Nursing Continue Education

Osteoporosis / Reading and Sharing

Osteoporosis, defined by Ferris (2018), is “a skeletal disorder characterized by a progressive loss of bone mass and a decline in bone quality that results in increased bone fragility and a higher fracture risk” (p.925). As a musculoskeletal disorder characterized with bone fragility resulting in the increased risk for fractures, it is a condition that results in the reduction in the density of the bones, thereby leading to reduced bone strength (Rossini et al., 2016). This is what leads to the ease of bone fractures in patients suffering from osteoporosis. It is important to note that at the beginning stages of the condition, osteoporosis might not have any signs or symptoms, and, as such, it might pass unnoticed until one suffers a major fracture or becomes susceptible to more fractures. However, the common signs that are associated with osteoporosis include the occurrence of painful structure even with minimal stress, and a hunched back appearance that is as a result of several fractures to the spine (Rossini et al., 2016). Chronic back pain is also another symptom that can be associated with osteoporosis.

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The incidences and prevalence rates of osteoporosis, especially among women and the elderly, is a reason for concern. The International Osteoporosis Foundation estimates that nearly 200 million individuals worldwide are affected by osteoporosis (International Osteoporosis Foundation, 2016). In Japan, Europe and the USA, the foundation indicates that 75 million individuals have been diagnosed with Osteoporosis (International Osteoporosis Foundation, 2016). The condition affects more women than men. According to the International Osteoporosis Foundation (2016), 1 in 3 women that are aged above 50 years will be affected by an osteoporotic fracture as compared to 1 in 5 men. The National Osteoporosis Foundation estimates that at least 10 million Americans suffer from Osteoporosis (National Osteoporosis Foundation, 2016). Another 44 million Americans are at risk for osteoporosis as a result of having low bone density. In terms of costs healthcare spending on treating osteoporosis and osteoporosis bone related fractures is estimated to be $19 billion (National Osteoporosis Foundation, 2016).

The basic mechanism that is attributed to the onset of osteoporosis includes the accelerated loss of bone density and poor bone mass acquisition as one develops or grows. The bone density is determined by the bone amount that is present in an individual’s skeletal structure. A higher bone density indicates that the bones are stronger. Bone density is accumulated during the growth period until an individual reaches around 25 years. The peak bone density attained at 25 is maintained for a period of 10 years after which an individual will gradually lose about 0.3% or 0.5% of the bone density yearly (Rossini et al., 2016). This is part of the normal age process. Osteoporosis can occur as a result of poor bone density accusation before an individual attains the age of 25. This can be attributed to lack of proper minerals such as calcium required for bone building and strength or due to genetics. As highlighted, faster loss of bone density may also result in osteoporosis. Women are at a greater risk factor for the development of osteoporosis because of increased loss of bone density. After the first five years when a woman enters menopause, the level of estrogen begin to drop (Jeremiah et al, 2016). Because estrogen is crucial in maintaining an individual’s bone density, the reduction in the level of estrogen results in at least 2% loss of bone density in one year.

Osteoporosis is often without signs or symptoms, but is associated with kyphosis, loss of height, skeletal pain typically associated with fracture, or reduced gait speed or grip strength (Ferri, 2018). Risk factors for osteoporosis include advanced age, previous fracture, long-term glucocorticoid use related to the inability to absorb calcium, low body weight, tobacco use, excessive alcohol use, and chronic diseases such as diabetes, IBS, hyperthyroidism, androgen deficiency, and hypercortisolism (Ferri, 2018).

Osteoporosis is diagnosed using the patient’s medical history, physical examination and diagnostic tests. The medical history focuses on aspects such as the illnesses in the family and whether any one has ever been diagnosed with osteoporosis or suffered fractures (Jeremiah et al., 2016). The physical examination entails checking whether there are changes in the shape of the spine or the bones. In addition, checking for previous fractures in the body is also part of the physical examination for osteoporosis. The main test used in the diagnosis of the condition is the bone mineral density (BMD) test, which measure the hip or spine and reported as a T score (Ferri, 2018), that is used to estimate an individual’s bone strength (Jeremiah et al., 2016).

