Introduction: Osteoporosis is a disease that threatens more than 28 million Americans. Characteristics of Osteoporosis include a reduction of bone density and a change in bone structure, both of which increase susceptibility to fracture. The normal homeostatic bone turnover is altered: the rate of bone resorption is greater than the rate of bone formation, resulting in a reduced total bone mass. Suboptimal bone mass development in children and teens contributes to the development of osteoporosis.
With osteoporosis, the bone becomes progressively porous, brittle, and fragile; they fracture easily under stresses that would not break normal bone. Osteoporosis frequently results in compression fractures of the thoracic and lumbar spine, fractures of the neck and intertrochanteric region of the femur, and Colles’ fractures of the wrist. The probability that a 50 year old Caucasian woman will experience a hip fracture during her lifetime is 14%; for a Caucasian man, it is 5% to 6%. The risk for African-Americans is lower- 6% for women, and 3% for men.
Multiple compression fractures of the vertebrae result in skeletal deformity. Osteoporosis is a costly disorder not only in terms of health care dollars but also in terms of human suffering, pain, disability, and death (Koopman,2001). The gradual collapse of the vertebra maybe asymptomatic; it is observed as progressive kyphosis. With the development of kyphosis or a “dowager’s hump”, there is an associated loss of height. Frequently, postmenopausal women lose height from vertebral collapse. The postural changes result in relaxation of the abdominal muscles and a protruding abdomen.
The deformity may also produce pulmonary insufficiency among women. Many patients, especially women complains of fatigue. Prevention: Primary osteoporosis occurs in women after menopause, but it is not merely a consequence of aging. Failure to develop optimal peak bone mass during childhood, adolescence, and young adulthood contributes to the development of osteoporosis without resultant bone loss early identification of at-risk teenagers and young adults, increased calcium intake, participation in regular weight-bearing exercise, and modification of lifestyle (ex.
Reduced use of caffeine, cigarettes, and alcohol) are interventions that decrease the risk for development of osteoporosis, fractures and other associated disability later in life. Secondary osteoporosis is the result of medications or other conditions and diseases that affect bone metabolism. Specific disease states and medications (ex. Corticosteroids, anti-seizure medications that place patient’s at-risk need to be identified and therapies instituted to reverse the development of osteoporosis.
Considerations: The prevalence of osteoporosis in women older than 80 years of age is 84%. The average 75 year old woman has lost 25% of her cotical bone and 40% of her trabecular bone. With the aging population, the incidence of fractures, pain, and disability associated with osteoporosis is rising. The mortality rate 1 year after hip fracture is 20%. Two-thirds of patients with hip fracture never regain their prefracture level of functioning (Bigos, S. et al. , 1994)
Elderly people absorb dietary calcium less efficiently and excrete it more readily through their kidneys; therefore, postmenopausal women and the elderly actually need to consume liberal amounts of calcium. As much as 1500 mg daily for post menopausal women may be prescribed. Most residents of long term care facilities have a low bone mineral density and are at risk for fracture. Hip protectors have been found to reduce the incidence of hip fracture in the elderly; however, complications in wearing these hip protectors are low (Kleerokeper, M. , et al. , 1999).