hey it's Sarah Thresh Turner sorry and.com and in this video I want to be doing an in-depth review over osteoporosis in this video is part of an inkless review series over the musculoskeletal system and as always at the end of this youtube video you can access the free quiz so let's get started first let's start out talking about what is osteoporosis it is a disease that thins the bones to a point where the bones cannot withstand that normal everyday stress on them and this results in fractures bone fractures and as a nurse I have taken
care of a lot of patients who have been admitted with a fall and when they fell they think that they broke their bone their hips specifically but in reality the hip bone broke and then they fell which contributed to the fall and we learn later on that the patient has osteoporosis so these happen now a type of fracture with osteoporosis is known as colles fracture and this happens whenever the lower part of the radius at the wrist of the distal part of the radius where it meets the wrist becomes fractured so here we have our
hand bones or wrist bones and we have our radius and we have our illness and right here in red is our fracture which is the distal part of the radius so that's colles fracture is one of the most common you may see in patients with osteoporosis and some common sites where these fractures tend to happen with this disease process include the wrist of course the hips and the spine so I would remember that now why is this happening why are these bones becoming so thin that they can't even stand that normal stress on them well
inside the bone is called spongy bone and the spongy bone is already porous but what happens is that over time due to certain factors which we're going to talk about in depth here in a moment causes those pores to become bigger and larger so it becomes increasingly porous which is going to do crease bone density you have a low bone density your bones are weak now here you're gonna see a picture on your left of a normal bone and it has the spongy bone notice the pores within the bone now on the right we see
a bone that has osteoporosis and the spongy bone is a lot more porous compared to the bone on the Left which right there that just lets you know that any extra stress on that bone can easily break it because it's bone density has decreased so in a nutshell what is happening is that these osteoclasts that were sod in that spongy bone that we just seen starts to outwork the osteoblasts now remember what osteoblasts do compared to osteoclasts okay osteoblasts blass be builds up the bone so it's going through there these cells and building up that
bone to keep it those pores nice and condensed however osteo class go and break down the bone it will take our calcium and phosphorus and put it back into our system whenever we need it depending on our blood levels and over time these osteoblasts and osteoclasts work at the same speed so we constantly have this nice balance of bone build up bone right now however due to certain risk factors and as you age this process becomes out of whack those osteoclasts are gonna work let me have harder than those osteoblasts and at the age of
30 you actually have peak bone density and then after that these osteoclasts will start out working those osteoblasts so that's why an older age you have a risk factor of developing osteoporosis now this disease tends to sneak up on patients really don't have symptoms until you have that surprise bone fracture so it's really important as a nurse we're teaching the patient prevention factors on how to prevent this disease now before we get in - our Osseo class versus our osteoblasts and how this disease develops along with those hormones that play a role in building bone
health let's talk about the actual role of our bones our bones are super important for how we move live our life and things like that and they are a very unique living organ because not only do they provide support and protect our internal organs but they allow us to move because muscles and ligaments attach to them so we can move around also it gives our body its unique shape some of us are tall some of us are short but really the coolest thing that I think that our bones do is film within the bone the
bone marrow and inside the bone marrow is this intricate system that maintains our survival which is through the production of red blood cells platelets and white blood cells and again this is found within that bone marrow and you have red marrow and yellow marrow and not only does that marrow produce these cells that we need to live we need red blood cells to carry oxygen throughout our body we need white blood cells to fight infection and we need platelets to clot whenever we get a cut or something but it also stores them along with storing
calcium and phosphorus and lipids which will be in the yellow marrow now let's talk about the parts of the bone on the outside the bone structure is really hard it's woven together tightly and it's known as the compact bone and then on the inside which looks like a sponge because it has lots of poor wicking areas it's called spongy bone and this is just a matrix of poor light components that is filled with proteins and minerals specifically calcium and phosphorus and then inside this spongy bone resides these important cells osteoclasts and osteoblasts and again what
