercises.
Administer analgesics and heat to relieve pain as
ordered.
Include the patient and his family in all phases of care.
Encourage the patient to perform as much self-care as
her immobility and pain allow.
Provide the patient activities that involve mild exercise.
Check the patients skin daily for redness, warmth, and
new painsites.
Monitor the patients pain level, and assess her response
to analgesics, heat therapy, and diversional activities.
Explain all treatments, tests, and procedure to the
patient.
Make sure the patient and her family clearly understand
the prescribed drug regiman.
Tell the patient to report any new pain sites
immediately, especially after trauma.
Provide emotional support and reassurance to help the
patient cope with limited mobility.