Osteoporosis is a disease that affects bones and occurs when the internal structure of a person’s bone becomes increasingly porous (Akkawi & Zmerly, 2018). It reduces the bone’s resistance to resisting fractures and tension, increasing the risk of breaking, compressing, and otherwise receiving damage (Akkawi & Zmerly, 2018). This disease is increasingly common in the US and the world, with approximately 54 million US citizens being affected by it (Yedavally-Yellaty et al., 2018). The purpose of this paper is to review the common symptoms, treatments, diagnostics, as well as matters concerning prevention and patient education.
Common Symptoms
Common symptoms of osteoporosis are few and are generally easy to identify. The primary indicators include back pain and a loss of height over time – this condition is caused by fractured and collapsing vertebrae (Rossini et al., 2016). As a result of the progression of the disease, individuals tend to have a stooped posture. Finally, osteoporosis results in increased vulnerability toward fractures, resulting in frequent trauma (Rossini et al., 2016).
Recommended Diagnostic Tests
The primary method to diagnose osteoporosis is the bone density test (BDT), which may be ordered by the treating physician following a fracture (Rossini et al., 2016). It is commonly performed using DXA (dual-energy x-ray absorptiometry) machines and measures the mineral density of bones (Rossini et al., 2016). Some of the common tests run as part of the BDT include bone x-ray as well as CT and MRI scans of the spine (Rossini et al., 2016). These measures allow for the detection of osteoporosis, evaluate the stage it is in, and assess the likelihood of fractures occurring.
Common Treatments
Osteoporosis is typically treated with medications that aim to address various aspects of the disease in a particular patient. Bisphosphonates, such as Alendronate or Risedronate, are given to patients with an increased risk of fractures (Akkawi & Zmerly, 2018). Monoclonal antibody medications, such as Denosumab, provide effects similar to bisphosphonates, improving the overall bone density and reducing the chances of fracture (Akkawi & Zmerly, 2018). Hormone-related therapy, utilizing estrogen or testosterone, allows for improving bone density in patients with naturally low levels of either and is frequently implemented in older patients (Akkawi & Zmerly, 2018). Finally, bone-building medications, such as Teriparatide or Romosozumab, stimulate new bone growth, which is useful in augmenting other treatments (Akkawi & Zmerly, 2018). Should the patient’s osteoporosis levels be manageable, medication treatments can be avoided altogether in favor of healthier diets, exercising, and avoiding falls.
Options for Primary Prevention
Primary prevention of osteoporosis is possible and lies with the adoption of a healthy lifestyle. Some of the suggestions include having a healthy diet with plenty of calcium-rich foods and vitamin D (Yedavally-Yellaty et al., 2018). These include fruits, vegetables, and whole grains, which contain the required elements. Additional prevention interventions can be aimed at reducing smoking and limiting alcohol and caffeine consumption (Yedavally-Yellaty et al., 2018). Finally, practicing sports and performing weight-bearing and strength-training exercises can reduce the risk of osteoporosis (Yedavally-Yellaty et al., 2018).
Patient Education
Patient education on osteoporosis should focus on preventative measures as well as necessary treatments associated with old age. Preventative advice is to offer strategies for healthy dieting and exercise (Rossini et al., 2016). Medication info must include the list of drugs that could be prescribed, their doses, and times of administration. Finally, nurses should provide fall-prevention information and practice to patients, with a specific focus on fall safety measures at home (Rossini et al., 2016). According to statistics, over 80% of osteoporosis-related fractures happen at home due to a loss of balance (Rossini et al., 2016). The informational pamphlets should contain a list of approved sources where patients can find information on their own. Comprehensive patient education can increase the effectiveness of treatments and reduce the effects of the disease on the general populace.
References
Akkawi, I., & Zmerly, H. (2018). Osteoporosis: Current concepts. Joints, 6(2), 122-127.
Rossini, M., Adami, S., Bertoldo, F., Diacinti, D., Gatti, D., Giannini, S.,… & Isaia, G. C. (2016). Guidelines for the diagnosis, prevention and management of osteoporosis. Reumatismo, 68(1), 1-39.
Yedavally-Yellayi, S., Ho, A. M., & Patalinghug, E. M. (2018). Update on osteoporosis. Primary Care, 46(1), 175-190.
