Nursing Care Plan for Osteoporosis

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Pathophysiology

Bone is a living tissue that is constantly breaking down and being replaced. Osteoporosis happens when growth of new bone does not keep up with the breaking down of old bone. This makes the bones very brittle and fragile. Primary osteoporosis is a result of the normal aging process, while secondary osteoporosis is a result of another disease process.  

Etiology

Bone regeneration normally takes place much faster than the deterioration process and the bones grow in mass reaching a peak in a person’s 20s. As people age, the breaking down process becomes faster than the regeneration process. The amount of bone mass at the peak can partly determine the likelihood of developing osteoporosis. There are many risk factors. It is most common in older women, due to a decrease in estrogen, as well as people taking corticosteroids or with a decreased dietary intake of calcium.

Desired Outcome

The goal of treatment is to address the underlying causes and prevent fractures.

Osteoporosis Nursing Care Plan

Subjective Data:

  • Bone Pain

There are typically no symptoms in the early stages of bone loss

Objective Data:

  • Loss of height over time
  • Stooped posture
    • Kyphosis of the spine
  • Bone fractures, especially hip/pelvis
  • Pathologic fractures
    • Occur without trauma

Nursing Interventions and Rationales

  • Assess and manage pain

 

Patients often complain of back pain as the vertebra collapse or pain from a fracture. Pain control is essential for the patient to participate in rehab.

 

  • Initiate fall precautions to prevent injury

 

Falls and injuries are more difficult to heal with osteoporosis as the bone takes longer to regenerate. Provide assistance with ambulation, remove rugs or fall hazards and maintain a clear and well-lit path.

 

  • Support fracture stabilization

 

If patient is in cast or splint, make sure the device fits properly and assess for skin integrity and circulation.

 

  • Administer medications appropriately
    • Bisphosphonates (alendronate, ibandronate)
    • Hormone therapy
    • Biologic drugs (denosumab)

 

Medications to slow bone loss may be given as an oral medication daily, weekly or monthly. Some medications require weekly, monthly or quarterly injections.

 

  • Monitor respiratory status and signs of fat embolism

 

Fat embolism is a complication of fractures and can lead to respiratory insufficiency.

 

  • Assist with repositioning

 

Pain and injury make positioning difficult for some patients. Assist in repositioning every 2 hours as needed to prevent skin breakdown and assist with mobility.

 

  • Assist with ROM activities

 

Immobility can cause atrophy of muscles. Assist as necessary with ROM activities to prevent injury.

 

  • Consult physical and occupational therapy as appropriate

 

Consult with PT/OT for evaluation and rehab to maintain functionality and mobility.

 

  • Nutrition and lifestyle education
    • Healthy diet, increase calcium intake
    • Exercise as tolerable in safe environment
    • Quit smoking
    • Limit or avoid alcohol

 

  • A healthy diet high in calcium and vitamin D can help prevent skin breakdown and exercise promotes circulation and healing.
  • Weight-bearing exercises can improve the strength of muscles around weak bones/joints as well as increase bone density to reduce the risk of fractures.
  • Smoking increases the rate of bone loss.
  • Limit alcohol to two drinks per day as it can decrease bone formation and increase the risk of falls.

 


References

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