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OSTEOPOROSIS Ann S. Goodson,R.N.,MSN,ONC Nurse Coordinator Pediatric Orthopedics University of Virginia Bone Is Living, Growing Tissue • CORTICAL BONE • TRABECULAR BONE Bone Cells 3 Types • OSTEOCLASTS • OSTEOBLASTS • LINING CELLS • OSTEOCYTES The Skeleton’s Function • • • • Support the body Protect internal organs Muscles attach for movement Mineral reservoir for Calcium and Phosphorus • Defense against acidosis • Trap for some dangerous minerals such as Lead. What is Osteoporosis? • OSTEO= BONE • POROSIS= FULL OF HOLES OSTEOPOROSIS IS A STEADY, PROGRESSIVE LOSS OF BONE DENSITY. OSTEOPOROSIS , THE “SILENT CRIPPLER” IS A PAINFUL BONE DISEASE THAT MAKES YOUR BONE GROW BRITTLE AND FRACTURE EASILY OSTEOPOROSIS • Re-absorption of bone cells slowly exceeds bone cell formation Schematic view of bone formation/re-absorption Risk Factors You Control Not Smoking Exercise Avoid alcohol Sex Hormones Medications Diet Risk Factors You Can Not Change • • • • GENDER ETHNICITY BODY SIZE AGE Exercise • Bone building exercises Walking Dancing Jumping rope Lifting weights Foods High in Calcium • DAIRY PRODUCTS • LEAFY GREEN VEGATABLES/BROCCOLI • SALMON ( WITH THE BONES IN) SARDINES • CALCIUM ENRICHED FOODS • ALMONDS Recommended Daily Calcium Intake for Males & Females AGE AMOUNT(milligrams per day) Birth-6 months 210 7 months-1 year 270 1-3 years 500 4-8 years 800 9-18 1300 19-50 1000 51-+ + + 1200 Pregnant & Lactating Same as for women of comparable age Diagnostics • Osteoporosis is preventable and treatable, therefore early diagnosis and treatment is important. • Most common technique is Dual Energy Xray Absorptiometry (DEXA scan) Precise measurement/high resolution Sensitive to changes Simple to perform, no pain or discomfort Less Radiation Consequences of Osteoporosis • • • • Vertebral Fractures Loss of height Acute and chronic back pain Morphologic changes *kyphosis *loss of waistline *protruding abdomen • Physiologic changes *Digestive function *Breathing difficulties • Increased mortality Consequences of Osteoporosis • Nonvertebral fractures (Examplehip,wrist,arm) • Pain • Loss of independence • Possible entry in a nursing home • Surgical complications MEDICATIONS Antiresorptive Agents Name of Medication Description Function Estrogen Replacement Therapy (ERT) 0.625 mg recommended for women that have had hysterectomy or oophorectomy before age of 50 ERT helps reduce osteoclast activity which results in a slower rate of bone loss and increased bone mass in the spine and hip Alendronate & Risendronate •Biophosphonates used in the treatment of bone loss associated with the use glucocorticords. •Dosage depends on useprevention and treatment •Decrease bone loss •Increase bone density Raloxifine •Selective estrogen receptor modulator –produce similar benefits as ERT without the side effects •Reduces the risk of spinal fractures •Encourages the bone density throughout the body Calcitonin-salmon •Synthetic compound identical to calcitonin found in salmon •Slow bone loss by binding to orthoclase •Increase spinal bone mass •Reduce risk for spinal fracture in postmenopausal women Demystifying Calcium Supplements • Calcium supplements-1000-1500 mg per day • Taken in doses not > 500 mg at a time • Elemental calcium Calcium carbonate Calcium citrate Calcium Phosphate • Vitamin D-is essential for Ca absorption Nursing Guidelines for Osteoporosis Prevention • Promote widespread patient and public education regarding osteoporosis • Encourage safe physical activity Discourage smoking and excessive alcohol consumption • Promote achieving and maintaining a healthy body weight and life styles • Investigate safe hormone replacement therapy • Fall and Injury Prevention THANK-YOU!