The priority concept in this scenario is to examine Osteoporosis in M.S after she complained of pain in her upper back. The pathophysiology is that regular homeostatic bone turnover is disrupted; the age-related bone resorption maintained by osteoclasts exceeds the rate of bone formation maintained by osteoblasts, resulting in a decrease in total bone density. Besides, Women are often more likely than men to develop osteoporosis since menopausal hormone levels significantly affect bone mass. Likewise, Women who drink heavily and smoke are at an even increased risk of getting osteoporosis. The assessment findings that led me to identify the problem include the pain in the patient’s upper back, and the disease is common in women who are past menopause (Akkawi & Zmerly, 2018). Besides, the findings that the patient has been a regular smoker at her tender age indicate that she has osteoporosis. Similarly, another concern in the assessment is that M.S. has never been screened for osteoporosis, and her parents were successfully treated with osteoporosis in their early 50s.
The most common nursing diagnoses for osteoporosis are acute pain from a fracture, a lack of knowledge about the osteoporosis procedure and treatment methods, and a danger of digestive disorders from immobility. Based on my understanding of how to care for M.S, I include relief of pain and understanding of osteoporosis and the clinical course (Tu et al., 2018). Equally, the interventions that will help M.S meet these are by encouraging the patient to sleep in the bed in a reclined or side-lying position numerous times per day and help educate body mechanics and sitting upright. Likewise, I will evaluate the following plan to care for the patient Identifying calcium and vitamin D-rich foods, discussing calcium supplements that will aid in strengthening the bones, and advising the patient to stop smoking.
Concept Map
Reference
Akkawi, I., & Zmerly, H. (2018). Osteoporosis: current concepts. Joints, 6(02), 122-127.
Tu, K. N., Lie, J. D., Wan, C. K. V., Cameron, M., Austel, A. G., Nguyen, J. K.,… & Hyun, D. (2018). Osteoporosis: a review of treatment options. Pharmacy and Therapeutics, 43(2), 92.
A medical condition called osteoporosis weakens bones, rendering them brittle and more prone to fracture. The current study proves that women with hysterectomies are more likely than the general population to develop osteoporosis and suffer from bone fractures (Xu et al., 2022). Early therapies may help postpone or lower the risk of osteoporosis and bone breakage for these vulnerable women. Therefore, this paper details the interventions for a patient (J.S.) diagnosed with osteoporosis.
Specific Goals of Therapy for J.S.
Osteoporosis and fracture prevention are the main goals of this intervention. Osteoporosis makes bones fragile that even minor stressors like coughing or stooping can break them. Another objective for J.S. treatment is to improve bone mineral density. Normal calcium balance and a normal vitamin D status are necessary to ensure well-balanced bone metabolism, thus preventing or treating osteoporosis (Chiodini & Bolland, 2018). Finally, the therapy is crucial to reduce the side effects of the treatment.
Potential Drug Therapy
The preferred medication is a bisphosphonate, called alendronate. Bisphosphonate can decrease osteoclast activity, prevent bone resorption, and enhance bone mineral density (BMD) in individuals receiving glucocorticoid therapy (Liu et al., 2022). Generally, by lessening bone resorption caused by osteoclasts, it raises BMD. Alendronate should be used with guidance from physicians to minimize the potential side effects, including bloating, stomach ache, constipation, migraines, nausea, and gas. Finally, a mixed estrogen agonist can be given to act as hormone replacement therapy.
The Parameters for Monitoring the Success of the Therapy
Specialists can check the overall bone density and inquire about J.S’s general well-being, like whether she has joint pain or tenderness. Improved BMD following bisphosphonate medication and a decreased fracture risk with few side effects are typical measurements (Radwan et al., 2022). They can also monitor other conditions like bloating and headaches to address the side effects. Finally, since J.S. had a hysterectomy, it is crucial to assess the success of the hormone therapy.
Patient Education Based on the Prescribed Therapy
The patient should be taught to continue the therapy and exercise caution to avoid breaking bones. According to Radwan et al. (2022), the information that patients receive from healthcare professionals is a significant factor in their compliance. Any adverse effects, like a rash, difficulty swallowing, or intense abdominal pain must be reported. Finally, to prevent drug-drug or drug-supplement interactions, J.S. should inform the primary provider of any medication or dietary supplements she takes.
Adverse Reactions of the Selected Agent
Alendronate may produce certain undesirable consequences in addition to its necessary effects. Hypersensitivity reaction, uveitis, esophageal ulcers and strictures, duodenal or gastric ulceration, hypocalcemia, and osteonecrosis of the jaw are serious side effects of alendronate that may call for withdrawal. Other adverse effects included dysphagia and sore, inflamed gums (Radwan et al., 2022). Even though not all of these side effects are likely to occur, if they do, medical treatment may be required.
