Osteoporosis

Osteoporosis is a disorder where the density of bone declines, weakening it and making it more brittle. Osteoporosis causes abnormally porous, collapsible bone that looks like a sponge. This skeleton condition causes the bone to become weaker and frequently fracture (break).

Calcium, collagen, and protein make up normal bone, which is what gives it its strength. Injuries that ordinarily wouldn't cause a bone to fracture can cause bones affected by osteoporosis to break (fracture). Osteoporosis-related fractures can happen in virtually any skeletal bone, but it most frequently affects the spine, hips, ribs, and wrists.

Pathophysiology

Bone is an active tissue that undergoes continuous remodeling in response to hormonal and mechanical stress. The transformation of a bone's quiescent surface into a bone resorptive surface marks the beginning of the bone remodeling process. Osteocytes play a key role in the start of bone remodeling by sending signals to osteoclasts and osteoblasts on the surface of the bone. Osteoclasts first form a resorption pit before resorbing the bone matrix. Apoptosis marks the end of their function, and thereafter coupling signals are delivered to osteoblasts. The bone matrix is then created by osteoblasts and proceeds through mineralization.Men with idiopathic osteoporosis and concurrent hypercalciuria have considerably lower osteoblastic and mineralizing surfaces than men with normocalciuria, according to research on histomorphometric indices for cancellous bone. Although the mechanism of this association is unknown, epidemiological studies have revealed that osteoporotic fractures occur more frequently in people with nephrolithiasis. Hypercalciuria and hypocitraturia are also significant risk factors for stone development.

Risk factors

You can divide risk factors for osteoporotic fracture into non-changeable and (possibly) modifiable categories. Additionally, osteoporosis is a known side effect of some illnesses and disorders. Although the use of drugs that raise the risk of osteoporosis may often be inevitable, pharmaceutical use is potentially adjustable. There is no link between caffeine and osteoporosis.

A female is more prone than a guy to get osteoporosis.

Non-modifiable

At around 30 years old, bone density reaches its pinnacle. Compared to men, women lose bone mass more quickly.

The most significant risk factors for osteoporosis are advanced age (in both men and women), female sex, and estrogen deficiency following menopause or surgical removal of the ovaries. In contrast, a decline in testosterone levels in men has a similar (but less pronounced) effect.

• Race:
  • While osteoporosis affects people of all racial and ethnic backgrounds, it is more likely to affect those with European or Asian ancestry.
• Heredity:
  • People who have a family history of osteoporosis or fractures are at a higher risk; poor bone mineral density and fracture heritability are both relatively common, with heritabilities ranging from 25 to 80%. The onset of osteoporosis is linked to at least 30 genes.
  • In comparison to those of the same age and sex, those who have already experienced a fracture are at least twice as likely to experience another one. Another risk factor is hysterectomy or early menopause.
• Build:
  • Another unchangeable risk factor linked to the onset of osteoporosis is small stature.

Potentially modifiable

Alcohol abuse: Although moderate drinking is likely beneficial (drinking increases bone density), chronic heavy drinking (drinking more than three units per day) is likely to increase the risk of fractures despite any potential benefits to bone density.

• Vitamin D deficiency:
  • Elderly people around the world frequently have low levels of circulating vitamin D. The production of parathyroid hormone (PTH) is elevated in mild vitamin D deficiency. PTH causes bone loss by accelerating bone resorption. Bone mineral density and serum 1,25-dihydroxycholecalciferol levels are positively correlated, whereas PTH is inversely correlated with bone mineral density.
• Tobacco smoking:
  • Smoking has been linked in numerous studies to poorer bone health, although the exact processes are unknown. Smoking tobacco is a known risk factor for osteoporosis and has been proposed to impede osteoblast function. Smoking also accelerates the onset of menopause, lowers body weight, and increases the breakdown of exogenous estrogen, all of which diminish bone mineral density.
• Malnutrition:
  • Nutrition has a significant and intricate part in the preservation of healthy bones. Low dietary calcium and/or phosphorus, magnesium, zinc, boron, iron, fluoride, copper, and vitamins A, K, E, and C have all been identified as risk factors (and D where skin exposure to sunlight provides an inadequate supply). One risk factor is too much salt. High blood acidity is a recognized opponent of bone and may be caused by nutrition. Low protein intake has been linked to both reduced bone mineral density in elderly populations and lower peak bone mass during youth, according to some studies. Protein is one of the reasons of dietary acidity, but others have cited low protein intake as a benefit. Omega-6 to omega-3 polyunsaturated fat imbalance is yet another known danger factor.
• High dietary protein from animal sources:
  • Animal protein-rich diets have been related to higher levels of urine calcium and an increase in fractures, according to research. Although higher protein diets seem to promote calcium absorption from the diet and are linked to increased bone density, the relevance of this result to bone density is uncertain. In fact, it has lately been suggested that low-protein diets are to blame for weak bones. Dietary protein has not been the subject of any interventional research for osteoporosis prevention and therapy.
• Underweight/inactive:
  • Physical stress triggers bone remodeling, hence being inactive can result in considerable bone loss. Weight-bearing activity can help people reach their maximal bone mass in adolescence, and studies have shown a strong relationship between bone and muscle strength. Overweight people have a decreased incidence of osteoporosis.
• Endurance training:
  • Large training loads can result in decreased bone density and an elevated risk of osteoporosis in female endurance athletes. The female athlete trifecta, which includes amenorrhea from hard exercise and the suppression of menstruation, may be the reason of this phenomenon. The situation is less clear for male athletes, and while some studies have found lower bone density in elite male endurance athletes, other studies have found increased leg bone density.
• Heavy metals:
  • Lead and cadmium have a well-established connection to the bone condition. Low-level exposure to cadmium is linked to a rapid loss of bone mineral density in both sexes, which causes discomfort and raises the risk of fractures, particularly in older people and women. Increased cadmium exposure causes osteomalacia (softening of the bone).
• Soft drinks:
  • Soft drinks, many of which contain phosphoric acid, may raise the risk of osteoporosis, at least in women, according to some studies. Others contend that soft drinks may indirectly cause osteoporosis by displacing calcium-rich beverages from the diet.