do those structures do osteo class starts with C class does it can zooms bones so these little cells go through there and when our calcium levels drop and how they know the calcium levels drop is through these hormones that we're going to talk about here in a second they go consume the bone and release calcium into the blood so you can have higher calcium then the osteoblasts be build the bone so he goes through there takes your extra calcium that's floating around in your blood and builds up the bones and makes them strong so what's
happening again an osteopath so you're not building the bone as much as you're breaking a dam now let's talk about these hormones that influence these osteoclasts and osteoblasts and the reason I want to hit on this is because when we're looking at the medication treatment for these for this condition you need to understand how the meds work and this will help you because a lot of these medications slow down osteo class activity and if you know what gland they're telling to slow down and quit secreting this hormone it'll make a little bit more sins okay
so in your body we have these feedback loops and we learn under an endocrine system about these loops and these loops communicate back and forth with each other to maintain our electrolyte levels and other things so first gland that we want to talk about is called our parathyroid gland and whenever your calcium levels drop your parathyroid gland secretes a hormone called PTH parathyroid hormone in parathyroid hormone plays a big role on the way that your bones build up and break down so parathyroid hormone indirectly influences osteoclast activity so those osteoclasts are going to start going
and consuming bone within that matrix of the spongy bone which is going to release calcium into the blood and increase their calcium levels the parathyroid also influences your small intestine by causing it to absorb to reabsorb more calcium that you're taking in through your food and it causes your kidneys to decrease the amount of calcium who lost throughout those renal tubules and as you're going to see whenever we're going over the medications that one of the things that's prescribed and severe osteoporosis is a parathyroid hormone and you may be asking yourself well why are we
gonna give them parathyroid hormone whenever this actually causes the bones to break down to release calcium into the system to increase calcium well it's really between the relationship between parathyroid hormone and the receptors on the osteoblast because parathyroid hormone binds with the osteoblasts which is going to regulate the activity of those osteoclasts indirectly which in the long run is going to cause formation of the new bone and cause them to be stronger over time so just remember that whenever we start going over that medication so you don't get confused because PTH indirectly influences osteo class
but it's unique relationship with the osteoblasts actually helps us build a new bone and make them stronger and prevent fractures and the long run okay another gland involved is a thyroid gland and whenever the calcium levels are high it causes the thyroid gland to release calcitonin and what does calcitonin do cows and toad calcitonin is going to decrease the activity of those osteo class so we're not going to be consuming as much bone which is why in our medications we'll be giving some of this if the physician prescribes it to help decrease the activity of
how much bone is being consumed and this will help bring our calcium level back down now another thing growth hormone influences the bones how dense they are things like that but another thing I want to hit on is estrogen and testosterone those sex hormones okay estrogen estrogen controls the activity from those osteoblasts and osteoclasts and what it does is that it prevents these osteoclasts from living long so they die they don't continue living for for a long time which will continue breaking down warm boom so the reason I want to point this out is because
whereas estrogen mainly secreted in the ovaries of the female now what happens is that as a woman ages she hits menopause she doesn't have anymore periods her estrogen levels are going to drop so what's going to happen we're not going to have this estrogen here regulating these osteoclasts and osteoblasts so our osteoclasts are just going to keep working consuming our bones and our osteoblasts aren't going to be working as much because as we learned earlier once we hit after 30 these osteoblasts and osteoclasts aren't working at the same rate so when you throw post menopause
in on this that's a double whammy in that that bone matrix is going to start being broken down even more because estrogen isn't there to regulate those osteo class and the osteoblasts aren't working as well as they should and this also affects men as well testosterone which converts into estrogen when a man gets older his testosterone levels can drop and he can also experience same thing as what the woman is now let's convince everything that we have learned up to this point and put it into some mnemonics to help us to remember the risk factors
and the signs and symptoms okay to help us remember risk factors let's remember the word calcium because that's really the big issue here we have those osteoclasts breaking down our bones specifically for that calcium and we want to maintain good calcium levels to help prevent this disease so see calcium and vitamin D intake is low your patient isn't consuming enough of these foods and vitamin D while that well that helps with the the reabsorption of calcium so we need those two hand-in-hand a for age as we get older that osteoclasts and osteoblasts activity goes out