OTC or Alternative Medicines Appropriate for the Patient
Calcium citrate and vitamin D (cholecalciferol) are the best alternative drug for the patient. Anti-fracture effectiveness increases when calcium and vitamin D are administered in pharmaceutical doses (Iuliano et al., 2021). Calcium supplements can raise BMD in postmenopausal women and individuals at risk of osteoporosis like J.S. Calcium citrate is recommended because it is absorbed better. Nonetheless, caution must be taken to avoid potential adverse effects.
Recommended Dietary and Lifestyle Changes
Increasing consumption of a diet rich in calcium and vitamin D is one recommendation for the patient. A higher calcium intake in the diet can benefit bones in various ways (Iuliano et al., 2021). J.S. should avoid falling to minimize fractures since her bones are weaker than expected. J.S. needs to maintain a nutritious diet and exercise as much as she can. Nonetheless, she should prioritize muscle strengthening through low-impact training.
Drug-Drug or Drug-Food Interactions for the Selected Agent
Alendronate’s intestinal absorption is decreased by calcium intake; therefore, it should be used cautiously. The excessive use of alendronate or the concomitant use of other medications is connected to the frequent adverse effects (Radwan et al., 2022). Alendronate’s bioavailability is lowered by coffee and mineral water; thus, one should avoid taking beverages while on this drug. Recombinant human PTH’s calcium-sparing actions are likewise lessened by alendronate.
Osteoporosis is defined as a bone condition when the body loses too much bone or does not produce enough for sustainable well-being. As a result of this condition, the bone matter becomes weaker as time goes on and thus increases the risks of breaking from falls. In the most severe cases of osteoporosis, patients can experience the breaking of bones because of such minor accidents as hitting bumps or sneezing. In this paper, the condition will be reviewed from different perspectives. The risk factors, etiology, pathophysiology, clinical manifestations, diagnostic tests, treatment options, and preventative measures of osteoporosis will be discussed in detail.
Risk Factors of Osteoporosis
The bone matter is in a continuous state of renewing itself, which means that its old cells break down while new ones are made. When people are young, these cells renew themselves quicker, thus making the bone stronger and less susceptible to breaking. The peak of gaining bone mass usually occurs in the middle of the ’20s. With age, the regeneration of bone matter slows down thus contributing to the loss of bone mass because the cells break down faster than they are created. Therefore, there is a direct connection between how much bone mass has a person developed during their young age (Delaisse, 2014). The higher the bone mass associated with the peak of its development, the more bone will be retained for the rest of the life. If there is not enough bone mass, the higher is the likelihood of osteoporosis development as time goes by.
There are multiple categories of risk factors that can initiate the development of osteoporosis. Among unchangeable risks, sex, age, race, family history, and body frame size are the most likely to influence the condition’s development (Delaisse, 2014). For instance, women have more likelihood of getting osteoporosis compared to men. As already mentioned, the older one gets, the higher the risks of osteoporosis are. When it comes to race, individuals of Asian descent and whites are more likely to get osteoporosis as well as those whose siblings have been diagnosed with the disease in the past. Moreover, one’s body frame size may affect the loss of bone matter, and individuals with smaller body frames lose their bone mass quicker.
Hormone levels have also been linked to the increased risks of osteoporosis. For instance, lower sex hormones contribute to the loss of bone mass. Menopausal women or those treated from breast cancer whose levels of estrogen drop face an increased likelihood of getting osteoporosis (Maeda & Lazaretti-Castro, 2014). Regarding men, the levels of testosterone may drop with age or due to treatments for prostate cancer, subsequently contributing to the loss of bone matter. In people with thyroid problems, the production of high numbers of the thyroid hormone contributes to the lower number of bone cells. Furthermore, when people take a lot of hormonal medication to treat an underactive thyroid, they can risk losing bone cells.
Lifestyle preferences including dietary factors have also been linked to the risks of getting osteoporosis. The low intake of calcium, eating disorders, and gastrointestinal surgery can contribute to the loss of bone mass. Calcium-rich foods and supplements are usually prescribed to reduce the risk factors for osteoporosis (Reid, 2014). The restriction of dietary choices due to such issues as food disorders has been shown to contribute to osteoporosis occurrence. Poor lifestyle habits such as alcohol abuse, tobacco smoking, and sedentary life increase the risks of osteoporosis. Because of this, eliminating unhealthy habits and being more active is often recommended.
