Bones are living tissues that are constantly changing. They are composed of collagen, calcium phosphate and calcium carbonate. Osteoporosis is a disease where bones become brittle and fragile from loss of tissue, often due to calcium or bone mineral deficiency or lack of bone formation. It can cause bones to fracture from minor falls or injuries. Risk factors include age, gender, family history and medications like steroids. Diagnosis involves bone density tests and x-rays. Treatment focuses on prevention with calcium, vitamin D and medications to slow bone loss such as bisphosphonates.

1. Kim Harper

2. Definition:
• Osteoporosis means “porous bone”. Too little
bone formation and excessive bone loss, or
both. This leads to fragile bones.- National Library
of Medicine.
• It is a common disorder of the skeletal system.

3. Bones
• Babies at birth have approximately 300 bones
• Adults have 206 bones.
• Bones stop growing at approximately 25 years of age.
• Collagen (a protein with flexible framework) is what bones
are made of.
• Calcium phosphate and calcium
carbonate are minerals designed
to strengthen and harden the bones.
–emedicineHealth
• Calcium and collagen give strength
and flexibility to the bone.

4. The skeleton is made
of many bones.
These bones play an
important role in giving
the body structure.
They also protect
internal organs.
Bones in the human
body are constantly
changing.

5. Most bones are made up of composite materials:-
• # Outer surface- periosteum which is thin and
dense
• # next layer- consists of compact bone which is
smooth and very hard. This is what we see as a
skeleton here.
• Compact bone is a bone that is smooth and very
hard.

6. • There are many layers of cancellous within the
compact bone. It is spongy-like and softer
than compact bone but remains strong.
• This protects the inner most section of the
bone (bone marrow)
which is thick
and jelly-like
and produces
blood cells.

7. Causative agents of the disease
Every day, adults lose bone minerals (resorbtion)
which needs to be replaced to keep bones
strong.
Over time the bones weaken (Osteopenia) and
become brittle leaving the bones prone to
fractures which brings the onset of
Osteoporosis.
Normally caused as a
result of a fall.

8. Signs & Symptoms of the disease
• Hip or knee or lower back pain
• Inability to stand or walk
• Bruising and swelling
• Foot turned out on an odd angle making one
leg look shorter than the other
• fracture Diagnosed by an X-ray, Magnetic
resonance imaging (MRI) or Computerised
Tomography Scan (CT)

9. Forms of osteoporosis;
oestrogen deficiency and calcium deficiency & aging of the skeleton.
Osteoporosis is the leading cause of a hip fracture –
Femural neck fracture cuts off blood supply to the head of the femur
which form the hip joint.
Intertrochanteric hip fracture below the neck of the femur.

10. Some Risk Factors
Age
Female gender
Family history
Previous fracture
Ethnicity
Menopause/hysterectomy
Rheumatoid arthritis
Low testosterone levels
Glucocorticoid Steroids
Alcohol
Smoking
Low body mass index
Poor nutrition
Vitamin D deficiency
Eating disorders
Insufficient exercise
Low dietary calcium intake
Frequent falls

11. Treatment
• There is no cure for osteoporosis therefore the
main focus is upon management and
treatment of the condition.
• Medication is one step in preventing the
progress of the condition.
• Calcium and Vitamin D are important
preventative measures for the condition

12. 1. Bone density test
• 15-20 minute test that measures the density of your spine
and hip bones ordered by a General Practitioner.
• The body lies flat on a padded table and the arm of the
machine passes over the body to
perform the scan.
• It indicates if the bones in your
body are normal, low bone density
(osteopenia) or if osteoporosis is present.
• It gives a T-test Normal is 1 to -1, -1 to 2.5 osteopenia, -2.5
or lower osteoporosis therefore very high risk of fractures
(Osteoporosis Australia).

