Small-framed, non-obese Caucasian women are at greatest risk for osteoporosis. Also, Asian women of slight build are at risk for low bone mineral density or BMD. African American women, who have a greater bone mass than Caucasian women, are less susceptible to osteoporosis. Nutritional factors contribute to the development of osteoporosis. A balanced diet- including adequate calories and nutrients needed to maintain bone, calcium, and Vitamin D- must be consumed. Vitamin D is necessary for calcium absorption and fro normal bone mineralization.
Dietary calcium and vitamin D must be adequate to maintain bone remodeling and body functioning. The best source of calcium and vitamin D is fortified milk. A cup of milk or calcium- fortified orange juice contains about 300 mg of calcium. The recommended adequate intake of calcium for the age range of puberty through young adulthood is 1300 mg per day. The goal of this daily level of calcium is to maximize peak bone mass. The AI (adequate intake) level for adults is 1000 mg per day, and the AI level of older adults is 1200 mg per day.
Inadequate intake of calcium or vitamin D over a period of years results in decreased bone mass and the development of osteoporosis. Medical Management: An adequate, balanced diet rich in calcium and vitamin D throughout life, with an increased calcium intake during adolescence, young adulthood, and the middle years, protects against skeletal demineralization. Such a diet would include three glasses of skim or while vitamin D-enriched milk or other foods high in calcium, daily.
To ensure adequate intake of calcium, a calcium supplement may be prescribed and taken with meals or with a beverage high in Vitamin C to promote absorption. The recommended daily dose should be split and not taken as a single dose. Common side effects of calcium supplements would be abdominal distention and constipation. Regular weight- bearing exercises promotes bone formation. From 20 to 30 minutes of aerobic exercise, 3 days or more a week is recommended. Weight training stimulates an increase in BMD.
In addition, exercise improves balance, reducing the incidence of falls and fractures. Fracture Management: Fractures of the hip are managed surgically by joint replacement or by closed or open reduction with internal fixation. Surgery, early ambulation, intensive physical therapy, and adequate nutrition result in decreased morbidity and improved outcomes. In addition, patients needs to be evaluated for osteoporosis and treated, if indicated. Osteoporotic compression fractures of the vertebra are managed conservatively.
Additional vertebral fractures and progressive kyphosis are common. Pharmacologic and dietary treatments are aimed at increasing vertebral bone density. A new procedure, percutaneous vertebroplasty which is an injection of polymethylmethacrylate bone cement into the fractured vertebra’ is reported to provide a rapid acute pain relief and improved quality of life (Levesque, J. , et al. , 1998). Assessment: Health promotion, identification of people at risk for osteoporosis, and recognition of problems associated with osteoporosis form the basis for nursing assessment.
The health history includes the questions concerning the occurrence of osteoporosis and focuses on family history, previous fractures, dietary consumption of calcium, exercise patterns, onset of menopause, and use of corticosteroids as well as alcohol, smoking, and caffeine intake. Any symptoms of the patient are experiencing such as, back pain, constipation, or altered body image, are explored. Physical examination may disclose a fracture, kyphosis of the thoracic spine, or shortened stature. Problems in mobility and breathing may exist as a result of changes in posture and weakened muscles.