Etiology and Pathophysiology of Osteoporosis
Osteoporosis is defined as a health condition characterized by skeletal fragility and the reduced mass of the bone associated with the deteriorating bone tissue, thus increasing the risks of fracture. The pathophysiology of osteoporosis is linked to the under-development of bone mass as well as overall skeletal components of fragility (Maeda & Lazaretti-Castro, 2014). In addition, the condition is characterized by extra-skeletal factors that consequently lead to fractures. The strength of the bone is determined not only by its mass but also by such factors as the shape and the size of the bone, its mineralization, turnover, and architecture. Due to the multifactorial pathophysiology of osteoporosis, there is a recommendation for having an all-encompassing approach and multifaceted prevention.
Bone is an active tissue that changes because of the influence of such factors as age, lifestyle choices, and hormonal changes. The process of bone remodeling starts with the resorption of the matter associated with the conversion of the quiescent bone surface into a resorptive one (Delaisse, 2014). When the bone’s surface receives signals to its osteoblasts and osteoclast, osteocytes initiate the process of bone restoration. The entire process is sustained with the help of calciotropic hormones (estrogen, calcitonin, 1,25-dihydroxy vitamin D, and PHT), cytokines (interleukins 1, 6, 11), and colony-stimulating factors. When the supply of these factors is not enough for the healthy remodeling of the bone matter, individuals lose bone mass and thus are more likely to be diagnosed with osteoporosis.
Clinical Manifestations
In most cases, patients diagnosed with osteoporosis at the early stages may not feel any symptoms. Once the bone matter becomes weaker and the body cannot retain the recommended amount of bone, some signs can include back pain associated with a collapsed or fractured vertebra. Other symptoms include the gradual loss of height over some time, an easy occurrence of bone fractures, as well as a stooped posture. It is recommended for patients to contact a health provider in cases when they have undergone early menopause or were prescribed to take corticosteroids for a long period. Also, people should be attentive to the risks of osteoporosis in cases when their parents had hip fractures as adults.
Osteoporosis is not diagnosed usually until a person fractures his or her bones. This is a problem because many patients who have not experienced any symptoms may wrongly believe that they do not have osteoporosis. However, patients with pain in their back or joints may suspect osteoporosis without really having it. Therefore, appropriate diagnosis procedures are necessary to address this issue as well as reduce the occurrence of fractures through administering appropriate medications and improving the lifestyle overall.
Diagnostic Tests
Before administering any diagnostic tests, a doctor will review a patient’s medical history as well as to inquire about the occurrence of adult fractures among his or her family members. The next step is conducting a bone mineral density (BMD) test because X-rays do not measure the density of bones but can help in identifying fractures. Dual-energy X-ray absorptiometry (DXA) is the most common BMD test that uses low-radiation X-rays that can detect the levels of bone loss. Usually, spine and hip bone density are measured while in some instances doctors may choose to measure the density of an entire skeleton (Liu et al., 2015). Different BMD tests that target specific areas in patients’ bodies include single-energy X-ray absorptiometry targeting wrists or heels, dual photon absorptiometry targeting hips, the spine, or an entire body, single-photon absorptiometry targeting wrists. Quantitative Computed Tomography (QCT) targets the hips and the spine, peripheral QCT targets the forearm, and Quantitative ultrasound targets fingers or heels through the use of sound waves.
As a result of these diagnostic tests, patients get a reference measurement for determining whether they have osteoporosis or not (see Table 1). Usually, osteopenia is evident when the t-score is in the range between 1 and 2.5. The table below shows the correspondence between t-test scores and the severity of osteoporosis:
Based on the t-test results presented above, doctors conclude whether patients require just dietary and lifestyle changes to address osteopenia or need to be prescribed complex medication for osteoporosis. Importantly, in the absence of fractures but high t-test scores, it does not mean that patients will have them in the future if they implement appropriate measures to address their condition. Radiological assessments of Bone Turnover Markers (BTM) have also been used for measuring the extent of osteoporosis. This test measures bone resorption markers, bone formation markers, as well as markers of osteoclast regulatory proteins (Shetty, Kapoor, Bondu, Thomas, & Paul, 2016).