13. • This is a computerized image of the hip and pelvic region
to determine pelvic fractures without having to make an
incision. • Generally
ordered by
a doctor,
post a fall,
and performed
by a
radiologist.
(B. Kran, no date,
Healthline)
2. Xray studies:

14. • According to ‘Better health Channel’ a full
blood count test is ordered by a doctor to help
diagnose a broad range of illnesses, infection
and diseases.
3. Full Blood Count (FBC):

15. Sample ‘Care Plan’ - nursing diagnosis, expected
outcomes, planning and implementation
Nursing Diagnosis Goal Strategies/Implementation
1) Actual Problem 1
Fracture
To maintain fracture as much
as possible to help bring the
fracture back to baseline
# Monitor vital signs
# Maintain skin integrity e.g
wound management
# Ongoing physiotherapy
# Monitor diet and maintain
good food and fluid intake e.g
# Monitor for signs of infection
# Regular pressure area care
# Monitor medication intake
# Occupational therapist
intervention for preparing for
discharge arrangements

16. Nursing Diagnosis Goal Strategies/Implementation
2)Actual Problem 2
Decreased mobility
To improve mobility back to
baseline
# Physiotherapy intervention
# Maintaining good food and
fluid intake. Ensure patient is
getting adequate calcium and
Vitamin D
# Offer pain relief prior to
ambulating
# Encourage mobility as per
physiotherapy plan

17. Nursing Diagnosis Goal Strategies/Implementation
1) Potential problem 1
Pressure areas
To maintain pressure area care to
prevent pressure sores
# Regular pressure area care
# Monitor/Maintain skin
integrity
# Referral to a dietician
# Education to pt and carers -
prevent pressure areas
# Monitor vital signs
# Maintain a prevent pressure
injury management plan
# Occupational Therapist and
Physiotherapist review
# Appropriate manual
handling techniques eg slide
sheets , remove draw sheets,
lower the bed head prior to
repositioning.
# Check tubes regularly
# Attend risk assessment

18. Nursing Diagnosis Goal Strategies/Implementation
2) Potential problem 2
Delirium
To understand why the
patient is delirious and treat
the condition
# Inform RN, MO
# Delirium assessment
# Check medical history
# Do a Mini Mental Status
Exam (MMSE)
# Monitor vital signs
# Check pt pain level 1-10
# Consider the environment,
# Obtain a U/A and MSU,
urinary output, colour, odour
bowel habits
# Social problems,
# Supportive bedside manner

19. Nursing Diagnosis Goal Strategies/Implementation
3) Potential problem 3
Depression
Monitor depression level # Inform RN, MO, SW.
# Use appropriate bedside
manner to provide care and
support to the patient
(written and verbal)
# Maintain close observation
of pt, Is the pt in a delirium
post fall, does the pt have
delirium or dementia
# Encourage activity
involvement by referring pt
to Diversional Therapist
# Check patient history
# Encourage family
involvement
# Check patient’s medications
# Offer counselling
# Referral to a mental health
consultant

20. Additional nursing procedures
which may be relevant.
• management and use of calf compressors normally on pt post operatively
• Us e of Thromboembolic deterrent stocking (TED) used for anti coagulation,
prevent DVTs
• Referral to physio straight away for immediate rehab
• Encourage deep breathing and coughing exercises to help clear the chest and
lung and to prevent the body for getting other medical conditions like
pneumonia
• Does the patient have a catheter in post surgery? Management of a catheter.
• Diet post surgery eg HPHE, dietician referral,
• Limb observations
• Circulation observations
• Neurological observations
• Ordering of a pressure mattress
• Fluid balance chart
• Bowel chart
• Review pain relief
• P’t may be on IV fluids. Management of p’t on IV fluids check the cannula site
etc.

