Transcript Bone Up on Osteoporosis - Nursing Center

Bone Up on Osteoporosis
By Joyce Seabolt, LPN
LPN2007, November/December 2007
2.0 ANCC/AACN contact hours
Online: www.nursingcenter.com
© 2007 by Lippincott Williams & Wilkins. All world rights reserved.
Growing Bones
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Osteoblasts: form new bone cells in a process called
remodeling
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Osteocytes: maintain bone as a living tissue
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Osteoclasts: break down calcium and phosphorus in a
process called resorption
Possible Causes of
Osteoporosis
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personal history of nontraumatic fracture
low peak bone mineral density
body weight less than 27 pounds
unexplained cessation of menstruation
anorexia nervosa
low lifetime calcium intake
vitamin D deficiency
lifestyle lacking weight-bearing exercises
Possible Causes of
Osteoporosis
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alcohol consumption of more than two drinks per day
cigarette smoking
family history of nontramautic fracture (primary relative)
and/or osteoporosis
long-term use (more than 6 months) of corticosteroids,
medroxyprogesterone (Depo-Provera), thyroid
hormones, anticonvulsants, aluminum-containing
antacids, methotradate sodium, cholestryamine
white or Asian race
Risk Factors for Osteoporosis
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Age - Older people more likely to develop osteoporosis
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Race - White and Asian most susceptible
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Sex - Women lose bone more rapidly than men
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Heredity - Family history increases chances
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Low weight and bone structure
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Estrogen deficiency or menopause
Risk Factors for Osteoporosis
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Contributing medical conditions/medications - Celiac
disease, corticosteroids, antiseizure medications
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Excessive alcohol use or smoking
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Diet low in calcium and vitamin D
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Inactivity and lack of weight-bearing exercise
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Lack of exposure to sunshine
Types of Osteoporosis
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Primary - Most common in 95% of cases; occurs
spontaneously
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Secondary - Results from a disease such as diabetes or
a medication such as steroids
Diagnosis
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Bone mineral density (BMD) test - Best determinant of
bone health
-- Dual energy x-ray absorptiometry (DXA) - gives
information to calculate fracture risk
-- T-score with negative numbers = bone loss
More Diagnostic Tests
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Computed tomography scan (CT) - can measure
spinal bone density
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Ultrasound - evaluates bones strength using sound
waves to measure bone density
Blood Tests to Evaluate and
Monitor Osteoporosis
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calcium levels
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estradiol levels
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vitamin D levels
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follicle-stimulating
hormone
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thyroid function
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testosterone
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osteocalcin levels
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parathyroid hormone
levels
Urine Tests
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24-hour urine to measure calcium metabolism
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NTx, a new biochemical urine test that shows rate of
bone breakdown
Lifestyle Modifications
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Eat diet rich in calcium and vitamin D
- 1000 to 1500 mg calcium over 25 years of age
- 400 to 1500 mg calcium in children and young adults
- 400 to 800 international units of vitamin D
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Exercise
- as little as 5 to 6 weight-bearing exercises two to three
times a week
- walking, dancing, climbing
Lifestyle Modifications
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Fall prevention
- wear low-heeled, nonskid shoes
- remove clutter from walkways
- secure or remove all rugs
- place skid-proof mats next to tubs and sinks
- make sure walkways are lit
Medication Choices
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Biphosphonates - slow bone loss
- Fosamax
- Actonel
- Boniva
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Selective estrogen receptor modulators - decrease
bone resorption
- Estiva
Medication Choices
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Cacitonin-salmon - peptide hormone inhibits bone
breakdown
- Miacalcin
- Calcimar
- Fortical
- Cibacalcin
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Hormone replacement therapy - decreases bone
breakdown in menopausal women (discuss with health
care provider due to many adverse effects)
Scary Statistics
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10 million Americans over age 50 have osteoporosis.
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About 1.5 million people have an osteoporosis-related
fracture each year.
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About 20% of people with a hip fracture end up in a
nursing home within the year.
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About 20% of people with a hip fracture will die within the
year due to complications.
Scary Statistics
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The World Health Organization reported that 50% of
people with hip fractures become permanently disabled;
they expect the number of hip fractures due to
osteoporosis to triple by the year 2050, bringing the
worldwide total number of hip fractures to 6 million.
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The lifetime risk of fracture in a 50-year-old woman is
about 40%.