Treatment Options
The treatment of osteoporosis encompasses both pharmacological and non-pharmacological options. The combination of the two methods has shown to be the most efficient because the disease is complex and thus requires several factors to be addressed. Importantly, the treatment is usually targeted to cater to the unique needs of different patients as well as the reasons that caused the condition’s development in the first place.
Pharmacological
Bisphosphonates are the most common medications that patients with osteoporosis are being prescribed. They include such prescription medications as alendronate, risedronate, ibandronate, and zoledronic acid. Alendronate targets the quick breakdown of bone matter and the increase of its thickness. Risedronate targets the same condition characteristics as alendronate while also being used for preventing osteoporosis that has been caused by taking steroid medications. Ibandronate has been approved for treating osteoporosis among postmenopausal women (Maeda & Lazaretti-Castro, 2014). Zoledronic acid is a medication that targets much more complex conditions apart from osteoporosis. For instance, it is prescribed for treating cancer that spreads from one organ to the bone (Liu et al., 2015). It should be mentioned that hormonal medications are used for addressing osteoporosis. Estrogen-based treatments have been prescribed for menopausal women for improving their bone health; however, they have been shown to have some negative side effects. When prescribing hormonal medications, it is important to weigh-in the benefits and threats about each patient.
Non-Pharmacological
Non-pharmacologic treatment of osteoporosis has been associated with enhancing the quality of one’s health and lifestyle by making positive behavioral choices. Patients diagnosed with the condition must be given information about the risks of the condition’s exasperation associated with making unhealthy life choices. For instance, individuals are recommended to eliminate smoking and alcohol use as well as encouraged to establish a calcium- and vitamin D-rich diet. Regular exercise programs are advised for retaining bone matter and slowing down its destruction. Alternative methods of treating osteoporosis are also commonly used. For instance, with the help of nuclear magnetic resonance (NMR) therapy, bone mineral density has been shown to increase significantly in a year (Krpan, Stritzinger, Lukenda, Overbeck, & Kullich, 2015).
Preventive Measures
The prevention of osteoporosis can be implemented during both childhood and adulthood. Children and adolescents are recommended to follow a nutritious diet that includes adequate amounts of calcium, proteins, and vitamin D. The peak bone mass is usually recommended to be increased by at least 10% to reduce the risks of osteoporosis in adulthood by 50% (Lewiecki, 2018). For adults, the same dietary advice is given for maintaining adequate bone mass. Adults should avoid malnutrition, and eating disorders in particular, which is why seeking psychological help is needed if nutrition has been undermined by mental instabilities. In addition to sustaining a healthy diet, adults are recommended to avoid heavy alcohol drinking and tobacco smoking (including second-hand). Overall, maintaining high bone mass is the target of preventive osteoporosis measures, and both diet and exercise can help in attaining this goal.
Conclusion
Osteoporosis is a complex condition, the symptoms of which do not manifest immediately, thus presenting some challenges for both patients and healthcare providers. However, by taking steps to establish a healthy lifestyle, patients of all ages can reduce the risks of osteoporosis occurrence. Apart from improving the overall health through exercise and a nutritious diet, pharmacological treatments are also available, especially in regards to elderly patients.
References
Delaisse, J. M. (2014). The reversal phase of the bone-remodeling cycle: cellular prerequisites for coupling resorption and formation. BoneKEy Reports, 3(561), 1-8.
Krpan, D., Stritzinger, B., Lukenda, I., Overbeck, J., & Kullich, W. (2015). Non-pharmacological treatment of osteoporosis with nuclear resonance therapy (NMR-therapy). Periodicum Biologorum, 117(1), 161-165.
Liu, M., Guo, L., Pei, Y., Li, N., Jin, M., Ma, L., … Li, C. (2015). Efficacy of zoledronic acid in treatment of osteoporosis in men and women-a meta-analysis. International Journal of Clinical and Experimental Medicine, 8(3), 3855-3861.
Maeda, S. S., & Lazaretti-Castro, M. (2014). An overview on the treatment of postmenopausal osteoporosis. Journal for the Brazilian Society of Endocrinology and Metabolism, 58(2), 162-171.
Reid, I. R. (2014). Should we prescribe calcium supplements for osteoporosis prevention? Journal of Bone Metabolism, 21(1), 21-28.
Shetty, S., Kapoor, N., Bondu, J. D., Thomas, N., & Paul, T. V. (2016). Bone turnover markers: Emerging tool in the management of osteoporosis. Indian Journal of Endocrinology and Metabolism, 20(6), 846-852.
