10.8 Osteoporosis
Osteopenia is an abnormal reduction of bone mass that can lead to osteoporosis. Osteoporosis is a progressive bone disease characterized by a decrease in bone density and deterioration of bone tissue, leading to bone fragility and increased risk of fractures in the hips, spine, and wrist.
Pathophysiology
The pathophysiology of osteoporosis involves an imbalance between bone resorption and bone formation. Bone resorption outpaces bone formation, leading to a reduction in bone mass and structural deterioration. See Figure 10.36 for an illustration of osteoporosis.
Risk factors for osteoporosis include age, gender (women are at a higher risk, especially after menopause), genetics, hormonal changes, inadequate calcium and vitamin D intake, certain medications like corticosteroids, and lifestyle factors like smoking, excessive alcohol consumption, and lack of exercise.
Fractures related to osteoporosis can have severe consequences, affecting mobility, causing chronic pain, and leading to complications that impact overall quality of life.[1],[2]
Assessment
Osteoporosis is often considered a “silent disease” because it typically progresses without noticeable symptoms in its early stages. Individuals may remain unaware of their condition until a fracture occurs, often resulting from a simple fall or even during routine daily activities. Common manifestations of osteoporosis are summarized in Table 10.8.
Table 10.8. Manifestations of Osteoporosis[3],[4],[5]
| Body System | Potential Assessment Findings |
|---|---|
| Skeletal | Decreased bone mineral density (seen in DEXA scans); decreased height; vertebral compression fractures; hip, wrist, or other fractures from minor trauma or falls; and kyphosis |
| Respiratory | Reduced lung capacity or respiratory complications due to spinal deformities caused by vertebral compression fractures or abnormal curvature of the spine |
Diagnostic Testing
Diagnostic testing for osteoporosis primarily involves assessing bone density and evaluating fracture risk[6],[7],[8]:
- DEXA scans are the gold standard for diagnosing osteoporosis. The scan provides a T-score, comparing an individual’s bone density to that of a young, healthy adult and indicating the risk of fracture. A T-score between -1 and -2.5 indicates osteopenia, and a T-score of lower than -2.5 is diagnostic for osteoporosis.
- Quantitative ultrasound (QUS) measures bone density with sound waves at peripheral sites such as the heel. It can provide an estimate of fracture risk.
- A FRAX screening tool may be used to assess an individual’s overall fracture risk. The FRAX tool is a fracture risk calculator that estimates a client’s ten-year probability of a hip fracture or other major fracture. Completion of the FRAX tool allows providers to help make appropriate recommendations about lifestyle modification and risk mitigation.
Nursing Diagnoses
Nursing diagnoses for clients with osteoporosis can help guide nursing care and address the specific ne