Osteoporosis

• Abnormal rarefaction of bone which may be idiopathic or secondary to other condition.
• This disorder leads to thinning of skeletal and decrease precipitation of lime salt.
• Osteoporosis is defined as systemic skeletal disease characterized by low bone mass and micro-architectural determination of bone tissue that leads to increase bone fragility and susceptibility to fracture or breakdown (hips,vertebrae,forearm)

Etiology :-

• increase aged
• Poor diet(low calcium and vitamin D)
• chronic alcoholism
• Tobacco,smoking
• Lack of exposure to sunlight
• lack of physical exercise
• Hyperthyroidism
• Estrogen deficiency after menopause
• surgical removal of ovaries
• Excessive secretion of parathyroid hormone 
• Certain medication (chemotherapy,Anti-seizure)
• Family history of genetic 
• Excessive consumption of soft drinks(increase amount of phosphoric acid)

Pathophysiology :-

1. Due to any etiological factor
2. calcium resorption
3. increase in osteoclast activity
4. Brittle or fragile bones
5. Reduction in resistance of bone towards physical stress
6. Fracture ,improper gait and reduction in height 

•   Bone is dynamic tissue that undergoes that continue remodeling (the process by which old bone is replaced by new bone)
• the remolding sequence start with activation of osteoclast which resorb a small portion of bone over a relatively short period of time (7-10 days)bone formation then take place as osteoblast form an organic matrix that is subsequently mineralized.

Clinical Manifestation :-

• Sudden onset of severe back pain .
• Kyphosis (posterior curvature of spine or humpback)
• Abdominal distention 
• Impaired respiration due to restricted lung expansion
• Loss of denture or teeth (due to loss in mandible) and finally fracture specially hip,vertebrae,forearm
• Improper gait, and reduction in height

Investigation :-

• Physical examination 
• Family history
• dual energy X-ray 
• Blood test 
• Urine calcium level
• CT,MRI

Management :-

Medial management :-

• Bisphosphonate
• Estrogen therapy (in early menopause)

Nursing management :-

• Pain related to fracture
• Altered nutrition less then body requirement related to calcium and vitamin D deficiency
• Risk of fracture due to disease condition softening of bone
• Impaired physical activity due to disease condition.

Nursing Responsibility :-

• Adequate intake of calcium and vitamin D
• Regular weight bearing exercise 
• Avoidance of alcohol and tobacco
• Assess clients at risk of fracture for activity level and dietary adiquency and programme appropriate teaching to prevent fracture
• Assessment include visual assessment medication that may cause dizziness or postural HTN.
• Difficulties with balance or co-ordination as well as the home environment for potential safety from hazards.
• Evaluation of the bone setting is performed via admission assessment discussion with the client consultation with specialist in social service and home safety evaluation by visiting nursing.
• Instruct the client who are prompt to dizziness to get up slowely from a lying position sitting on the site of the bed first.
• An aid to ambulation such as a cane or walker may also the indicated to prevent falling.
• Hand rails should be also available or provided specially in bathroom or toilets.