Osteoporosis Reading Questions
Terms in this set (71)
what is osteoporosis?
Is a chronic metabolic disease in which bone loss causes decreased density and possible fracture.
when does the first sign of osteoporosis occur?
In most people, follows some kind of fracture
What is bone remodeling?
Bone is undergoing changes
What is osteopenia?
Low bone mass
When osteoclastic activity is > osteoblastic activity
What are osteoclasts?
What happens to BMD after 30 yrs of age?
The lack of what hormone causes bone mineral density to decrease most rapidly?
serum estrogen levels
What type of bone is lost first?
Trabecular or cancellous (spongy) bone is lost first
Using the T-score, what T-score indicates osteopenia?
-1 and above -2.5
What T-score indicates osteoporosis?
How often will medicare reimburse for DMB testing?
Every 2 years in people 65 years and older who are:
What 5 characteristics of the patient must be present for medicare to reimburse?
Estrogen deficient, have vertebral abnormalities, receive long-term steroid therapy, have primary hyperparathyroidism, and are being monitored while on osteoporosis drug therapy
What is generalized osteoporosis?
Involves many structures in the skeleton and is further divided into primary and secondary
What is primary osteoporosis?
More common. Occurs in postmenopausal women and in men in their 7th or 8th decade of life
Why do men have a slower loss of bone mass?
Decreasing levels of testosterone and altered ability to absorb calcium
What is secondary osteoporosis? What medications can cause it?
Secondary may result from other medical conditions such as hyperparathyroidism, long-term drug therapy, prolonged immobility
Medications that cause secondary is corticosteroids
What is regional osteoporosis? How long does it take to develop? What occupation also results in the loss and why?
When immobilization occurs and also can occur from spending a prolonged time in a gravity-free environment
Disease risk factors for osteoporosis?
DM, hyperthyroidism, hyperparathyroidism, cushing's syndrome, GH deficiency, metabolic acidosis, female hypogonadism, cirrhosis, HIV/AIDS, RA, prolonged immobilization, bone cancer
Drug risk factors for osteoporosis?
Corticosteroids, heparin, anticonvulsants, ethanol, cytotoxic agents, immunosuppressants, loop diuretics, aluminum-based antacids
What is primary osteoporosis caused by? Secondary?
Caused by a combination of genetic, lifestyle, and environmental factors
What is the hormone that builds bone tissue in men that decreases with age?
Testosterone levels decrease
How do bodybuilding and weight influence who gets osteoporosis?
Osteoporosis occurs most often in older, lean-built Euro-American and Asian women
Who is at risk due to decreased vitamin D?
African Americans are at risk for decreased vitamin D
What effect does weight bearing exercise have on osteoporosis?
Weight-bearing exercise reduces bone resorption and stimulates bone formation
What effect does excessive caffeine have on calcium?
Excessive caffeine in the diet can cause calcium loss in the urine
A diet lacking enough Calcium and Vitamin D stimulated the parathyroid glad to produce parathyroid hormone.
Institutionalized homebound patients are at higher risk because they are not exposed to sunlight enough
What is the relationship between calcium and phosphorus? Who is at a high risk for calcium loss?
Calcium loss occurs at a more rapid rate when phosphorus intake is high.
People who drink large amounts of carbonated beverages each day are at high risk regardless of age or gender
What affect does protein have on the body's ability to use calcium? Which type of diet can become a problem? What is the RDA for protein in healthy adults?
Protein deficiency may also reduce bone density b/c protein is needed to use calcium.
A high-protein, low-carbohydrate diet like the Atkins diet
RDA = 0.8 g/kg
What two substances promote acidosis? Effect of alcohol on bone tissue?
Excessive alcohol and tobacco use
Alcohol has a direct toxic effect on bone tissue by decreasing bone formation and increasing bone resorption
When can osteoporosis occur in young adults? Which types of athletes may overtrain without sufficient caloric intake?
Occurs in young adults who participate in excessive exercise or weight-loss dieting or in those who have eating disorders
Dancers, gymnasts, and other athletes may overtrain without sufficient caloric intake
how does hip fracture affect the mortality rate for older patients? What did the national study by Gloth and Simonson report on nursing home patients?
