Pathophysiology
Decreased bone mass and density, increased bone fragility and fracture risk. Type I (postmenopausal): trabecular bone loss. Type II (senile): both cortical and trabecular. Primary: age, estrogen deficiency. Secondary: corticosteroids, hyperthyroidism, hyperparathyroidism, malabsorption, immobilization, smoking, alcohol.
Diagnosis & Screening
DEXA scan: T-score. Normal: >-1.0. Osteopenia: -1.0 to -2.5. Osteoporosis: <=-2.5. Severe: <=-2.5 + fragility fracture. Screen: women >=65, men >=70, younger with risk factors, anyone with fragility fracture. FRAX score estimates 10-year fracture risk. Risk factors: family history, low BMI, smoking, excess alcohol, corticosteroids, prior fracture.
Nursing Management
Lifestyle: weight-bearing exercise (walking, jogging, resistance training), adequate calcium (1000-1200 mg/day) and vitamin D (800-1000 IU/day), smoking cessation, limit alcohol, fall prevention. Medications: bisphosphonates (alendronate — first-line), SERMs (raloxifene), denosumab, teriparatide (anabolic). Teach: take bisphosphonates on empty stomach, stay upright 30 min, report jaw pain.
Important Notes
- Bisphosphonates must be taken on empty stomach with full glass of water — patient must stay upright for 30 minutes to prevent esophageal erosion.
- Report jaw pain or unusual thigh pain while on bisphosphonates — may indicate osteonecrosis or atypical fracture.
Clinical Tips
- Weight-bearing exercise is the most effective type for osteoporosis — swimming and cycling do not maintain bone density.
- DEXA T-score <=-2.5 confirms osteoporosis — all women >=65 should be screened.
Summary
Osteoporosis management requires calcium/vitamin D supplementation, weight-bearing exercise, bisphosphonate therapy, fall prevention, and DEXA screening.
