Osteoporosis, Osteomyellitis, Etc Up To End

OSTEOPOROSIS
-a metabolic disease in which bone demineralization results in decreased

density and subsequent fractures= BONES BECOME PROGRESSIVELY
POROUS, BRITTLE & FRAGILE
Often referred as “silent disease.”

…because bone loss occurs without symptoms.
"You may not know that your bones have become porous (not as dense)
until a sudden strain, bump, or fall causes a fracture."
Most often affected bones:

wrist
hip
vertebral column
40-45% of a woman’s bone mass is lost during her life span.

KYPHOSIS OR
DOWAGER’S HUMP
since bone is a dynamic tissue, it is constantly undergoing changes in a
process: bone remodeling
▼
osteoclastic (bone resorption) activity > osteoblastic (bone building) activity
▼
disruption in the bone remodeling process
▼
>osteopenia (low bone mass) & osteoporosis results
>↓bone mineral density (BMD)
BMD
-determines bone strength
-peaks between 30 & 35 years of age
- ses rapidly in post menopausal women as serum estrogen levels  ses
Bone density test
being done at the
ankle using a
peripheral
device.
Bone density (DEXA)
measurements to
assess overall bone
health status.
These low energy

Xray tests will be
used to measure the
bone mineral density
(BMD) of both hips,
the lumbar spine
(both AP and lateral
views).
These DEXA tests

usually require 20 to
30 minutes for
completion.
MANAGEMENT:
Drug Therapy
HRT (Hormone replacement therapy)
-has been used as a primary prevention strategy for reducing bone loss in
the postmenopausal woman
-long-term effects:  a woman’s risk of breast cancer, cardiovascular dse &
stroke
-conjugated estrogens/ medroxyprogesterone (Prempro, Premphase) use
are carefully evaluated by the health care provider & client
PTH
-approved tx for both men & women
-self-administered, daily subq injection teriparatide (Forteo)
-stimulates new bone formation =ing BMD
-monitor for s/sxs of hypercalcemia: fatigue, anorexia, n&v, constipation,
polyuria
Calcium
-Ca alone is not a tx but an impt part of a prevention program to promote
bone health
-OTC supplements like calcium carbonate (Tums/ Oscal) ; calcium citrate
(Citracal)
-Taken with foods & 6-8 ozs of water
Vitamin D
-for optimal Ca absorption in the intestines
-400-800 International Units/day
Biphosphonates
-inhibit bone resorption by binding with crystal elements in bone, esp
spongy, trabecular bone tissue
-3 BPs: alendronate (Fosamax), ibandronate (Boniva) & risedronate
(actonel) are commonly used for the prevention & management of
osteoporosis
-side effects: not common but when it occurs, they tend to be serious
=esophagitis & esophageal ulcers esp if the tablet is not completely swallowed
=s/sxs: chest pain; d/c drug & call their doctor
-early AM with 8 ozs of water & wait 30 mins before eating
-c/i to clients with poor renal fx, gi reflux dse (GERD)
SERMs (Selective Estrogen Receptor Modulators)
-newer class of drugs designed to mimic estrogen in some parts of the body
while blocking its effect elsewhere
-raloxifene (Evista)
Calcitonin
-thyroid hormone that inhibits osteoclastic activity, thus decreasing bone loss
-IM or subq salmon calcitonin (refrigerated); intranasally Miacalcin=preferred
bec it improves compliance, minimizes side effects & is convenient ; alternate
nostrils to prevent s/e like nasal mucosal irritation
-salmon calcitonin may  its effect are use for 2 or more years requires
holiday from this tx
Diet Therapy
 Ca & vit D intake; alcohol & caffeine discouraged
If w/ fracture:
protein, vit C & iron intake
Exercise
>plays a vital role in pain management & cardiovascular fx
together with the physician , PT prescribes exercises for strengthening
the abdominal and back muscles which improve posture & provide
improved support for the spine, deep breathing
>general weight-bearing exercise program= walking for 30 mins 3x a week,