Signs and symptoms

Early on in the process of bone loss, there are typically no symptoms. However, once osteoporosis has weakened your bones, you might experience the following signs and symptoms:

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

Diagnosis

• DEXA Scan (Dual X-ray Absorptiometry):
  • Dual X-ray absorptiometry, also known as DXA or DEXA, is the most used osteoporosis test. It measures a person's spine, hip, or entire body bone density to assist determine their risk of fracture.
• Beyond DEXA: Other Bone Mineral Density Tests:
  • Numerous techniques, such as quantitative computed tomography and ultrasound, can be used to measure bone density (QCT). The results of tests for bone density and their price may differ.
• Blood Test Markers:
  • Your doctor may request a blood or urine test to check your bone metabolism, regardless of whether you are receiving treatment or screening for osteoporosis. This offers hints about how your disease is developing.
• Bone Densitometry:
  • Similar to an X-ray, bone densitometry is a technique that swiftly and precisely determines the density of bone.

Treatment

• Bisphosphates:
  • The main medications used to treat and prevent osteoporosis in postmenopausal women are bisphosphates. Alendronate, ibandronate, and risedronate can all be administered orally. Most are consumed orally, typically once every week or once per month. It can be administered intravenously, but this is less common.
• Calcitonin:
  • It is a medication that reduces bone pain and displays the rate of bone loss. It is available as an injectable or nasal spray.
• Hormone replacement therapy:
  • Estrogens or hormone replacement therapy are rarely used to treat women who already have osteoporosis, and they are not licensed for the prevention of the disease.
• Teriparatide:
  • It is authorized for the treatment of postmenopausal women with severe osteoporosis who are thought to be at high risk for fractures.
• Raloxifene:
  • Osteoporosis is treated and prevented by the drug raloxifene. It is comparable to the tamoxifen breast cancer medication. It can almost 50% lower the risk of spinal fractures. However, it doesn't seem to stop other fractures, like hip fractures. It might offer protection from breast cancer and heart problems.
• Exercise:
  • For those with osteoporosis, regular exercise can lower their risk of bone fractures. Yoga, cycling, jogging, tennis, walking, dancing, using a rowing machine, etc. are a few examples.
• Diet:
  • Consume the recommended quantities of calcium, vitamin D, and protein. While this won't entirely stop bone loss, it will make sure that there is a supply of the substances the body needs to create and maintain bones.
  • Stop bad behaviors like smoking and drinking too much alcohol, which can weaken bones and increase the chance of falling and fracturing a bone.
• Avoid falling:
  • Falling must be avoided at all costs. To lower the chance of fractures, stay away from sedative medications and get rid of domestic hazards. Make sure the patient has clear vision.
• Monitoring:
  • Bone mineral density readings taken every one to two years can be used to track a patient's response to treatment. Mammograms, pelvic exams, and pap smears are recommended for estrogen-using women.

Nursing management

• Concentrate on ambulation, correct alignment, and workout regimen.
• Apply heat and analgesics as directed to ease pain.
• During all stages of the care process, involve the patient and family.
• Encourage the patient to take care of himself as much as their pain and immobility will allow.
• Give the patient exercises that don't need much effort.
• Daily check for new pain spots, warmth, and redness on the patient's skin.
• Keep an eye on the patient's pain level and evaluate how she responds to analgesics, heat therapy, and distractions.
• Inform the patient of all procedures, tests, and treatments.
• Ensure that the patient and his or her family are aware of the specified medication schedule.
• In particular after trauma, remind the patient to report any new pain sites right away.
• Giving the patient emotional support and assurance will help them cope with their limited mobility.

 References

• deosteoporosis.blogspot.com/2012/06/osteoporosis-definition.html
• docslide.us › Documents
• domangueneuro.com/conditions-treated/osteoporosis/
• edoc.hk/main.php?id=51
• entralmed.com.tw/Eng-science.html
•  es.scribd.com/doc/44646987/Osteoporosis
• faculty.citadel.edu/bogle/hess_508/slides/ch11.pptx
• gurman.sk/imgs/receptar/201413/Xgo8
• jerrymondo.tripod.com/lgev/id21.html
• Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013
• medicinenet.com › home › arthritis center › arthritis a-z list › osteoporosis index
• modernandbeautiful.weebly.com/osteoporosis.html
• msafe.in/Health_Articles/Osteoporosis
• pfizer.com.pk/your-health/womens-health/osteoporosis
• prezi.com/c118fafb1gug/
• stkfupm.com/forum/attachments/reading-osteoporosis-doc.6433/