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"POROUS BONES“from Greek: οστούν/ostoun meaning

"bone" and πόρος/poros meaning "pore"

KERSTIN KAREN VICENTE, RN

A condition of skeletal fragility characterized by compromised bone strength predisposing to an increased risk of fracture

ASSESSMENT

Age/Gender

Race

Lifestyle/Diet

Personal/family history of fractures

Height

Spinal curves

DIAGNOSTICS

Dual-Energy X-Ray Absorptiometry (DEXA)

Measures bone mineral density which can be determined from the absorption of each beam by bone

Ultrasound

Transmits painless sound waves through the heel of the foot to measure bone density. Heel bone - a weight bearing bone with a high incidence of trabecular bone and is on the

same axis as the hip joint.

Alkaline phosphatase (AST)

Elevates following a fracture, and serum bone Glaprotein (osteocalcin), marks of osteoclastic activity.

This test is most useful to evaluate the effects of treatment, rather than as indicator of the severity of the disease.

INCIDENCE

Incidence

Awareness of osteoporosis in the Philippines was one of the lowest when compared to other Asian countries in the mid 1990s.

Ten years later, awareness of the disease has moved one level higher.

Incidence

The National Osteoporosis Foundation (2006)

10M people have osteoporosis34M have low bone mass80% are women

Phil.Population: 96M. Over 60 yo: 6.0 to 6.7% (6M) of population

It is expected to increase to 110 million by 2020 and 146 million by 2050.

Incidence

1:2 women1:4 men

Over age 50 will have an osteoporosis related fracture

PATHOPHYSIOLOGY

Male Female

↓Testosterone

Menopause

↓ Estrogen

↓Ca absorption

↓Thyroid stim↓Calcitonin

↑Osteoclast

↓Osteoblast

↓

Race

↓Pigmentation

↓Bone mass

Europeans

Americans

Asians

Endocrine Disorders

Hyperthyroidism

Hyperparathy

Cushing’s DM

↓Bone minerals

Age

↓BMD

Smoking

Vasoconstriction Impaired cell absorption

↓Blood supply

↓Osteoblast

↓Bone density

Lifestyle

Female athletes

Eating disorder

s

Amenorrhea

↓Estrogen Nutritional deficiency

Sedentary

Minimal blood flow to bones

↓Nutrients

Alcohol

Moderate

↑Estrogen&Calcium

↑Bone mineral content

Intoxication

Suppressed bone

formation

Diet

Removal of ca from skeleton

↑ Phosphate

↑ Protein↓ Ca

Weakened bone tissue

Acidosis

Attempts to buffer

excess acid

Osteoclast formation

Medication

Corticosteroids Heparin

Affects calcium & sex

hormones

Aluminum containing antacids,

Anti-convulsants

↑ Resorption

↑Ca excretionBone

density loss

↑BONE RESORPTION

↓BONE FORMATION

Susceptible to fractures

Thinner outer supporting

cortex

Diameter of bone enlarges

Wedging & collapse of vertebrae

Kyphosis↓Height

Dowager’s hump

TYPE I

Post menopausalSenile

PRIMARY

TYPE II

DrugsDiseases

SECONDARY

NURSING DX

Acute painrelated to compression of vertebral spine secondary to osteoporosis

Imbalanced nutrition: less than body requirements related to inadequate calcium intake

Risk for injury related to bone fragilitysecondary to osteoporosis