Osteoporosis is a chronic and progressive disease of the bone characterized by deterioration of bone tissue and low bone mass, leading to increased bone brittleness and fragility. The main concern with osteoporosis is the increased risk of fractures, which can happen very easily since the bones are porous and weak.
This condition affects women more than men due to various reasons:
- Women have lower calcium intake than men
- Women have less bone mass due to their often smaller frames
- Bone resorption begins earlier in women and becomes rapid during menopause
- Pregnancy takes up a woman’s calcium reserve
- Longevity increases the risk of the development of osteoporosis (women often live longer than men)
Risk factors of osteoporosis include the following:
- Advancing age
- Female gender
- White or Asian ethnicity
- Low body weight
- Cigarette smoking
- Estrogen deficiency in women
- Sedentary lifestyle
- Family history of osteoporosis
- Low calcium diet or vitamin D deficiency
- Excessive alcohol intake
- Low testosterone in men
- Long-term use of drugs like chemotherapy, corticosteroids, and some antiseizure drugs
This condition typically affects the bones in the wrists, hips, and spine. Over time, a patient diagnosed with vertebral fractures and wedging due to osteoporosis may notice a gradual loss of height and kyphosis, which is a humped thoracic spine.
A bone mineral density (BMD) test is used to diagnose osteoporosis and evaluate changes in bone density over time.
Nursing Process
Nurses can begin conversations with older adult patients about getting screened for osteoporosis. Nurses can also identify at-risk patients and educate them on prevention and safety measures.
Interprofessional and nursing care for osteoporosis include ensuring the patient adheres to proper nutrition, providing vitamin D and calcium supplementation, participating in an exercise regimen, preventing falls and fractures, and adhering to drug therapy.
Nursing Care Plans Related to Osteoporosis
Impaired Physical Mobility
Patients with osteoporosis can experience impaired physical mobility since their bones are susceptible to fracture. This can impair their ability to move freely and may result in back pain, hunched posture, and lost height.
Nursing Diagnosis: Impaired Physical Mobility
Related to:
- Disease process
- Bone loss
- Fracture
- Bone pain
As evidenced by:
- Decreased range of motion
- Decreased strength
- Difficulty turning
- Engages in substitutions for movement
- Slowed movement
- Uncoordinated movement
Expected outcomes:
- The patient will maintain functional mobility with or without the use of mobility aids
- The patient will participate in physical therapy as prescribed
Assessment:
1. Assess the patient’s functional mobility.
Assess for any difficulties with ambulation or performing ADLs.
2. Assess the patient’s risk factors.
Older age, female sex, use of certain medications, sedentary lifestyle, and diet history can predispose the client to osteoporosis.
Interventions:
1. Encourage the patient to perform range of motion exercises.
Range of motion exercises prevents immobility, including joint contractures and muscle atrophy in patients with osteoporosis.
2. Consult with a physical therapist.
Physical therapy and rehabilitation programs can help provide an appropriate exercise regimen based on the patient’s current condition.
3. Assist with self-care activities.
Allow the patient to perform some self-care activities with minimal supervision to promote patient control over the situation and self-directed wellness.
4. Review lifestyle choices.
Excessive alcohol consumption, tobacco use, and a sedentary lifestyle increase the risk of osteoporosis. Discuss ways to improve lifestyle habits if the client is interested.
Risk for Injury
Patients with osteoporosis develop porous and weaker bones, increasing the risk of fractures and injuries.
Nursing Diagnosis: Risk for Injury
Related to:
- Disease process
- Bone fracture
- Bone pain
- Weak bones
- Sedentary lifestyle
- Vitamin D deficiency
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at the prevention of signs and symptoms.
Expected outcomes:
- The patient will remain safe and free from injuries
- The patient will demonstrate behaviors that decrease the risk of injuries
Assessment:
1. Assess factors that can contribute to increased risk for injury.
Some risk factors can be modified to decrease the chances of the patient experiencing injuries.
2. Review recent lab work.
Review recent bone density tests, vitamin D, and calcium levels that predispose the patient to injury.
Interventions:
1. Instruct and administer medications.
Bisphosphonates like alendronate or zoledronic acid slow bone loss and reduce the risk of fractures. Denosumab injections improve bone density results and reduce the incidence of fractures.
2. Provide and teach the use of assistive aids.
Assistive aids like walkers, canes, grab bars, shower benches, toilet risers, and more can reduce the incidence of falls and fractures.
3. Improve environmental safety.
Osteoporosis typically affects the elderly, who may have problems with vision. Instruct on removing throw rugs, using night lights, and hiding cords that could be potential fall hazards..
4. Refer the patient to occupational therapy.
Occupational therapists can recommend equipment, footwear, and tips to improve safety in the home and outside.
Deficient Knowledge
Deficient knowledge about osteoporosis, its prognosis, complications, and available treatment options can lead to the development of preventable fractures.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Misinformation
- Inadequate knowledge of resources
- Inadequate participation in care planning
- Inadequate access to resources
- Inadequate commitment to learning
- Inadequate interest in learning
- Inadequate awareness of resources
As evidenced by:
- Nonadherence to bone density testing
- Inaccurate follow-through of instructions
- Inaccurate statements about a topic
- Development of fractures
Expected outcomes:
- The patient will verbalize understanding of the disease process, complications, and treatment regimen
- The patient will demonstrate lifestyle modifications and adhere to the treatment regimen
Assessment:
1. Assess the patient’s knowledge about osteoporosis, its complications, and treatment options.
This will determine additional information needed and correct any misconceptions about the disease if the patient has any.
2. Assess the patient’s motivation to learn and their support system.
Assessment of the patient’s motivation and ability to learn will guide teaching. A support system can be included to reinforce instructions.
Interventions:
1. Instruct on strength training.
Strength training is the best form of exercise to strengthen bones and muscles and prevent fractures.
2. Instruct on foods high in calcium.
Nutrition plays an important role in osteoporosis. Adequate calcium intake, which increases with age, supports strong bones. Calcium-rich foods include dairy products, broccoli, salmon, and fortified cereals and breads. Calcium supplements may be needed for some patients.
3. Teach the patient about vitamin D supplements.
Vitamin D is important because it allows the body to absorb calcium. Vitamin D can be obtained through milk, supplements, and sunlight exposure.
4. Provide information about support and community groups.
Online support groups can offer additional information about healthy living with osteoporosis.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- Osteoporosis. Cleveland Clinic. Reviewed: April 27, 2020. From: https://my.clevelandclinic.org/health/diseases/4443-osteoporosis
- Osteoporosis. Mayo Clinic. Reviewed: August 21, 2021. From: https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968
- Osteoporosis. National Institute on Aging. Reviewed: November 15, 2022. From: https://www.nia.nih.gov/health/osteoporosis
- Osteoporosis Overview. NIH Osteoporosis and Related Bone Diseases National Resource Center. Reviewed: October 2019. From: https://www.bones.nih.gov/health-info/bone/osteoporosis/overview