swimming, biking
>high-impact recreational exercises ( horseback riding, bowling) are
avoided bec it may cause vertebral compression
Osteomalacia is softening of the bones, caused by not having
enough vitamin D, or by problems with the metabolism
(breakdown and use) of this vitamin.
These softer bones have a normal amount of collagen that

gives the bones its structure, but they are lacking in calcium.
Treatment

Oral supplements of vitamin D, calcium, and
phosphorus may be given depending on the
underlying cause of the disorder.
Larger doses of vitamin D and calcium may

be needed for people with intestinal
malabsorption.
REVIEW QUESTIONS: OSTEOPOROSIS & OSTEOMALACIA
1. A patient may have Osteoporosis unknowingly because:
A. Most women die before it becomes a problem.
B. Fractures resulting from Osteoporosis are rare.
C. There is no way to determine the mineral content of the bone.
D. There are no clear warning signs and symptoms.
2. Which of the following diagnostic tests would best evaluate the severity of a
patient’s Osteoporosis?
A.Computed tomography scan C.Magnetic resonance imaging
B.Bone scan D.Dual-energy X-ray absorptiometry
3. Nursing intervention in Biphosphonates include
A. Advise client to lie down after taking the drug
B. Advise the client to take the drug at night
C. Advise the client to remain upright 30mins after taking the drug
D. Instruct client to take the drug with meals.
4. Which medication is administered to suppress bone loss, increase bone
mineral density?
A.NSAID’s C.Calcitonin
B.Corticosteroids D.Glucocorticoids
5. All are true about the drug therapy for osteoporosis except
A. Calcium alone is a treatment
B. Biphosphonates inhibit bone resorption
C. SERMs mimics estrogen in some parts of the body
D. Calcitonin inhibits osteoclastic activity
ANSWERS:
1. D
2. D
3. C
4. C
5. A
It became infected by one of 3
MODES:
1. Extension of soft tissue
infection (infected pressure
or vascular ulcer, incisional
infection)
2. Direct bone contamination fr

bone surgery, open fracture
or traumatic injury (GSW)
3. Hematogenous (bloodborne)
spread fr other sited of
infection (infected tonsils,
boils, infected teeth, upper
resp infections). Typically
occurs in a bone area of
trauma or lowered resistance.
Tuberculosis of the Spine
Tuberculosis (TB) of the backbone is not

common, but is still seen in poor
communities, especially in children.
It is the most common form of tuberculosis
of the bone.
It is important to recognize and treat
it early, before damage to the backbone
causes nerve damage and paralysis.
As the spine collapses forward,

the child may have to hold
himself up using his arms.
Signs
It begins little by

little-often without
pain at first.
A bump develops in
the backbone.
This is because the
front part of one or
more vertebrae is
destroyed and
collapses.
The child has trouble
bending over to pick
things up.
Prevention
consists of early diagnosis and treatment of tuberculosis, and
in the fight against poverty.
Vaccination against TB may also help.
The carpal tunnel is an
opening through the wrist to
the hand that is formed by the
bones of the wrist on one side
and the transverse carpal
ligament on the other.
This opening forms the carpal

tunnel.
The median nerve passes

through the carpal tunnel into
the hand.
It gives sensation to the

thumb, index finger, long
finger, and half of the ring
finger.
Carpal tunnel syndrome (CTS)
is a common problem affecting
the hand and wrist.
Symptoms begin when the

median nerve gets squeezed
inside the carpal tunnel of the
wrist, a medical condition known
as nerve entrapment.
This syndrome has received a lot

of attention in recent years
because of suggestions that it
may be linked with occupations
that require repeated use of the
hands, such as typing on a
computer keyboard or doing
assembly work.
Actually, many people develop
this condition regardless of the
type of work they do.
• any condition that makes the area inside the carpal tunnel smaller
or
• increases the size of the tissues within the tunnel
=can lead to symptoms of CTS.
Example:
-after a wrist fracture or dislocation, the area inside the tunnel can
also be reduced, if the bone pushes into the tunnel
-a traumatic wrist injury may cause swelling and extra pressure within
the carpal tunnel
first symptoms of CTS
-gradual tingling and

