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OSTEOPOROSIS RISK FACTORS

Nonmodifiable Risk Factors

Gender and Age: The leading causes of osteoporosis are a drop in estrogen in women at thetime of menopause and a drop in testosterone in men. Women over age 50 and men over age

70 have a higher risk for osteoporosis. Race and Heredity: While osteoporosis occurs in people from all ethnic

groups, European or Asian ancestry predisposes for osteoporosis. Those with a family

history of fracture or osteoporosis are at an increased risk; the heritability of the fracture,

as well as low bone mineral density, are relatively high, ranging from 25 to 80%.

Chronic rheumatoid arthritis, chronic kidney disease, eating disorders Taking corticosteroid medications (prednisone, methylprednisolone) every day for more

than 3 months, or taking some antiseizure drugs

History of hormone treatment for prostate cancer or breast cancerModifiable Risk Factors

Vitamin D deficiency: Low circulating Vitamin D is common among the elderlyworldwide. Mild vitamin D insufficiency is associated with increased parathyroid

hormone(PTH) production. PTH increases bone resorption, leading to bone loss. A

positive association exists between serum 1,25-dihydroxycholecalciferol levels and bone

mineral density, while PTH is negatively associated with bone mineral density

Drinking a large amount of alcohol: Although small amounts of alcohol are probablybeneficial (bone density increases with increasing alcohol intake), chronic heavy drinking

(alcohol intake greater than three units/day) probably increases fracture risk despite any

beneficial effects on bone density.

Low body weight Smoking: Many studies have associated smoking with decreased bone health, but the

mechanisms are unclear. Tobacco smoking has been proposed to inhibit the activity of

osteoblasts, and is an independent risk factor for osteoporosis. Smoking also results in

increased breakdown of exogenous estrogen, lower body weight and earlier menopause,

all of which contribute to lower bone mineral density.

Malnutrition: Nutrition has an important and complex role in maintenance of good bone.Identified risk factors include low dietary calcium and/or phosphorus, magnesium, zinc,

boron, iron, fluoride, copper, vitamins A, K, E and C (and D where skin exposure tosunlight provides an inadequate supply). Excess sodium is a risk factor. High blood

acidity may be diet-related, and is a known antagonist of bone.

Immobility: Bone remodeling occurs in response to physical stress, so physical inactivitycan lead to significant bone loss.

Endurance training: In female endurance athletes, large volumes of training can lead todecreased bone density and an increased risk of osteoporosis.

[26]This effect might be

caused by intense training suppressing menstruation, producing amenorrhea, and it is part

of the female athlete triad.

http://en.wikipedia.org/wiki/Parathyroid_hormonehttp://en.wikipedia.org/wiki/Parathyroid_hormonehttp://en.wikipedia.org/wiki/Bone_remodelinghttp://en.wikipedia.org/wiki/Osteoporosis#cite_note-25http://en.wikipedia.org/wiki/Osteoporosis#cite_note-25http://en.wikipedia.org/wiki/Osteoporosis#cite_note-25http://en.wikipedia.org/wiki/Amenorrheahttp://en.wikipedia.org/wiki/Female_athlete_triadhttp://en.wikipedia.org/wiki/Female_athlete_triadhttp://en.wikipedia.org/wiki/Amenorrheahttp://en.wikipedia.org/wiki/Osteoporosis#cite_note-25http://en.wikipedia.org/wiki/Bone_remodelinghttp://en.wikipedia.org/wiki/Parathyroid_hormonehttp://en.wikipedia.org/wiki/Parathyroid_hormone

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OSTEOPOROSIS NURSING MANAGEMENT

Focus on careful positioning, ambulation, and prescribed exercises. Administer analgesics and heat to relieve pain as ordered. Include the patient and his family in all phases of care. Encourage the patient to perform as much self-care as her immobility and pain allow. Provide the patient activities that involve mild exercise. Check the patients skin daily for redness, warmth, and new pain sites. Monitor the patients pain level, and assess her response to analgesics, heat therapy, and

diversional activities.

Explain all treatments, tests, and procedure to the patient. Make sure the patient and her family clearly understand the prescribed drug regimen. Tell the patient to report any new pain sites immediately, especially after trauma. Provide emotional support and reassurance to help the patient cope with limited mobility.

DIANOSTICS PAGETS DISEASE

Paget's disease is diagnosed based on the X-ray appearance. Paget's disease might also bedetected with other imaging tests, such as a bone scan, MRI scan, and CT scan. Alkaline

phosphatase, an enzyme that comes from bone, is frequently elevated in the blood of people with

Paget's disease as a result of the abnormal bone turnover of actively remodeling bone. This bloodtest is also referred to as the serum alkaline phosphatase (SAP) and is used to monitor the results

of treatment of Paget's disease.

The bone scan is particularly helpful in determining the extent of the involvement of Paget'sdisease as it provides an image of the entire skeleton. Bone that is affected by Paget's disease can

easily be identified with bone scanning images.