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×
  


*Medications: corticosteroids and heparin (effects

metabolism of calcium)
*Cigarette smoking
*Excessive caffeine ingestion
*Prolonged bed rest (bones not being used)
*Alcoholism
*Soft drink consumption (increased phosphorus =
decreased calcium)
*Normal aging process
*Withdrawal of estrogen at menopause
*Endocrine disorders (hyperthyroidism,
hyperparathyroidism), eating disorders, GI
surgery
*Lack of weight bearing exercise
*Family history of osteoporosis
*Low calcium diet (high calcium food: broccoli,
turnip greens, salmons, almonds, figs, dairy
products)
0

   


* A family history of osteoporosis.

*Sex: Female
*Ancestors from the British Isles, northern Europe,
China, or Japan.
*Being very fair skinned.
*Being small-boned.
*Over the age of 35 start losing bone (start
exercise to increase bone strength)
*Ovaries removed.
*Allergies to milk and milk products

   


*Stress
*Smoking
*Alcohol consumption
*Avoiding milk and cheese in your diet
*Not exercising enough
*Consumption of too many soft drinks
*Not enough protein in your diet help to absorb
calcium
2
2 

’ In Adults the most common is: Staphylococcus

Aureus ± most common (70 (70--80%). Strep is 2nd most
common
’ They will invade the bone
’ Initial response inflammation, Increased vascularity
vascularity,,
edema
’ 2-3 days thrombosis blood vessels occur in area
resulting in ischemia with bone necrosis
· Unless treated promptly bone abscess forms which
contains dead bone tissue which does not easily
liquefy and drain cavity cannot collapse and heal
’ New bone growth (involucnum
(involucnum)) forms and
surrounds sequestrum
’ Chronically infected sequestrum remains
and produces reoccurring abscesses
throughout the patients life (chronic
osteomyelitis))
osteomyelitis
’ Increased incidence of PCN resistance

’   of the long
bones are the most
common sites to be
involved.
’ This predilection is
seen because the
branches of the
nutrient artery (artery
supplying the bone)
arch below the growth
plate and terminate
into venous sinusoids,
thus slowing down the
blood flow.
’ These venous
sinusoids provide an
ideal pool of blood for
the bacterial seeding
and proliferation
 
  


* X-rays identify osteoporosis when there is a 25% to 40%

demineralization.
* Lab studies including serum calcium, phosphorous levels
and alkaline phosphatase, urine calcium, PTH, and
hydroxyproline.

Dual-energy x-ray absorptiometry (DEXA)

‡³bone density scan´
‡Takes 5-15 minutes
‡provides information about spine and hip bone mass
and bone mineral density (BMD)
‡Analyzed and reported by T-scores ± the number of
standard deviations (SD) above or below the average
BMD.
×
× 





*Height loss
* Dorsal Kyphosis or ³Dowager¶s Hump´
*Cervical Lordosis (look like pregnant women)
*Fractures (wrist fractures common)
*Bone pain
   



aimed at á
 
  

 
 á
  
 

2 


 
 

* Hormone Replacement Therapy (HRT) decrease bone

reabsorption increases bone mass
‡estrogen and progesterone
‡worry about cancer

*Calcitonin (Calcimar) started 5 years after menopause

‡Inhibits bone resorption
*Raloxifene (Evista)
‡Selective receptor modulators (SERMs)
‡Estrogen receptor modulator, increases BMD without
stimulating endometrium, indicated both for prevention and
treatment of osteoporosis. (safer than HRT¶s)

*Biphosphonates: alendronate (Fosomax), risedronate

(Actonel), ibandronate (Boniva)
‡Slows normal and abnormal bone resorption without
inhibiting bone formation and mineralization.
2 


 
 

*³B´ for bone mass rebuilding

*³O´ for only take with full glass of water
*³N´ for nausea - do not lie down
*³E´ for esophageal irritation

Goes towards biphosphonates (must use

³BONE´ therapy)


 
 

2 


 
 

*HRT: caution pt. of risk involved in estrogen use

*Calcimar: Assess for allergy to salmon or fish products. May
give SC, IM, or intranasally.
*Evista: Monitor for possible long term effects including
cancer and thrombosis. Arrange for periodic blood counts.
Safer than HRT¶s
*Fosomax, Actonel, and Boniva (most commonly used): Stay
upright for 30 minutes.

0



· Impaired physical mobility R/T pain, devices, weight

bearing limitation

· Knowledge deficit R/T dz process and therapeutic

regimen

· Pain R/T pathological process and surgery R/T

inflammation, pain
· Ineffective coping R/T fear of unknown,
perception of dz process, inadequate support
system

· Disturbance self esteem R/T loss of body part or

alteration in role performance
·


 

*Brimming with 302 mg of calcium an 8 ounce glass

of milk can save your body from nibbling away at its
own framework to satisfy its need for this mineral.

*A slice of Swiss cheese layered in a ham sandwich

racks up 272 mg

*A cup of nonfat cottage cheese with your salad

contains 150 mg

*Two tbsp of parmesan cheese dusted on your

pasta brings in 138 mg
*One cup of nonfat yogurt packs around 400 mg
*Broccoli at 178 mg a cup is and tofu at 260 mg
*Collards 148 mg and turnip greens at 198 mg per cup
*Every ounce of protein that you take in over four
ounces, you need an extra 100 mg of calcium to stay
even (calcium 1000mg)
* Osteoporosis-pale, thin, female. Exercise, take
calcium, take vitamin D
* Take biphosphates at least 30 minutes before meals
×

 


If not treated promptly it results in chronic osteomyelitis,

which may be complicated by:
1. Septicaemia: due to invasion of the blood by the
organisms
2. Septic embolism resulting in abscess in the kidneys,
lungs, heart, etc.
3. Destruction of the growth plate resulting in the limb
length discrepancy especially in children.
4. Amyloidosis may develop in long standing cases
5. Secondary malignancies like sarcomas (rare) and
Squamous cell carcinoma of the sinus tract may also
develop.