of whack because remember at the age of 30 that's where we have peak bone density and then after that our osteoclasts start out performing or osteoblasts and women are really at risk for this because we have less of a bone mass compared to men so there's less Sprunt bones for those osteoclasts to break down compared to men and we tend to live longer so we're at risk for this also that decreased testosterone level and decreased estrogen this happens as a person ages women hit menopause men just as they get older their testosterone decreases which limits
our osteoblast activity el lifestyle such as smoking which is very hard on the bones using regular alcohol as with alcoholics or just overconsumption of alcohol and a daily basis and alcoholics also tend to have bottom and deficiencies so that can be traced back to this having a sedentary lifestyle or being immobile doing weight-bearing exercises being active builds that muscle which is going to cause that bone to be built because it has to hold that muscle so not really doing a lot of that fit some at risk for this say for being Caucasian or Asian and
this typically affects the women who are Caucasian or Asian I for inherited so genetics mom or dad had it broke a hip really early or a little bit later in life you may be at risk for it so there's a genetic factor you for being underweight having a body mass index of less than 19 also being really thin and small-framed and again that's just because people who are thin and have small frames have less bones so there's osteo class they can really work hard breaking down that bone because there's less bone to break down compared
to someone who has a large frame and being interesting due to not consuming the foods that they need to maintain their bone health and then em our medications okay what medicines can increase a patient's risk I remember these because like tests like to throw out these risk factors and say which patients at risk for osteoporosis okay so glucocorticoids those are those steroid and if they use them longer than three months it's been shown to cause osteoclast activity to increase over the osteoblast the osteoblast activity will decrease another type of drugs are called the anti convulsant
and these do the same thing as those glucocorticoids will decrease the activity of your osteoblasts and that includes phenobarbital carbamazepine which is tegretol finis tonin which is dilantin and valproate which is depakote okay now let's look at our signs and symptoms what's this patient gonna have okay let's remember the word frail because what's going on here we have frail bones so s fractures and where were those fractures going to be more common in our hips our spine and our wrists remember colles fracture that was that radius the distal part where it meets the wrist have
a fracture are four rounding of the upper back and this is where you get severe deformity of the upper back like a hunchback and it's called Dow Agers hump and this is from a spinal fracture and it's causing deformity and one thing about spinal fractures spine fractures you may think that they may be very painful patient may know they have them but a lot of times they're painless and some patients don't even know that they have a fracture in there a lot of times patients are asymptomatic without symptoms until they get a fracture I inches
of height is lost this can vary anywhere from two to three inches and this is from their young adult height so if they have lost a lot of hype in between that range they need to be getting with their doctor getting some testing which we're gonna go over here in a second and see what's going on and why is that it's because of those spinal fractures l4 lower back neck and hip pain maybe on palpation it hurts when you palpate those areas or any type of activity like bending anything that puts pressure on that bone
can cause pain now let's look at the testing what tests are ordered for osteoporosis one thing is called a bone density test and this is ordered as either a DEXA de XA or a DX scan and what it does is it's x-ray imaging taken to measure the calcium and other minerals in the bones now there's no really special prep work for this the patient will lie flat under this machine that will tell you take x-ray imaging however it's important that you know as the nurse or educate the patient who may be doing this as an
outpatient that they do not want to take any calcium supplements 24 hours prior to the scan and that includes like tums Rolaids or any type of vitamins that could have calcium in them so educate them about that because if they show up and they've taken that they'll be rescheduled for another day and that's no fun when you have to reschedule your tests now let's look at our nursing interventions where you're going to be doing for this patient who has all Co Prosis or is it risk for it okay number one we want to be assessing
those risk factors and that goes back to that mnemonic calcium you want to be doing a checklist in your head and seen does this patient have these risk factors and discussing with the patient how they can change those modifiable factors because inherited genetics they can't change that but they can change the fact that they smoke or if they use alcohol or they have an sedentary lifestyle they can start exercising and quit smoking and that can help reduce their risk of developing this also looking for those signs and symptoms next educating them about the testing procedure
