114 chapter 53

metabolic disease in which the bone demineralization results in decreased density and subsequent fractors

• low bone mass
• which occurs when there is disruption in the bone remodeling process (osteoclastic activity is greater than osteoblastic activity)

• bone strength
• 25-30 years of age

• Excessive Caffeine
• Malabsorption of nutrients
• old age both genders all races
• parental H/O osteoporosis (especially mother)
• H/O low trauma fracture after 5
• Low Body Weight
• Chronic low calcium and/or Vit D intake (lack of sunlight)
• Protein Deficiency (50% calcium is bound to protein)
• Estrogen or Androgen deficiency
• Smoking
• high alcohol intake
• lack of physical exercise

• DM
• Hyperthyroidism
• Hyperparathyroidism
• Cushing's Syndrome
• Growth Hormone Deficiency
• Pagets Disease
• Prolonged immobilization
• Bone Cancer
• metabolinc acidosis

• thin white females
• and at an earlier age

because 50% of calcium is bound to protein

• ensure adequate calcium intake
• (milk, Cheese, Green leafy Veg)
• Avoid Sedentary lifestyle
• Continue program of weight barring exercise
• Decrease risk factors

Kyphosis (humpback)

postmenopausal women and men in their 60s and 70s

• decrease in estrogen promotes and increases the rate of bone reabsorption
• decrease in testosterone levels & altered ability to absorb calcium in men result in generalized osteoporosis

an associated medical condition such as hyperparathyroidism (increase in circulating calcium), long term drug therapy, long term immobility, long term steroid use

• a limb is immobilized
• Fracture, limb immobility or paralysis

• estrogen-primary prevention strategy for reducing bone loss but usually risks outweigh benefits
• can increase womens risk for breast cancer, cardiovascular disease and stroke

• stimulates new bone formation and increases BMD
• SQ injection (teach patient how to give daily injections)May have physical dexterity to give daily injections

necessary to give to institutionalized patients

steroids

• a hormone that gets rid of extra calcium in the blood
• used to treat osteoporosis
• paget's disease
• and hypercalcemia

• most common for osteoporosis
• inhibits bone resorption by binding with the crystal elements in bone
• Fosamax, Boniva, Actonel,
• Must be taken with 8 ounces of water on empty stomach for maximum absorption

• Esophagaitis
• Esophageal Ulcers and irritation

Pt with poor renal function or GERD not a canidate

full glass water, take sitting up, take on empty stomach, do not crush

• recent addition for patients who cannot tolerate PO meds or have proven ineffective
• Aredia 3-6 months
• Reclast 1 year

small risk of osteonecrosis, usually of the jaw, especially when being treated for cancer

• Mimic Estrogen
• Should NOT be given to women with H/O DVT
• Teach to monitor S/S

• EVISTA given to postmenopausal women increases BMD by decreasing bone resorption and LOWERS SERUM CHOLESTEROL
• Can cause Elevated Liver Function

• Protein (50% calcium binds to it)
• Magnesium
• Vit K
• Trace Minerals
• Calcium and Vit D
• Avoid Caffeine and Alcohol

• walking for 30 mins day, 3-5 day week
• avoid high impact aerobics
• prevent falls
• strengthen abdominal muscles

• hazard free environment
• no rugs
• well lit hallways
• no heels on shoes
• hip protectors
• lo beds

Loss of bone related to Vitamin D deficiency

Cause Vit D Defv, lack of sunlight, (adult equal of rickets)

major Tx: Vit D

• partial or total gastrectomy, or bariatric surgery, due to malabsorption
• Chrohn's Disease (malabsorption)

• chronic metabolic disorder, bone is excessively broken down (increased osteoclast activity)
• second most common after osteoporosis, cause may be genetic
• usually Dx after 50
• Often confined to 1 bone 
• Hip and pelvis most often but can even be ear bone involved

• osteogenic sarcoma
• bone cancer

• infection of the bony tissue
• can be severe and difficult to treat

Exogenous: infection enters from outside the body (open Fracture)

• Endogenous/Hematogenous
• infection carried by the bloodstream fro other areas

Most Common Type

• osteomyelitis
• infection results from skin infection of adjacent tissue
• (DM foot ulcer)

DM foot ulcers

• long term IV Abx
• possibly multiple agents
• pain meds (very Painful)
• Wound irrigation and Abx solutions

• Clean tech now reccommended
• may require contact precautions if MRSA or other resistant pathogen

• treatment to increase tissueperfusion for clients with chronic unremitting osteomyelitis
• affected area exposed to high concentrations of O2 that diffuses to promote healing
• Given in conjunction with high doses of Abx and surgical debridement

debridement of infected bone allows revascularization of bone (bone will not heal in the presence of necrotic tissue)

Bone Graft if sequestrectomy is large

• used to fill dead space after debridement
• flap provides wound coverage and enhances blood flow to promote healing

if the infection can not be resolved the limb may have to be amputated

• Chondrogenic (from cartiloage)
• Osteogenic (from bone)
• Fibrogenic ( from fibrous tissue)

• lesion is aggressive and can metastasize in the lung although classified as benign
• affect women 20-30

lung

• those that originate in the bone
• Usually the  distal femur 50%
• classic sunburst presentation

not common but malignant

pain swelling leukocytosis and anemia

onion skin appearance on the bone

children and young adult most commonly affected

radiation for breast or lung cancer

start as primary tumors of the prostate, breast, kidney, thyroid, and lungs

• treatment aimed at reducing or removing the _tumor
• _chemo
• _radiation
• surgical management
• Pain Management is major Problem

fingers contract down

round cystlike lesion often overlying wrist joint or tendon

can be aspirated but excision is preferred

• deformity referred to as bunion
• very painful
• great toe deviates laterally

Bunionectomy-remove over growth of bone (long healing time 6-12 wks)

dorsiflexion of any Metatarsalphalageal joint

• inflammation of the plantar fascia in the arch of the foot
• Common in runners
• severe pain in morning when getting out of bed, and with weight barring
• rest, ice, stretches, arch support, NSAIDS
• Worse in the Mornings

• changes in the vertebrae as they rotate and move
• Congenital
• When curvature reaches 60* cardiopulmonary compromise results (life threatening)
• Spinal Instability at 50* (needs surgery)

females

• <50 curvature indicates conservative treatment
• >50 requires surgical intervention

• Surgical Fusion and often Harrington Rods
• Post op limitations can be 3 weeks to 6 onths

Beerbelly or Preg Lady

Humpback

osteopenia

calcium  to be released from the bone into the blood

you don't have a place for the O2 and nutrient s to attach and flow to the part of the body needing healing help

Cannot carry oxygen