The mortality rate for older adults with hip fractures is very high especially within the first 6 months
Gloth & Simonson reported that 42% of residents were categorized as having a high risk
what is the best defense against developing osteoporosis in later adulthood?
The best defense is building strong bones as a younger adult
What is the role of the nurse to help prevent this?
Teaching should begin with young women because they begin to lose bone after 30 years of age
What is the focus of osteoporosis prevention? What teaching is important?
Prevention is to decrease modifiable risk factors
Teach patients to:
Include enough dietary calcium
Read food labels for sources of calcium
Get adequate amount of sun exposure
Get adequate amount of vitamin D
Limit the amount of carbonated beverages
Importance of exercise & what types
What fault risk factors should be included in a complete health history?
Assess for fall risk factors such as delirium, dementia, immobility, muscular weakness, history of falls, visual or hears deficits, and current drug & usage.
what is a dowager's hump? Why is assessment of height and weight important? Describe how pain presents in osteoporosis? What is the most common type of osteoporotic fracture? What can movement restriction and spinal deformity result in?
Dowager's hump or kyphosis is where the patient may state that they have gotten shorter by a normal convex curvature of the spine
The height & weight will help determine if the patient has gotten shorter or not
Back pain may be present after they lift, bend, or stoop where the pain may be sharp and acute in onset and worsen with activity and relieved by rest
Most common type of fracture is compression vertebral fracture
Movement restriction and spinal deformity may result in constipation, abdominal distention, reflux esophagitis, and respiratory compromise in severe cases
how can the quality of life the impact it by osteoporosis?
The quality of life may be further impacted by pain, insomnia, depression, and fallophobia
How does the patient's concept of body image change?
The patient may have difficulty finding clothes that fit. Just assess their body image
Why might social interaction be avoided?
May be avoided because of a change in appearance or the physical limitations of being unable to sit in chairs
How might sexuality be impacted?
Occur as a result of poor self-esteem or the discomfort caused by positioning during intercourse
true or false; there is a definitive laboratory test to confirm the diagnosis of primary osteoporosis.
What five biochemical markers can provide information about bone resorption and formation activity?
Bone-specific alkaline phosphatase (BSAP)
Increased levels of these markers are found in what three kinds of diseases?
Indicate a risk for osteoporosis, Paget's disease, and bone tumors
What is Paget's disease? What is osteomalacia?
Paget's disease is a chronic metabolic disorder where bone is excessively broken down where the bone is structurally disorganized that causes increased bowing
Osteomalacia is loss of bone related to a vitamin D deficiency that causes softening of the bone
What tests can be performed to rule out secondary osteoporosis?
A battery of tests can be performed such as serum calcium, vitamin D, and phosphorus.
why are conventional x-rays of the spine and long bones not diagnostic in osteoporosis?
The show decreased bone density but only after 25-40% bone loss has occurred
What is a DXA (or DEXA) scan? How is the patient prepared for a DXA (or DEXA) scan?
Most commonly used screening and diagnostic tool used for measuring bone mineral density
Stays dressed but removed any metallic objects
What is quantitative computed tomography(QCT)? Why is it not use more often?
This can measure bone density by analyzing the trabecular and cortical bone separately & is especially sensitive to changes in the vertebral column
It is more expensive and exposes them to more radiation
What is peripheral quantitative ultrasound? Why is it preferable?
An effective and low-cost screening tool that can detect osteoporosis and predict risk for hip fracture.
No special prep, quick, no radiation exposure, or specific follow-up care
What are the most common problems for patients with osteoporosis or osteopenia?
The potential for fractures related to weak, porous bone tissue
When should drug therapy begins?
Drug therapy should begin when the BMD T-score for the hip is below -2.0 with no other risk factors or when the T-score is below -1.5 with one or more risk factors or previous fracture
What should you teach patients about their diet?
About the adequate amounts of protein, magnesium, vitamin K, and trace minerals that are needed for bone formation. Avoid excessive alcohol and caffeine.
How can people who are lactose intolerant use diet to help avoid osteoporosis?
They can choose a variety of soy and rice products that are fortified with calcium and vitamin D
What should the dietary plan emphasize?
