osteoporosis /os″tē·ōpərō″sis/ [Gk, osteon + poros, passage, osis, condition] , a disorder characterized by abnormal loss of bone density and deterioration of bone tissue, with an increased fracture risk. It occurs most frequently in postmenopausal women, sedentary or immobilized individuals, and patients on long-term steroid therapy. Osteoporosis may be without a known cause or secondary to other disorders, such as thyrotoxicosis or the bone demineralization caused by hyperparathyroidism. −osteoporotic, adj. ▪ OBSERVATIONS: Individuals are typically asymptomatic early in the disease. The first symptom is usually a dull, aching, constant pain in the bones, particularly the back and chest. The pain may radiate down the leg, and muscle spasms may be present. As the spinal column mass diminishes, dorsal kyphosis and cervical lordosis increase, leading to multiple compression fractures of the spine and a reduction in height. Other fractures occur with minimal or no trauma. Clinical evaluation reveals a complex of risk factors such as estrogen deficiency, androgen deficiency, hyperthyroidism, nulliparity, chronic malnutrition, long-term lack of calcium intake, long history of tobacco use, ethanol abuse, steroid use or abuse, sedentary lifestyle, immobility, familial history, and underlying skeletal disease. Bone mineral density (BMD) tests reveal loss of bone density. X-rays show decreased radiodensity after 25% to 40% loss of bone calcium. Immobility from increased fractures and deformity from spinal crushing are common complications. ▪ INTERVENTIONS: Acute treatment focuses on calcium and vitamin D supplementation; use of calcitonin, bisphosphonates (etidronate, alendronate, pamidronate), or selective estrogen receptor modulators (raloxifene) to prevent bone resorption; nonsteroidal antiinflammatory drugs for pain; and use of estrogen-progestin supplements, which is controversial. Calcium levels are monitored regularly. ▪ PATIENT CARE CONSIDERATIONS: Nursing care is aimed at prevention and early detection. Prevention is centered around proper nutrition with a balanced diet rich in calcium and vitamin D; regular exercise that emphasizes strengthening and weight bearing; cessation of tobacco use and ethanol abuse; and adequate fluoride ingestion. Bone density surveys should be encouraged every 1 to 3 years after age 49 for early detection. Acute care stresses good nutrition with calcium and vitamin D supplementation; a consistent exercise regimen, including moderate, weight-bearing hyperextension and resistance exercises to slow calcium loss and strengthen musculature; heat and massage for muscle spasm; orthopedic supports for back and neck to prevent stress fractures; and canes to aid in walking. Instruction in fall and fracture prevention measures is important to help the individual decrease fracture risk and maintain independence in activities of daily living. Education about medication effects and side effects is needed.
