Essay On Osteoporosis

Osteoporosis is a chronic condition in which bone loss causes a decrease in density and possible fracture. The spine, hip, and wrist are most often the bones that fracture, although any bone can fracture. Bone is tissue that is constantly undergoing changes in a process referred to as bone remodeling. Bone remodeling is defined as where bone tissue is removed from the skeleton and new bone tissue is formed. Osteoporosis occurs when osteoclast cells are more active than osteoblast cells. This results in a decreased bone mineral density, which determines bone strength. Bone mineral density decreases rapidly in postmenopausal women as the estrogen level decreases, which helps prevent bone loss. Spongy bone is often lost first, then followed by compact bone.

Osteoporosis is classified as generalized or regional. Generalized osteoporosis is divided into two sub-categories, primary and secondary. Primary osteoporosis is more common and occurs in postmenopausal women and in men in their seventies or eighties. Secondary osteoporosis may result from other medical conditions. Examples of causes of secondary osteoporosis are hyperparathyroidism, long term drug therapy, use of corticosteroids, or prolonged immobility. Regional osteoporosis occurs when a limb is immobilized related to a fracture, injury, or paralysis. Immobility for longer than eight to twelve weeks can result in regional osteoporosis.
When assessing a patient, health history with an assessment of risk factors is important in the prevention, early detection, and treatment of osteoporosis. When performing a musculoskeletal assessment, inspect and palpate down the vertebral column. Kyphosis of the dorsal spine is often present. The patient may have back pain after lifting, bending, or stooping. The pain is acute in onset and may be sharp. Pain is worse with activity, but is often relieved by rest. Palpation of the vertebrae can increase the patient’s discomfort, therefore palpation should be gentle. Ask the patient to locate all areas that are painful and observe for signs and symptoms of fractures such as swelling and malalignment.

A psychosocial assessment is important as well. Women often associate osteoporosis with menopause, getting older, and becoming less independent. The disease can affect the patient’s well-being and life satisfaction. Socialization may be avoided because of a change in appearance or the physical limitations. Changes in sexuality may occur as a result of poor self-esteem or the discomfort caused by positioning during intercourse. The threat of a fracture can cause anxiety and fear and result in further limitation of social or physical activities. Assess for these feelings to aid in treatment decisions and health teaching.

Interventions are important and often include nutritional therapy, exercise, lifestyle changes, and drug therapy. The nutritional considerations for the treatment of a patient with osteoporosis are the same as those for preventing the disease. Teach patients about adequate amounts of protein, magnesium, vitamin K, and trace minerals that are needed for bone formation. Calcium and vitamin D intake should be increased. Excessive alcohol and caffeine consumption should be avoided. For the patient who has sustained a fracture, adequate

intake of protein, vitamin C, and iron is important to promote bone healing. Exercise is important in the prevention and management of osteoporosis. It also plays a vital role in pain management, cardiovascular function, and an improved sense of well-being. Exercises for strengthening the abdominal and back muscles are important for those at risk for vertebral fractures. Encourage active range of motion exercises which improves joint mobility and increases muscle tone. Teach patients that walking for thirty minutes three to five times a week is the single most effective exercise for osteoporosis prevention. The health care provider may prescribe calcium and vitamin D3 supplements, bisphosphonates, or estrogen agonist/antagonist or a combination of several drugs to treat or prevent osteoporosis. Teach patients to take calcium supplements with food and with six to eight ounces of water as well as for women to start taking supplements in young adulthood to assist in maintaining peak bone mass. Because vitamin D is needed for calcium absorption by the body, vitamin D supplementation is often indicated. Remind patients to take these drugs under the supervision of a health care provider because hypercalcemia can occur and cause serious damage to the urinary system and other body systems. Bisphosphonates, the most common drug used for osteoporosis, slow bone resorption by binding with crystal elements in bone, especially spongy bone tissue. Common bisphosphonates are alendronate, ibandronate, and risedronate. After taking any of these drugs for three years, the patient needs a DXA scan to determine if bone density has been maintained or has improved. Oral bisphosphonates are often associated with esophagitis especially when the tablet is not completely swallowed. Educate patients to take bisphosphonates early in the morning with eight ounces of water and wait thirty to sixty minutes in an upright position before eating. Estrogen agonist/antagonists are a class of drugs designed to mimic estrogen in some parts of the body while blocking its effects elsewhere. Raloxifene is currently the only approved drug in this class and is used for prevention and treatment of osteoporosis in postmenopausal women. Raloxifene increases bone mineral density, reduces bone resorption, and reduces the incidence of vertebral fractures. A newer drug, denosumab is a monoclonal antibody that has been approved for treatment of osteoporosis when other drugs are not effective. The drug binds to a protein that is essential for the formation, function, and survival of osteoclasts and is given subcutaneously twice a year. By preventing the protein from activating its receptors, the drug decreases bone loss and increases bone mass and strength.