Osteoporosis and osteomalacia

.

1. OSTEOPOROSIS Ratheesh R L

2. DEFINITION A medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D.

3. CAUSES The strength of bone depends on their size and density : bone density depends in part on the amount of calcium , phosphorous and other minerals bones contains. When the bones contains fewer minerals than normal , they are less strong and eventually lose their internal supporting structure.

4. RISK FACTORS:- SEX:- Fractures from osteoporosis are about twice more in women than in men . Risk in women at menopause(45yrs) that accelerates bone loss. Risk in men is greater than age 75 AGE:-The older, The higher risk of osteoporosis . Bones become weaker as ages. RACE:-Greatest risk – White or of South-East Asian descent . Black men and women have less risk.

5. FAMILY HISTORY:-Osteoporosis runs in families. Parent or siblings with osteoporosis puts at greater risk , especially if having a family history of fractures. FRAME SIZE :- Men and women who are exceptionally thin or have small body frames tend to have higher risk because they may have higher risk because they may have less bone mass to draw from as they age. LIFETIME EXPOSURE TO ESTROGEN:-The greater a woman’s lifetime exposure to estrogen , the lower her risk of osteoporosis.

6. EATING DISORDERS:-Women and Men with anorexia nervosa or bulimia are at higher risk of lower bone density in their lower backs and hips. THYROID HORMONE :- Too much of thyroid hormone can cause bone loss. OTHER MEDICATIONS :- Long term use of the blood thinning medication, the cancer treatment drug , some anti-seizure medications and aluminum containing antacids also can cause bone loss.

7. BREAT CANCER:- Postmenopausal women who have had breast cancer are at increased risk of osteoporosis , especially if they were treated with chemotherapy( which suppresses estrogen) LOW CALCIUM INTAKE :-A lifelong lack of calcium plays a major role in the development of osteoporosis. MEDICAL PROCEDURES THAT DECREASES CALCIUM ABSORPTION:-Stomach surgery can affect the body’s ability to absorb calcium.

8. SEDENTRY LIFESTYLE :-Bone health begins in childhood . Children who are physically active and consume adequate amount of calcium-containing foods have the greatest bone density . Exercise throughout life is important , but can increase bone density at any age. EXCESS SODA CONSUMPTION:- The link between osteoporosis and caffeinated soda isn’t clear , but caffeine may interfere with calcium absorption and its diuretic effect may increase mineral loss.

9. PATHOPHYSIOLOGY Scientists have yet to learn all the reasons why this occurs, but the process involves how the bone is made . Bone is continuously changing – new bone is made and old bone is broken down - a process called remodeling or bone turnover. A full cycle of bone remodeling takes 2-3 months. In young – the body makes new bone faster than it breaks down old bone , and the bone mass increases.

10. Reaches the peak bone mass in mid- 30’s After that , bone remodeling continues, but loses slightly more than it gains. At menopause, when estrogen level drop, bone loss increases dramatically. Many factors contribute to bone loss, the leading cause in women is decreased estrogen production during menopause.

11. Risk of developing osteoporosis depends on How much bone mass attained during ages 25-35 (peak bone mass) and how rapidly loses it rapidly, The higher peak bone mass , the more bones “in the bank” and less likely to develop osteoporosis as ages . Not getting enough vitamin D and calcium in the diet may lead to a lower peak bone mass and accelerated bone loss later.

12. SIGNS AND SYMPTOMS There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you may have signs and symptoms that include:

13. Back pain, caused by a fractured or collapsed vertebra Loss of height over time A bone fracture that occurs much more easily than expected Kyphosis

14. DIAGNOSIS HISTORY COLLECTION PHYSICAL EXAMINATION The best screening test is dual energy X-ray absorptiometry (DEXA)- measures the density of bone in the spine, wrist , hip , and is used to accurately follow changes in these bones over time .

15. X Ray Blood studies- calcium, phosphorous and alkaline phosphatase CT Scan MRI Scan

16. Treatments and Drugs Hormone therapy (HT):- estrogen Prescription Medications:- Bisphosphonates, selective estrogen receptor modulators (SERM’S) , Calcitonin Calcium and vitamin supplimentation . Proper nutrition and exercise of the patient

17. ESTROGEN AND BONE PROTECTION Estrogen is essential for healthy bone, and that when the production of estrogen is reduced (in postmenopausal women and exposure to radiation or chemotherapeutic drugs )bones become brittle and break easily . However the mechanisms involved aren't clearly understood.

18. PREVENTION Do exercise such as walking , running , skipping rope , jogging regularly. Add soy in diet – plant estrogen found in soy helps to maintain bone density and reduce the risk of fracture. Avoid smoking , it can reduce the level of estrogen and increases bone loss. Avoid excessive alcohol . Avoid caffeine , which is very harmful. Consider hormone therapy.

19. NURSING MANAGEMENT Assess the condition Closely monitor the weight Advocate the patient for daily activities Advice to avoid hard activities Provide nutritional diet Maintain I/O chart

20. OSTEOMALACIA

21. definition Is a rare condition of adult bone associated with Vit D deficiency resulting in decalcification and softening of bone

22. etiology Lack of exposure to ultraviolet rays GI malabsorption Extensive burns Chronic diarrhea Pregnancy Kidney disease Drugs such as phenytoin

23. pathophysiology insufficient vit D intake Interfere with normal mineralization of bone Failure or insufficient calcification of bone bone softening

24. Clinical features Localized bone pain Difficulty rising from a chair Difficulty walking Low back and bone pain Weight loss Progressive muscular weakness Progressive deformities of the spine( kyphosis ) or extremities Fractures are common and demonstrate delayed healing when they occur

25. Diagnostic measures HISTORY COLLECTION PHYSICAL EXAMINATION BLOOD STUDIES Decreased S. calcium and phosphorus levels Decreased S. 25 hydroxy vitamin D Elevated S. alkaline phosphatase X-RAY CT SCAN AND MRI SCAN

26. management Correction of vit D deficiency Vit D3 ( cholecalciferol ) and vit D2 ( ergocalciferol ) can be supplemented Calcium salts or phosphorus supplements can be prescribed Dietary ingestion of eggs, low fat milk, fish and vegetables is encouraged Exposure to sunlight