Test 5

• Osteoporosis


  Chronic, progressive metabolic bone disease marked by low bone mass and deterioration of bone tissue that leads to increased bone fragility
• Osteoporosis is known as the “silent thief”

  Higher incidence in white and Asian American women; risk of fracture higher in white women
• Reasons osteoporosis is more common in women

  • Lower calcium intake
  • Less bone mass
  • Bone resorption begins earlier and becomes more rapid at menopause
  • Pregnancy and breastfeeding
  • Longevity
• Risk Factors for Osteoporosis

  • Calcium and Vitamin D deficiency
  • Advancing age greater than 65
  • Estrogen deficiency
  • Low testosterone
  • Excessive alcohol
  • Smoking
  • Sedentary lifestyle
  • Family history
  • White & Asian women
  • Low body weight
  • Corticosteroids
  • Antiseizure drugs
  • Thyroid replacements
• Common sites for osteoporosis

  • Spine
  • Hips
  • Wrists
• Clinical Manifestations of Osteoporosis

  • Back pain
  • Spontaneous fractures
  • Gradual loss of height
  • Kyphosis or “dowager’s hump”
• Screening guidelines for Osteoporosis

  1. Initial bone density test in women over age 65

  2. Repeat in 15 years if normal

  3. Earlier and more frequent if high risk
• 1. ray and lab studies are not diagnostic until 25% to 40% of bone is lost
• Bone mineral density (BMD)


  A measure used to diagnose osteoporosis
• Quantitative ultrasound (QUS)


  A diagnostic tool for osteoporosis
• Dual-energy x-ray absorptiometry (DEXA)


  A diagnostic tool that also assesses effectiveness of treatment for Osteoporosis
• 1. score interpretations

  • Normal bone density: +1 to -1
  • Osteopenia: -1 to -2.5
  • Osteoporosis: -2.5 or lower
• Focus on for Osteoporosis care

  • Proper nutrition
  • Calcium and vitamin D supplements
  • Exercise
  • Prevention of falls and fractures
  • Drug therapy
• Drug therapy for Osteoporosis

  • Bisphosphonates
  • Alendronate (Fosamax)
  • Risedronate (Actonel)
  • Zoledronic acid (Reclast)
• Bisphosphonates


  Inhibit bone resorption and slow remodeling drug used for Osteoporosis
• Side effects of Bisphosphonates

  • Anorexia
  • Weight loss
  • Gastritis
  • Osteonecrosis (rare)
• Proper administration of Bisphosphonates

  1)Take with full glass of water

  2)Take 30 minutes before food or other meds

  3)Remain upright for at least 30 minutes

  4)Continue treatment for 5 years
• Good sources of calcium

  • Milk
  • Yogurt
  • Turnip greens
  • Cottage cheese
  • Ice cream
  • Sardines
  • Spinach
• Supplemental calciumfor Osteoporosis

  Take in divided doses; 500mg best absorption
• Types of calcium supplementsfor Osteoporosis

  • Calcium carbonate (40% elemental calcium)
  • Calcium citrate (20% elemental calcium)
• Vitamin D

  Necessary for calcium absorption/function; bone formation
• Sunlight for 20 minutes is adequate for Vitamin D
• Groups needing Vitamin D supplements

  • Postmenopausal
  • Older adults
  • Homebound/long-term care
  • Northern climates with decreased sun exposure
• Weight-bearing exercises

  • Build up and maintain bone mass
  • Increase strength
  • Increase coordination
  • Increase balance
• Exercise recommendations

  • Walking (30 minutes 3 times per week)
  • Consider gait aid and protect areas prone to pathologic fractures
• Osteoarthritis (OA) symptoms

  • Joint stiffness after periods of rest
  • Early morning stiffness resolves within 30 minutes
  • Discomfort with movement
  • Crepitation (grating sensation)
• OA affects joints asymmetrically
• Goals of OA care

  • Managing pain and inflammation
  • Preventing disability
  • Maintaining and improving joint function
• Nondrug interventions for OA management

  • Ice
  • Heat
  • Compression
  • Rest
  • Elevation
• Rest and Joint Protection strategies for OA

  • Balance rest and activity
  • Rest during acute inflammation
  • Functional positioning with splints or braces
  • Avoid increased stiffness by limiting immobility to less than 1 week
  • Modify activities to decrease joint stress
• Heat and Cold Application for OA

  • Ice for acute inflammation
  • Heat therapy for stiffness
• Drug therapy for OA

  • Nonsteroidal anti-inflammatory drug (NSAID)
  • Ibuprofen
  • Capsaicin cream
  • Diclofenac gel
  • COX-2 inhibitor celecoxib (Celebrex)
• Rheumatoid Arthritis (RA) symptoms

  • Fatigue
  • Anorexia
  • Weight loss
  • Generalized stiffness that becomes localized stiffness with progression
  • Joint involvement with pain, stiffness, limited motion, and signs of inflammation
• Diagnostic tests for RA

  • X-RAYS
  • CBC
  • ESR
  • CRP
  • RF
  • Anti-CCP
  • ANA
• Ambulatory Care strategies for RA

  • Rest
  • Cold/Heat applications
  • Exercises
• Systemic Lupus Erythematosus (SLE) symptoms

  • Fever
  • Weight loss
  • Joint pain
  • Excessive fatigue
• Dermatologic problems in SLE

  • Vascular skin lesions
  • Butterfly rash
  • Chronic cutaneous lupus
  • Oral/nasopharyngeal ulcers
  • Alopecia
  • Dry, itchy, atrophied scalp
• Fibromyalgia symptoms

  • Widespread, nonarticular musculoskeletal pain
  • Fatigue
  • Multiple tender points
  • Sleep disturbances
  • Morning stiffness
  • Irritable bowel syndrome
  • Anxiety
  • Cognitive effects
• Drug therapy for Fibromyalgia

  • Pregabalin (Lyrica)
  • Duloxetine (Cymbalta)
  • Milnacipran (Savella)
  • Muscle relaxants
  • OTC and nonopioid analgesics
• Patient education for Fibromyalgia

  • Limit intake of sugar
  • Limit intake of caffeine
  • Limit intake of alcohol