numbness in the area
-symptoms are intermittent

They will commonly occur at
night or when driving.
Many people will describe

waking up in the night with their
hands feeling dead or numb,
some say that their fingers feel
like sausages.
Holding the wrists bent will also

bring on the problem.
The best way of making the diagnosis is on the history, however
sometimes that is not enough.
There are several tests that can be done:
Tinel's sign is performed by

briskly tapping a nerve, the
median nerve at the wrist.
(+) = results in shooting

electric-like sensations in
the distal distribution of
the nerve
Phalen's test is performed
by asking the patient to hold
her wrist in maximum flexion.
(+) = if the thumb and finger

becomes numb
Nonsurgical Treatment
A wrist brace
will
Activities that are causing your sometimes
symptoms need to be changed decrease the
or stopped: symptoms in
the early
- Avoid … stages of
 repetitive hand motions CTS.
 heavy grasping
 holding onto vibrating tools A brace keeps
 positioning or working with your wrist the wrist in a
bent down and out resting
 smoking position, not
- Lose weight if you are overweight. bent back or
bent down too
far.
- Anti-inflammatory medications may also help
 common OTC medications such as ibuprofen and aspirin
 oral steroid medications
- High doses of vitamin B-6
-Cortisone injection may help ease symptoms and can aid the
doctor in making a diagnosis
Surgery
 Open release procedure involves simply cutting the transverse carpal

ligament.
 Endoscopic carpal tunnel release
The surgeon merely nicks the skin in order to make one or two small
openings for inserting the endoscope.
An endoscope is a thin, fiber-optic TV camera that allows the surgeon
to see inside the carpal tunnel.
Upon inserting the endoscope, the surgeon can see the wrist structures
on a TV screen.
A special knife is used to cut only the transverse carpal ligament.
The loose ends of the transverse carpal ligament are left apart after
endoscopic release to keep pressure off the median nerve.
The gap eventually fills in with scar tissue.
Hallux valgus actually describes what happens to the big toe.
Hallux is the medical term for big toe, and valgus is an anatomic term that
means the deformity goes in a direction away from the midline of the
body.
“the big toe begins to point towards the outside of the foot”
A bunion is when your big toe points toward the second toe.
Bunions are often caused by
narrow-toed, high-heeled shoes.
These compress the big toe and

push it toward the second toe.
The condition may become painful
as extra bone and a fluid-filled sac
grow at the base of the big toe.
This leads to swelling and pain.

Bunions occur more frequently in
women and sometimes run in
families.
If the bunion gets worse -- resulting in severe deformity or pain --
surgery to realign the toe and remove the bony bump
=bunionectomy= can be effective.
Hallux Valgus Splint
Completely immobilizes the hallux for uninterrupted healing

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OSTEOPOROSIS

-a metabolic disease in which bone demineralization results in decreased

Often referred as “silent disease.”

Most often affected bones:

40-45% of a woman’s bone mass is lost during her life span.

These low energy

These DEXA tests

>general weight-bearing exercise program= walking for 30 mins 3x a week,

These softer bones have a normal amount of collagen that

Larger doses of vitamin D and calcium may

2. Direct bone contamination fr

Tuberculosis (TB) of the backbone is not

As the spine collapses forward,

It begins little by

This opening forms the carpal

The median nerve passes

It gives sensation to the

Symptoms begin when the

This syndrome has received a lot

• increases the size of the tissues within the tunnel

=can lead to symptoms of CTS.

-gradual tingling and

-symptoms are intermittent

Many people will describe

Holding the wrists bent will also

There are several tests that can be done:

Tinel's sign is performed by

(+) = results in shooting

(+) = if the thumb and finger

- High doses of vitamin B-6

 Open release procedure involves simply cutting the transverse carpal

These compress the big toe and

This leads to swelling and pain.

Completely immobilizes the hallux for uninterrupted healing

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