Muskulosckeletal

• Bone Function


  • Shape and support for the body
  • Protection of organs
  • Storage of vital minerals
  • Storage and formation of blood cells

  
• Safe Mobility


  • The most important aspect of physiologic function
  • Maintenance for independence
  • Risks affecting mobility
  • Falls & fractures
  • Safety is the integral aspect of mobility
• Age-Related Considerations: The Musculo-skeletal System

  • Muscles: decrease in muscle cells, decrease in elasticity in ligaments and cartilage, reduced ability to store and release glycogen
  • Joints: Decreased cartilage between bone ends and loss of water between vertebrae
  • Bone: decrease in bone density
• Bone Physiology


  • Osteoprogenitor cells: differentiate into osteoblasts
  • Osteoblasts (bone forming cells): On the surface of the bone. Synthesize and secrete bone matrix
  • Osteocytes: deviate from osteoblasts, make up 90% of all bone cells. Orchestrate bone remodeling
  • Osteoclasts (bone resorbing cells): bone resorption depends on osteoclasts secretion of minerals

  
• Calcium Physiology


  • Functions and daily requirements
  • Body stores
  • Absorption
  • Excretion
• Osteoporosis


  Chronic, progressive metabolic bone disease characterized by: Porous bone, Low bone mass, Structural deterioration of bone tissue, Increased bone fragility

  
• Fractures from osteoporosis are more common than heart attack, stroke & breast cancer combined!
• In Canadians of 40 years or older, 1.5 million (10%) reported having been diagnosed with osteoporosis
• Québec 2015-2016: ~25% of Quebecers over age 65 (~370 000 people) had a diagnosis of osteoporosis & 5% were at high risk of fractures
• Osteoporosis Risk Factors


  • Culture: White race, Northern European ancestry, Higher risk of development in immigrants (especially Asian Canadians) due to differences in nutritional intake
  • Healthy Child Development: Strong bone formation during childhood reduces the likelihood of osteoporosis in adulthood
  • Gender: More common in women than men
• Other Osteoporosis Risk Factors

  • Age ≥65 yr (both women and men)
  • Fragility fracture after age 40
  • Inadequate physical activity, esp. weight-bearing exercises
  • Low dietary calcium intake
  • Prolonged use of glucocorticoids & other high-risk medications
  • Parental hip fracture
  • Vertebral fracture or osteopenia identified on radiography
  • Cigarette smoking
  • High alcohol intake
  • Low body weight (<60 kg) or major weight loss (>10% of body weight at age 25 yr)
  • Rheumatoid arthritis, malabsorption syndromes
• Osteoporosis Pathophysiology


  • Peak bone mass is achieved before age 20
  • Peak mass determined by heredity, nutrition, exercise, and hormone function
  • Bone loss from midlife onward is inevitable, but rate of loss is variable
  • In osteoporosis, bone resorption exceeds bone deposition
  • Occurs most commonly in spine, hips, and wrist
• Osteoporosis (silent disease) Clinical Manifestations

  • Fractures (spontaneous or traumatic)
  • Back pain
  • Loss of height
  • Spinal deformities
• Osteoporosis - Diagnostic Studies


  • History and physical exam
  • Measure bone mineral density (BMD) - DEXA scan
  • T-score: Normal, Osteopenia, Osteoporosis

  
• Nursing and Collaborative Care for Osteoporosis

  • Focus on proper nutrition, exercise, prevention of fractures and drugs
  • Prevention and treatment depend on adequate calcium and vitamin D intake
  • Loss of bone cannot be significantly reversed but further loss can be prevented
• Sources of Calcium


  • 250ml Yogurt = 415mg
  • 250ml Low fat skim milk = 302mg
  • 1 cup almonds = 304mg
• Reducing Osteoporosis-Related Risk & Injury


  • Exercise: Weight-bearing physical activity helps maintain bone mass
  • Nutrition
  • Lifestyle changes that reduce risk factors
  • Fall prevention measures
  • Basic body mechanics
  • Home safety
• Pharmacological Interventions for Osteoporosis

  • Adequate intake of calcium and vitamin D
  • Combination calcium–vitamin D
  • Bisphosphonates: Fosamax, Actonel, and Boniva