The plan should emphasize fruits & veggies, low-fat dairy & protein sources, increased fiber, and moderation in alcohol and caffeine
What lifestyle change is important in the prevention and management of osteoporosis?
Exercise is important in the prevention and management of osteoporosis
What exercises should be done for those at risk for vertebral fractures and why?
Strengthening the abdominal and back muscles because they improve posture and support for the spine
What exercises should be done to increase lung capacity? What exercises should be done to improve joint mobility?
Abdominal muscle tightening, deep breathing, and pectoral stretching are stressed
Active ROM exercises improve joint mobility and increase muscle tone
What non-weightbearing exercise promotes overall muscle health?
What is the single most effective exercise for osteoporosis prevention? What types of exercise should be avoided?
Walking for 30 mins 3-5 times a week is the single most effective exercise for prevention
Running, bowling, and horseback riding should be avoided
What other lifestyle changes may be needed? In the hospital and long-term care facilities, how do risk management programs help?
Avoid tobacco, prevent falls, importance of a hazard-free environment.
They assess for the risk for falls. They use colored armbands or other methods
true or false: calcium is a medical treatment for osteoporosis.
Which formula of calcium should be recommended for those who have gastric upset when taking a calcium supplement? How should the calcium supplement be taken? When should you start taking calcium supplements? What is needed for the uptake of calcium?
Citracal or calcium citrate for gastric upset
Take calcium supplements with food and 6-8 oz of water
Women should start taking them in young adulthood to assist in maintaining peak bone mass
Vitamin D is needed for the uptake of calcium
What is hypercalcemia and what can it do to the body?
Hypercalcemia is excess serum calcium and can cause serious damage to the urinary system and etc
What should patients do to help prevent urinary or renal calculi?
Teach patients to drink plenty of fluids
What are bisphosphenates? What three are FDA approved and commonly used for prevention and treatment of osteoporosis? Which one mentioned is available as an IV preparation? What is the most common serious problem associated with oral BPs?
Bisphosphonates slow bone resorption by binding with crystal elements in bone.
3 FDA approved are:
ibandronate (Boniva) → IV prep
Most common problem is esophasitis
How often should IV Reclast (zoledronic acid) be given? How often should IV Aredia (pamidronate) be given? What complication is associated with both drugs?
Reclast is only needed once a year
Aredia is given every 3-6 months
Common complication is jaw osteonecrosis where the jaw bone dies
What is the other name for estrogen agonist/antagonists? What are these medications designed to do? What is the only drug in this class approved to be used for prevention and treatment of osteoporosis in postmenopausal women? What does this medication do? Who should it not be given to?
Selective estrogen receptor modulators (SERMs)
Designed to mimic estrogen in some parts of the body while blocking its effect elsewhere
raloxifene (Evista) is the only drug for prevention and treatment
Raloxifene increases BMD, reduces bone resorption, and reduces the incidence of osteoporotic vertebral fractures
What is teriparatide? How is it given? What does it do? What are some side effects? What should the patient do when side effects occur?
Parathyroid hormone also known as Forteo and it is a bone building agent for prevention in postmenopausal women with high risk for fracture
It is a subcut injection
Stimulates new bone formation which increases BMD
May experience dizziness or leg cramping
They should lie down and notify the health care provider ASAP
What is calcitonin? What does it do? What other diseases is it used for? How is it given? Why is the nasal rate preferred? What can happen after two or more years? What can the patient do to help this?
Calcitonin is a thyroid hormone
Inhibits osteoclastic activity that decreases bone loss
Used for treatment of osteoporosis, Paget's disease, and hypercalcemia associated with cancer
Subcut or intranasally
Nasal route is preferred because it improves drug adherence, decreases side effects, and is convenient
Effect of calcitonin may decrease
Alternate nares to prevent mucosal irritation and must be refrigerated
how do disease management programs affect populations with osteoporosis?
Those are managed by NPs and have helped diagnose and treat the disease
What national organization provides information to patients and healthcare professionals regarding osteoporosis in the treatment?
Refer to the National Osteoporosis Foundation
Common examples of drug therapy
Calcium with vitamin D