Patho
an increase in bone resorption and a decrease in bone formation, which results from an
imbalance in osteoclast and osteoblast activity. This imbalance diminishes bone density
and bone quality, especially in trabecular bones (vertebra, wrist, femoral neck, and
ribs). In menopausal osteoporosis, estrogen deficiency is associated with accelerated
bone resorption and rapid bone loss that begins during the perimenopausal and early
menopausal periods. Decreased bone formation is more problematic in the late periods
of menopause.
Osteoporosis is a systemic skeletal disease characterized by low bone mass,
microarchitectural deterioration of bone tissue leading to enhanced bone fragility, and a
consequent increase in fracture risk. In postmenopausal women, osteoporosis is usually the
result of accelerated bone turnover due to estrogen deficiency, whereas in aging women
and men, vitamin D insufficiency and secondary hyperparathyroidism may further contribute
to bone loss.
Bone mass in older adults equals the peak bone mass achieved by age 18–25 minus the
amount of bone subsequently lost. Peak bone mass is determined largely by genetic factors,
with contributions from nutrition, endocrine status, physical activity, and health during
growth.
Osteoporosis is defined as bone density more then 2.5 standard deviations below the average
bone mass for a healthy young adult.
The process of bone remodeling that maintains a healthy skeleton may be considered a
preventive maintenance program, continually removing older bone and replacing it with new
bone. Bone loss occurs when this balance is altered, resulting in greater bone removal than
replacement. The imbalance occurs with menopause and advancing age. With the onset of
menopause, the rate of bone remodeling increases, magnifying the impact of the
remodeling imbalance. The loss of bone tissue leads to disordered skeletal architecture and
an increase in fracture risk.
Cosman, F., De Beur, S., LeBoff, M., Lewiecki, E., Tanner, B., Randall, S., & Lindsay, R.
(2014). Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int,25,
2359-2381. doi:10.1007/s00198-014-2794-2
(Cosman et al., 2014)
Bone mass in older adults equals the peak bone mass achieved by age 18–25 minus the
amount of bone subsequently lost. Peak bone mass is determined largely by genetic factors,
with contributions from nutrition, endocrine status, physical activity, and health during
growth.
International Osteoporosis Foundation. (2017). Epidemiology. Retrieved from
https://www.iofbonehealth.org/epidemiology
(International Osteoporosis Foundation, 2017)
Risk factors you cannot change:
Sex. Your chances of developing osteoporosis are greater if you are a woman. Women have
less bone tissue and lose bone faster than men because of the changes that happen with
menopause.
Age. The older you are, the greater your risk of osteoporosis. Your bones become thinner
and weaker as you age.
Body size. Small, thin-boned women are at greater risk.
Ethnicity. White and Asian women are at highest risk. African American and Hispanic women
have a lower but significant risk.
Family history. Fracture risk may be due, in part, to heredity. People whose parents have a
history of fractures also seem to have reduced bone mass and may be at risk for fractures.
Risk factors you can change:
Sex hormones. Abnormal absence of menstrual periods (amenorrhea), low estrogen level
(menopause), and low testosterone level in men can bring on osteoporosis.
Anorexia nervosa. Characterized by an irrational fear of weight gain, this eating disorder
increases your risk for osteoporosis.
Calcium and vitamin D intake. A lifetime diet low in calcium and vitamin D makes you more
prone to bone loss.
Medication use. Long-term use of certain medications, such as glucocorticoids and some
anticonvulsants can lead to loss of bone density and fractures.
Lifestyle. An inactive lifestyle or extended bed rest tends to weaken bones.
Cigarette smoking. Smoking is bad for bones as well as the heart and lungs.
Alcohol intake. Excessive consumption of alcohol increases the risk of bone loss and
fractures
National Institutes of Health Osteoporosis and Related Bone Disease. (2018). Osteoporosis
Overview. Retrieved by https://www.bones.nih.gov/sites/bones/files/pdfs/osteopoverview-
508.pdf
(National Institutes of Health Osteoporosis and Related Bone Disease, 2018)
Charlotte, S. (2016, January 05). The Risk Factors for Osteoporosis in Women. Retrieved from
https://www.scoopcharlotte.com/2014/04/29/risk-factors-osteoporosis-women/
(Charlotte, 2016)
S/s
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:
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
With fractures, especially of vertebra (compression fracture), femoral neck, wrist,
and ribs.
Mayo Clinic. (2016). Osteoporosis. Retrieved from https://www.mayoclinic.org/diseases-
conditions/osteoporosis/symptoms-causes/syc-20351968
Epocrates. (2019). Osteoporosis. Retrieved from
https://online.epocrates.com/diseases/8535/Osteoporosis/Differential-Diagnosis
(Epocrates, 2019)
(Mayo Clinic, 2016)
Diagnostic
Dual-energy x-ray absorptiometry (DXA) of the hip and spine.
o Using DXA to measure bone density of the hand, wrist, forearm, and heel detect
women who are at increased risk for fracture
Quantitative ultrasound
o Inexpensive and performed with portable equipment
Qualitative CT
o Precise but uses more radiation than dual-energy
Radiographic absorptiometry
Single-energy x-ray absorptiometry
Peripheral DXA
Fitzgerald, M. A. (2017). Nurse practitioner certification examination and practice
preparation(5th ed.). Philadelphia: F.A. Davis Company.
(Fitzgerald, 2017)
Medline Plus (2019). Bone density scan. Retrieved from
https://medlineplus.gov/ency/imagepages/1073.htm
Treatment
Nonpharmacologic: exercise, increased dietary intake of calcium, decreased dietary
intake of phosphates, vitamin D supplementation, and smoking cessation.
Pharmacologic: bisphosphonates, rh-PTH, and raloxifene.
Jeremiah, M. P., Unwin, B. K., Greenawald, M. H., & Casiano, V. E. (2015). Diagnosis and
Management of Osteoporosis. American Academy of Family Physicians,92(4), 261-268.
Retrieved from https://www.aafp.org/afp/2015/0815/p261.pdf.
(Jeremiah, Unwin, Greenawald & Casiano, 2015)
Oral bisphosphonates should be taken only with water and a wait of at least 30 minutes
before reclining or ingesting other medication or food. This decreases upper gastrointestinal
adverse effects and allows for appropriate absorption.
Uptodate. (2019). Patient education: Osteoporosis prevention and treatment. Retrieved from
https://www.uptodate.com/contents/osteoporosis-prevention-and-treatment-beyond-the-
basics#H2
Results
When a patient has osteoporosis, what are they most at risk for?
Questions for class
1) Please explain the difference between primary osteoporosis and secondary osteoporosis.
https://www.aafp.org/afp/2001/0301/p897.html
2) What are the recommendations for osteoporosis screening?
3) What clinical disorders can increase the risk for osteoporosis
4) Before prescribing Bisphosphonates, what education should the nurse practitioner
provide to minimize the risk of drug-induced esophagitis?
5) What is the difference between osteopenia and osteoporosis?
6) Why is osteoporosis more common in women than in men?
7) What are the most common parts of the body susceptible to fractures?
8)
