Osteoporosis Management (Home Health Care) - CE
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Osteoporosis may decrease functionality and quality of life. Aging is a risk factor for osteoporosis. Consider an osteoporosis risk factor assessment, screening, and treatments for all older adult patients.
Certain diseases, such as cancer, and their treatment may increase the risk of developing osteoporosis.
Osteoporosis is a common bone disease characterized by low bone mass, deterioration of bone tissue, and decreased bone strength, all of which can lead to an increased risk for fractures. The disease currently affects many people of both sexes and all races. It is becoming increasingly more prevalent as the population ages.undefined#ref1">1,5
Osteoporosis is a condition in which a decrease in bone density results in porous, brittle, and fragile bones. Osteopenia is a reduction in bone density that precedes osteoporosis. Osteopenia and osteoporosis result in part from a decline in estrogen and testosterone levels that occur with aging in both sexes.
In addition to aging, a number of other characteristics and occurrences are risk factors for the development of osteoporosis (Box 1). Certain disease processes or the treatments prescribed for them can lead to osteoporosis. For example, cancer treatments involving androgen or estrogen deprivation therapy as well as other common medications used in oncology (Box 2) can lead to osteoporosis. The nurse should assess the patient for and document these risk factors.
Osteoporosis is considered a silent disease because many people are unaware that they have it until a fracture occurs. Once the fracture does occur, osteoporosis can place a significant burden on the afflicted individual. Osteoporosis can be prevented, detected, and treated before it progresses and leads to fractures.1
Preventing osteoporosis and maintaining good bone health are key to decreasing mortality and morbidity. Nurses should be well versed in preventive measures (Box 3) and should educate patients about these interventions.
All postmenopausal women as well as men 50 years of age and older should be evaluated for osteoporosis risk to determine the need for further screening.1,5 Advanced screening for osteoporosis (bone mineral density [BMD] testing or vertebral imaging) is recommended for women who are 65 years of age and older and for younger women who are at high risk for fractures.6 Currently, there are no specific recommendations for advanced screening for men without previously known fractures or secondary causes of osteoporosis.6
In many cases, osteoporosis is diagnosed after a hip or vertebral fracture in the absence of major trauma. The diagnosis is confirmed by measuring BMD with a dual-energy x-ray absorptiometry (DXA or DEXA) scan of the hip and lumbar spine.1 Nurses should identify patients at high risk who may benefit from evaluation and screening to mitigate the risk of fractures.
Prevention and treatment of osteoporosis includes dietary evaluation and modification to ensure adequate intake of calcium and vitamin D, lifestyle and behavioral changes to include regular weight-bearing and muscle-strengthening exercises, cessation of tobacco use, limited alcohol consumption, and identification and mitigation of fall risk. Pharmacologic treatment, when indicated, may include bisphosphonates, calcitonin, parathyroid hormone, a selective estrogen receptor modulator (SERM), or monoclonal antibody therapy (Table 1).1,5 Nurses play a key role in assisting patients with adhering to their prescribed regimen.
Rationale: Identifying risk factors (e.g., age, history of hip or vertebral fractures, insufficient calcium or vitamin D intake, lack of exercise, small bone frame) drives further diagnostic workup and treatment decisions.
Rationale: Providing adequate daily calcium and vitamin D is a safe and inexpensive way to help reduce fracture risk. Daily requirements vary and should be prescribed and monitored by the patient's practitioner.
Rationale: Vitamin D deficiency in adults is generally treated with Vitamin D
2 or D
3 50,000 IU/week for 8 to 12 weeks or until a 25(OH)D blood level of approximately 30 ng/ml is achieved.
Rationale: Physically active people are less likely to develop osteoporosis.
Rationale: The use of tobacco products is detrimental to the skeleton.
Rationale: Moderate alcohol intake has no known negative effect on bone; however, an intake of more than two drinks per day for women or three drinks per day for men may impact bone health and increases the risk of falling.
Rationale: Bisphosphonates reduce the rate of bone turnover.
Bisphosphonates have a small risk of causing osteonecrosis of the jaw (ONJ), especially if the patient has poor dentition or oral habits or has an invasive dental procedure performed during bisphosphonate therapy.
Rationale: Oral bisphosphonates must be taken 30 minutes before eating or drinking to ensure full efficacy of the medication.
3 The patient also should remain in an upright position for 30 minutes to lessen the risk of gastrointestinal adverse effects.
Oral bisphosphonates may cause gastrointestinal problems, such as esophagitis, heartburn, and ulcers.
Use IV bisphosphonates with caution in patients with renal impairment because renal dysfunction may result.
Rationale: SERMs bind to estrogen receptors and decrease bone remodeling.
SERMs are contraindicated in women with blood clots or a history of blood clots.
Rationale: The RANKL antibody binds with RANKL, preventing osteoclast activation, reducing bone resorption.
Monoclonal antibodies are contraindicated in patients with hypocalcemia; use caution with patients who have renal impairment.
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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