OSTEOPOROSIS
Ratheesh R L

DEFINITION
A medical condition in which the bones
become brittle and fragile from loss of
tissue, typically as a result of hormonal
changes, or deficiency of calcium or
vitamin D.

CAUSES
• The strength of bone depends on their size
and density : bone density depends in part
on the amount of calcium , phosphorous and
other minerals bones contains.
• When the bones contains fewer minerals than
normal , they are less strong and eventually
lose their internal supporting structure.

RISK FACTORS:-
• SEX:- Fractures from osteoporosis are about
twice more in women than in men . Risk in
women at menopause(45yrs) that
accelerates bone loss. Risk in men is greater
than age 75
• AGE:-The older, The higher risk of
osteoporosis . Bones become weaker as ages.
• RACE:-Greatest risk – White or of South-
East Asian descent . Black men and women
have less risk.

• FAMILY HISTORY:-Osteoporosis runs in
families.
Parent or siblings with osteoporosis puts at
greater risk , especially if having a family history
of fractures.
• FRAME SIZE :- Men and women who are
exceptionally thin or have small body frames
tend to have higher risk because they may have
higher risk because they may have less bone
mass to draw from as they age.
• LIFETIME EXPOSURE TO ESTROGEN:-The
greater a woman’s lifetime exposure to
estrogen , the lower her risk of osteoporosis.

• EATING DISORDERS:-Women and Men
with anorexia nervosa or bulimia are at
higher risk of lower bone density in their
lower backs and hips.
• THYROID HORMONE :-Too much of
thyroid hormone can cause bone loss.
• OTHER MEDICATIONS :- Long term use of
the blood thinning medication, the cancer
treatment drug , some anti-seizure
medications and aluminum containing
antacids also can cause bone loss.

• BREAT CANCER:- Postmenopausal women who
have had breast cancer are at increased risk of
osteoporosis , especially if they were treated
with chemotherapy( which suppresses estrogen)
• LOW CALCIUM INTAKE :-A lifelong lack of
calcium plays a major role in the development
of osteoporosis.
• MEDICAL PROCEDURES THAT DECREASES
CALCIUM ABSORPTION:-Stomach surgery can
affect the body’s ability to absorb calcium.

• SEDENTRY LIFESTYLE :-Bone health begins
in childhood . Children who are physically
active and consume adequate amount of
calcium-containing foods have the greatest
bone density . Exercise throughout life is
important , but can increase bone density at
any age.
• EXCESS SODA CONSUMPTION:-The link
between osteoporosis and caffeinated soda
isn’t clear , but caffeine may interfere with
calcium absorption and its diuretic effect
may increase mineral loss.

PATHOPHYSIOLOGY
• Scientists have yet to learn all the reasons
why this occurs, but the process involves
how the bone is made . Bone is
continuously changing – new bone is made
and old bone is broken down - a process
called remodeling or bone turnover.
• A full cycle of bone remodeling takes 2-3
months.
• In young – the body makes new bone
faster than it breaks down old bone , and
the bone mass increases.

• Reaches the peak bone mass in mid- 30’s
• After that , bone remodeling continues, but loses
slightly more than it gains.
• At menopause, when estrogen level drop, bone
loss increases dramatically.
• Many factors contribute to bone loss, the leading
cause in women is decreased estrogen production
during menopause.

• Risk of developing osteoporosis depends
on
How much bone mass attained during ages
25-35 (peak bone mass) and how rapidly
loses it rapidly, The higher peak bone mass
, the more bones “in the bank” and less
likely to develop osteoporosis as ages .
• Not getting enough vitamin D and
calcium in the diet may lead to a lower
peak bone mass and accelerated bone
loss later.

SIGNS AND SYMPTOMS
• There typically are no symptoms in the early
stages of bone loss. But once your bones have
been weakened by osteoporosis, you may
have signs and symptoms that include:

• Back pain, caused by a fractured or
collapsed vertebra
• Loss of height over time
• A bone fracture that occurs much more
easily than expected
• Kyphosis

DIAGNOSIS
• HISTORY COLLECTION
• PHYSICAL EXAMINATION
• The best screening test is dual energy X-ray
absorptiometry (DEXA)- measures the
density of bone in the spine, wrist , hip ,
and is used to accurately follow changes in
these bones over time .

• X Ray
• Blood studies- calcium, phosphorous and
alkaline phosphatase
• CT Scan
• MRI Scan

Treatments and Drugs
• Hormone therapy (HT):- estrogen
• Prescription Medications:- Bisphosphonates,
selective estrogen receptor modulators
(SERM’S) , Calcitonin
• Calcium and vitamin supplimentation.
• Proper nutrition and exercise of the patient

ESTROGEN AND BONE
PROTECTION
• Estrogen is essential for
healthy bone, and that
when the production of
estrogen is reduced (in
postmenopausal women
and exposure to
radiation or
chemotherapeutic drugs
)bones become brittle
and break easily .
However the
mechanisms involved
aren't clearly
understood.

PREVENTION
• Do exercise such as walking , running ,
skipping rope , jogging regularly.
• Add soy in diet – plant estrogen found in
soy helps to maintain bone density and
reduce the risk of fracture.
• Avoid smoking , it can reduce the level of
estrogen and increases bone loss.
• Avoid excessive alcohol.
• Avoid caffeine , which is very harmful.
• Consider hormone therapy.

NURSING MANAGEMENT
• Assess the condition
• Closely monitor the weight
• Advocate the patient for daily activities
• Advice to avoid hard activities
• Provide nutritional diet
• Maintain I/O chart

OSTEOMALACIA

definition
• Is a rare condition of adult bone associated
with Vit D deficiency resulting in
decalcification and softening of bone

etiology
• Lack of exposure to ultraviolet rays
• GI malabsorption
• Extensive burns
• Chronic diarrhea
• Pregnancy
• Kidney disease
• Drugs such as phenytoin

pathophysiology
insufficient vit D intake
Interfere with normal mineralization of bone
Failure or insufficient calcification of bone
bone softening

Clinical features
• Localized bone pain
• Difficulty rising from a chair
• Difficulty walking
• Low back and bone pain
• Weight loss
• Progressive muscular weakness
• Progressive deformities of the spine(kyphosis)
or extremities
• Fractures are common and demonstrate

Diagnostic measures
• HISTORY COLLECTION
• PHYSICAL EXAMINATION
• BLOOD STUDIES
• Decreased S. calcium and phosphorus levels
• Decreased S. 25 hydroxy vitamin D
• Elevated S. alkaline phosphatase
• X-RAY
• CT SCAN AND MRI SCAN

management
• Correction of vit D deficiency
• Vit D3 ( cholecalciferol) and vit D2
(ergocalciferol) can be supplemented
• Calcium salts or phosphorus supplements can
be prescribed
• Dietary ingestion of eggs, low fat milk, fish
and vegetables is encouraged
• Exposure to sunlight