21. Common medications that may be used for a
patient with this disorder.
Check for any allergies to medications prior to
administration
• Bisphosphonates eg: Risedronate (Actonel):
A type of drug that prevents the loss of bone mass
• Opioid eg: Endone
A painkiller containing the active ingredient
Oxycodone hydrochloride

22. Possible impact that hospitalisation could have on both
the patient and carer.
May impact on the social, emotional, psychological, financial and physical
welfare of both patient and carer eg:
Patient:
• Loss of independence.
• Impacts on ability to attend to own ADL’s.
• Separation from family/familiar carer
• Risk of infection
• Polypharmacy eg: some medications may cause constipation or
diarrhea
Carer:
• Carer may be required to deliver more assistance
• Travelling to visit patient can be costly & tiring
Both patient and carer:
• Anxiety, Agitation, Depression, Loss of appetite
• Isolation effects mood

23. Possible ‘discharge planning requirements’ – including patient
education, follow up appointments, available community services if
required.
• Assessment of need--- consider: Age, medical history, physical condition,
personal circumstance
• Self care assessment prior to discharge to see if patient can care for self
eg shower, nutrition (dietitian)
• Rehabilitation arrangements eg: hydrotherapy, physiotherapy,
occupational therapy
• Falls prevent program for pt and carer . Program called ‘Stepping On’
referred by physio and it focuses on falls prevention e.g footwear, eyewear
• Follow up: outpatients clinic, Psych/Social worker
• Wound management education and information
• Transport arrangements eg Community transport, taxi vouchers
• Home care services eg: home help. Meals on wheels, shopping, respite
care
• Pharmacy arrangements eg: scripts and a patient understanding of the
medications that they will be taking
• Mobility assessment eg managing stairs at home etc.
Arrange mobility aids eg: 4 wheel walker

24. Quick Quiz
1. Name some of the signs & symptoms of
Osteoporosis.
2. Name one form of Osteoporosis.
3. Name 3 risk factors for Osteoporosis.
4. What are the 2 tests commonly used to
detect/confirm Osteoporosis?
5. Is there a cure for Osteoporosis?

25. References
• The University Of Chicago Medicine (2015). Accessed on 07/06/2015
• http://www.uchospitals.edu/online-library/content=P08957
• International Osteoporosis Foundation. (2015). Accessed on 07/06/2015
• http://www.iofbonehealth.org/pathophysiology-biological-causes-osteoporosis
• What Is Osteoporosis and How It Affect Bones (2014). Accessed on 07/06/2015
• https://www.youtube.com/watch?v=OeDDteAEMkk
• What Is Osteoporosis – Definition, Causes, Treatment (2015). Accessed on
07/06/2015
• https://www.youtube.com/watch?v=XoL1z8jjsp4
• Teach PE. Anatomy & Physiology of the bone- Bone Structure. Accessed
01/07/2015
• http://www.teachpe.com/anatomy/bone_structure.php
• The Journal of Clinical Investigation: J Clin Invest. (2005);115(12):3318-3325. Doi:
10.11772/JCI27071
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297264/
• The Nemurs Foundation. (1995-2015). Kids Health. Accessed 01/07/2015
• http://kidshealth.org/kid/grownup/conditions/osteoporosis.html

26. • Lister Hill National Center for Biomedical Communications Accessed
01/07/2015
• U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda, MD
20894
• National Institutes of Health, Department of Health & Human Services.
Taylor & Francis (2007).
• http://openi.nlm.nih.gov/detailedresult.php?img=2771707_copd-4-
365f2&req=4
• Osteoporosis Australia.(2014). Accessed on 01/07/2015
• http://www.osteoporosis.org.au/diagnosis
• Your Guide to Recovery After A Fractured Hip Repair (2008). Accessed
02/06/2015
• http://www.trilliumhealthcentre.org/programs_services/neurosciences_m
usculoskeletal_services/mississauga/documents/Fractured_hip_patient_in
formation_booklet_April2008FINAL.pdf
• Lecture Notes And Resource Kit, Poole’s Algorithim Nursing Managenet of
Disturbed Behaviour in Aged Care Facilities (2009). Accessed on
10/06/2015
• http://www.dementia-
assessment.com.au/flowcharts/pooles_algorithm_full.pdf