that we just talked about with the DEXA scan no calcium 24 hours before the scan and safety this is a huge one we want to protect our patients from those potential Falls because if they're admitted with pneumonia we don't want to prolong their hospitalization because they got up and they broke a bone because they have osteoporosis and they're out for it so just a simple fall that a person who experiences without osteoporosis won't break a bone but for them it can break a bone so one thing is use the call light at all times ask
for assistance use non-slip socks because getting up and socks without those resistant slip areas will allow you to fall communicate fall risk to the other department so they know what to expect with this patients use the bathroom they just can't go the bathroom all by theirself they need to have help have a clutter free environment because in the hospital we have a lot of things in the way like that bedside table trash cans telemetry cords the telemetry box I'm the phone things like that can get in the patient's way and they can fall also make
sure that they're using their eyewear when they get up so they can see because a lot of patients can't see very well and at home you want to tell them get rid of the rugs because you can fall I've had so many patients tell me that they slipped on the rug or a pet got at their feet and got them all tangled up and they fell down so tell them to watch pets and how to use good body mechanics ok prevention those pieces how can they prevent this well number one is weight bearing exercises anything
that they have to put resistance against gravity like lifting weights tennis hiking those other exercises like riding running riding bikes things like that they're good for cardiovascular helps so that it will help that but they need to do those exercises that are weight-bearing so stress that because that builds muscle which builds that bone to have to carry that muscle also eating a diet rich in calcium which includes foods like yogurt milk sardines cheese broccoli collard greens along with foods that are rich in vitamin D because remember vitamin D helps us absorb calcium like salmon tuna
cheese egg yolks now if your patient smokes let them know it's super important they quit smoking and limiting their alcohol intake because all these factors hurt bone hills and last but not least let's look at these medications that are ordered for osteoporosis okay one thing is calcium and vitamin D supplements replenishing the calcium so those osteoblasts can build bones and the vitamin D helps us absorb that calcium popular brand of drugs are called the bisphosphonates and these work to decrease bone breakdown so it's going to limit the life of those osteoclasts which consume bones and
then and it's also going to prolong the osteoblasts which build up bones and some drugs included in this category they tend to end in d Rona T and we have a Lind renee which is fossa max and I band renee which is boniva now as a nurse what you want to remember with this is how to administer them because they cause GI upset and inflamed the soffit yes which is not good so whenever you give this you want to give it on an empty stomach preferably in the morning before breakfast with a full glass of
water the patient needs to set up for at least 30 minutes or 60 minutes 60 minutes with boniva and wait for one hour before consuming food because that will help absorb as much as in the medicine in the system as possible then there is calcitonin and this is made from Selman calcitonin because remember our thyroid naturally makes calcitonin and whenever we have really high calcium levels it will decrease the activity of those osteoclasts so our bones aren't being consumed and calcium entering into the system however because of that when a patient takes this through at
risk for hypocalcemia so monitor them for low calcium levels another type of drug is a hormone replacement therapy HRT this is for women her postmenopausal because remember estrogen levels are low so we don't have a good balance between our osteoclasts and osteoblasts activity and we're breaking down more bone than we however these are typically used for short term because there's a risk for stroke cardiovascular itch issues and clots one type of drug that can be used that sort of has the same effect is a roll aux a theme which is visa and this is a
selective estrogen receptor modulators so the one thing you have to watch out for our deep vein thrombosis without so make sure you're looking at your patients extremities you don't see any red hard warm areas that could represent a clot and our last but not least drug is the Terry para tied for tio which is that drug I was talking about whenever we are talking about the parathyroid and this is used in severe cases of osteoporosis and this is extra parathyroid hormone and how you can remember this is the word Terry para so we're dealing with
parathyroid hormone so remember that part of the word and what's gonna happen is it's gonna stimulate those osteoblasts and make them live longer so you're gonna have new bone formation and stronger because remember it has PTH has a unique relationship with the osteoblasts because it binds with that and it keeps those osteoclasts and check in a sense with how they work so it'll help actually make new bone keep them stronger and hopefully prevent them from getting future fractures okay so that wraps up this lecture on osteoporosis thank you so much for watching don't forget to
take the free quiz and to subscribe to our channel for more videos