There are also a variety of assessment tools to use with your patient. The U.S. Preventive Services Task Force (2015) website provides links to the fracture risk assessment tool (FRAX) as well as the osteoporosis risk assessment instrument (ORAI). The gold standard diagnostic test is a dual-energy x-ray absorptiometry (DEXA) scan and is considered such due to its availability, low cost, and minimal radiation exposure (Ferri, 2018).

The U.S Preventive Services Task Force (2015) recommends that osteoporosis screening should occur in postmenopausal women, women aged 65 years and older, those with identified risk factors, and in younger women whose fracture risk is high. The FRAX tool can be used for women between the ages of 50 and 64, and if the 10-year major osteoporotic risk is greater than or equal to 9.3%, screening with DEXA scan in recommended (U.S. Preventive Services Task Force, 2015). Lab testing can include renal and hepatic function, metabolic profile, complete blood count, TSH, 24-hour urine calcium, and vitamin D level (Ferri, 2018).

The treatment for osteoporosis depends on the risk for bone fractures and injuries depending on the bone density. For individuals at low risk for bone fractures, treatment focuses on reducing the risk factors through means other than medication. However, for patients that are at a higher risk for bone breakage because of low bone density and strength, medications known as bisphosphonates are prescribed. These are medications that serve to increase the strength of the bone while at the same time preventing bone loss. Examples include alendronate, calcitonin, zoledronic acid, and risedronate (Jeremiah, 2016). Medications such as teriparatide that help in bone formation can also be prescribed for individuals at a higher risk for osteoporosis. Hormone related therapy is also another popular pharmacological intervention that is used in osteoporotic patients facing increased risks for bone fractures (Rossini et al., 2016). Estrogen can be started to help strengthen the patient’s bones if she is post-menopause. Supplements such as calcium can also be provided to reduce the progression of the condition.

Patient education focuses on reducing a patient’s risk for worsening of osteoporosis or experiencing fractures. Patient will be reminded not to smoke as it increases the rates of bone loss. Secondly, the patient will also be urged to avoid the consumption of alcohol as it decreases the formation of bones and may increase the risk for falls and bone breakage. Fall prevention information such as wearing low heeled shoes, avoiding slippery surfaces and modeling one’s area of living to be fall proof are also areas that will be emphasized (Rossini et al., 2016). Reputable websites may also provide photos, videos, demonstrations of exercises, and recipes to enhance knowledge, self-care skills, and promote engagement in the plan of care (Nguyen, 2016).

Follow up and evaluation should include a repeat health history, assessment of any new risk factors, and a physical assessment. Repeat bone density testing is based on the initial T score with advanced osteoporosis needing repeat DEXA scans annually, mild osteoporosis needing repeat screenings every three to five years, and normal bone density and mild osteoporosis needing repeat testing every ten to fifteen years (Ferri, 2018).

References

Facts and Statistics | International Osteoporosis Foundation. (2016). Retrieved from https://www.iofbonehealth.org/facts-statistics

Ferri, F. F. (2018). 2018 Ferri’s clinical advisor. Philadelphia, PA: Elsevier.

Jeremiah, M. P., Unwin, B. K., Greenawald, M. H., & Casiano, V. E. (2015). Diagnosis and management of osteoporosis. Am Fam Physician, 92(4), 261-268.

National Osteoporosis Foundation. (2016). Osteoporosis Fast Facts. Retrieved from https://cdn.nof.org/wp-content/uploads/2015/12/Osteoporosis-Fast-Facts.pdf

Nguyen, V.H. (2016). Osteoporosis knowledge assessment and osteoporosis education recommendations in health professions. Osteoporosis and Sarcopenia, 2(2016), 82-88.

Rossini, M., Adami, S., Bertoldo, F., Diacinti, D., Gatti, D., Giannini, S., … & Pedrazzoni, M. (2016). Guidelines for the diagnosis, prevention and management of osteoporosis. Reumatismo, 68(1), 1-39.

U.S. Preventive Services Task Force. (2015). Osteoporosis: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/osteoporosis-screening

 

 

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