Download Osteoporosis

Osteoporosis
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Osteoporosis
Chronic, progressive metabolic bone
disease characterized by
 Porous bone
 Low bone mass
 Structural deterioration of bone tissue
 Increased bone fragility
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Osteoporosis
At least 10 million people in the
United States have osteoporosis
One in two women and one in eight
men over 50 will sustain an
osteoporosis-related fracture
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Osteoporosis
Eight times more common in
women than men for several
reasons
1. Lower calcium intake than men
2. Less bone mass because of smaller
frame
3. Bone resorption begins earlier and
accelerates after menopause
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Osteoporosis
More common in women than men
(cont’d)
4. Pregnancy and breastfeeding deplete
woman’s skeletal reserve of calcium
5. Longevity increases likelihood of
osteoporosis; women live longer than
men
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Etiology
Risk factors
 Female gender
 Increasing age
 Family history
 White or Asian ethnicity
 Small stature
 Early menopause
 Excess alcohol intake
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Etiology
Risk factors (cont’d)
 Cigarette smoking
 Anorexia
 Oophorectomy
 Sedentary lifestyle
 Insufficient calcium intake
 Low testosterone levels in men
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Etiology and Pathophysiology
Peak bone mass is achieved before
age 20
 Peak mass determined by heredity,
nutrition, exercise, and hormone
function
Bone loss after midlife is inevitable
but rate of loss is variable
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Normal vs. Osteoporotic Bone
Fig. 64-10
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Etiology and Pathophysiology
In osteoporosis, bone resorption
exceeds bone deposition
Occurs most commonly in spine,
hips, and wrist
Many drugs can interfere with bone
metabolism
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Etiology and Pathophysiology
Diseases associated with osteoporosis
• Intestinal malabsorption
• Kidney disease
• Rheumatoid arthritis
• Hyperthyroidism
• Chronic alcoholism
• Cirrhosis of the liver
• Hypergonadism
• Diabetes mellitus
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Collaborative Care
Focus on proper nutrition, calcium
supplements, exercise, prevention of
fractures, and drugs
Prevention and treatment depend on
adequate calcium intake
Increased calcium prevents future
loss but will not form new bone
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Collaborative Care
Good sources of calcium
 Milk
 Yogurt
 Turnip greens
 Spinach
 Cottage cheese
 Ice cream
 Sardines
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Collaborative Care
Poor sources of calcium
 Eggs
 Beef
 Cream cheese
 Poultry
 Pork
 Apples and bananas
 Potatoes and carrots
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Collaborative Care
Supplemental vitamin D may be
recommended
Weight bearing exercise should be
encouraged to build up and maintain
bone mass
Patients should be instructed to quit
smoking or cut down on alcohol intake to
decrease loss of bone mass
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Diagnostic Studies
History and physical exam
Bone mineral density (BMD)
Quantitative ultrasound
Dual-energy x-ray absorptiometry
(DEXA)
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Diagnostic Studies
Osteoporosis is a BMD of at least 2.5
standard deviations below that of a
young adult BMD
Osteopenia is more than normal
bone loss but not yet at the level of
osteoporosis
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Clinical Manifestations
Often termed the “silent disease”
because there are no symptoms
Since no symptoms, the usual first
signs are back pain and spontaneous
fractures
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Clinical Manifestations
Manifestations include
 Sudden strain
 Fractures
 Back pain
 Loss of height
 Spinal deformities (Dowager’s hump)
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Collaborative Care
Drug therapy
 Estrogen replacement after menopause
 Calcitonin
 Bisphosphonates inhibit osteoclastmediated bone resorption
(e.g., etidronate (Didronel),
alendronate (Fosamax)
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Collaborative Care
Drug therapy (cont’d)
 Selective estrogen receptor modulators
• Raloxifene (Evista)
 Teriparatide (Forteo)
• Portion of parathyroid hormone
• First drug to stimulate new bone
formation
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Osteomalacia
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Osteomalacia
A rare condition of adult bone
associated with Vitamin D
deficiency, resulting in
decalcification and softening of bone.
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Etiologies
Lack of exposure to sunlight
GI malabsorption
Extensive burns
Chronic diarrhea
Pregnancy
Kidney disease
Dilantin (phenytoin)
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Symptoms
Localized bone pain
Difficulty rising from a chair
Difficulty walking
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Treatment
Increase vitamin D and calcium
intake, either dietary or
supplemental
Increase exposure to sunlight
Weight bearing exercise
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Paget’s Disease
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Paget’s Disease
A skeletal muscle disorder in which
there is excessive bone resorption
followed by replacement of normal
marrow by vascular, fibrous
connective tissue
The new bone is larger and weaker
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Incidence
Men affected 2:1 over women
Rarely seen in men under age 40
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Etiology
Unknown
Possible viral cause
Probable genetic component
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Clinical Manifestations
In milder form, none
Common early symptom – bone pain
Fatigue
Waddling gait
Loss of height
Increased head size
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Complications
Pathological fractures (may be a first
sign of disease)
Bone tumors
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Diagnostic Testing
Elevated alkaline phosphatase in
advanced disease
X-ray abnormalities
Bone scan shows increased uptaake
in affected bones
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Collaborative Care
Symptomatic and supportive
Correction of secondary deformities
by surgery or braces
Calcitonin and osteoporotic drugs
can slow bone resorption
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Collaborative Care
Firm, supportive mattress
Corset or back brace
Teach patent to minimize activities
that involve lifting or twisting, to use
good body mechanics
Diet high in calcium and vitamin D
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