- Osteoporosis is a long-term (chronic) disease which makes your bones more likely to break from minor injuries or falls.
- Many people don’t know that they have osteoporosis until they are diagnosed with a broken or fractured bone.
- Osteoporosis can be managed through lifestyle changes, such as stopping smoking or increasing exercise, and with prescription medicines that strengthen your bones.
- If you are a man over 50, or a woman who no longer has a period, you should ask your doctor if you are at risk of osteoporosis and what you can do to prevent it.
Osteoporosis is a long-term (chronic) disease which makes your bones less dense and more fragile. If you have osteoporosis, you are more likely to fracture or break a bone if you have a mild injury or minor fall. Osteoporosis can be managed with medicines to strengthen your bones, and through lifestyle changes such as how you exercise and stopping smoking.
What are the symptoms of osteoporosis?
The most common symptom of osteoporosis is breaking or fracturing a bone because of a mild injury, such as falling over. Other symptoms include:
What causes osteoporosis?
Osteoporosis is caused by a decrease in bone density, which makes your bones more fragile and easily broken. Everyone’s bones become weaker as they age, but in some people this process happens too quickly. You are more likely to develop osteoporosis if you have risk factors for the disease. Some of the risk factors can be reduced through lifestyle changes or medications but others, such as your age, cannot be changed.
Risk factors that cannot be changed include:
- being over 70 years of age
- being female
- having fallen in the past
- your parents having had hip fractures
- early menopause
Risk factors that can be reduced include:
If you suffer from certain diseases, you are more likely to develop osteoporosis. These include:
Some medications can also increase your risk of developing osteoporosis, including:
- steroids — when used for more than 3 months
- anti-androgen therapy — drugs that block testosterone from working and which are sometimes used to treat prostate cancer
- aromatase inhibitors — drugs that block oestrogen from being produced and working and which are sometimes used to treat or prevent ovarian or breast cancer
- thyroid hormone replacement therapy — which can be a risk factor when used for too long
- antidepressant medications — particularly medicines from the SSRI group
- proton pump inhibitors (PPIs) — medicines which make your stomach less acidic
- thiazolidinedione (TZD) — a medicine sometimes used to treat diabetes
- antipsychotic medications — some medicines used in mental illnesses such as schizophrenia
- anti-epileptic medications — some medicines used to control epilepsy
You can find out more about how your risk factors affect your chance of developing osteoporosis by using the Know your Bones self-assessment tool, developed by the Garvan Institute of Medical Research and Healthy Bones Australia.
How is osteoporosis diagnosed?
Osteoporosis is diagnosed based on your medical history, a physical examination by your doctor, and a bone mineral density test. The bone density test uses a special x-ray to look for signs that your bones are becoming weaker, and assigns you a “T-score” based on the results. If your T-score is -2.5 or less, your doctor will diagnose you with osteoporosis. The higher your T-score, the healthier your bones are.
How is osteoporosis treated or managed?
There is no cure for osteoporosis, but the symptoms of the disease can be managed with medicines and lifestyle changes. Depending on your age, sex and medical history, your doctor will recommend different treatments that will be able to help you. The aim of treatment is to strengthen your bones so that they are less likely to break, and to prevent falls that could damage your bones. Falls are a major source of injury in older people, and osteoporosis makes it more likely that you will be seriously injured after even a minor fall.
Lifestyle changes
Exercise can strengthen your bones and muscles and decrease your risk of falling. Your doctor or physiotherapist can help you build a safe exercise plan which suits your needs and reduces your risk of fracturing your bones. This may include strength training, like lifting weights, and weight bearing exercises (exercise done while on your feet so you bear your own weight) like brisk walking, jogging, tennis or volleyball. Exercises that help improve your balance are useful to help avoid falling over in the future. Examples of some exercises that can help you improve your balance are:
- Tai Chi
- standing with your feet close together
- standing on one leg
- walking backwards
Maintaining a healthy weight can also help you manage osteoporosis. Stopping smoking and reducing your alcoholic consumption to just 2 standard drinks a day can improve your bone strength.
Reducing your likelihood of falling is also important. Consider how you might arrange your home and workplace so you are less likely to trip — for example by fixing down rugs and keeping the floor clear. Wearing sensible shoes and glasses if you need them can also help to keep you stable as your move around.
Medicines
If you have osteoporosis, you doctor may recommend medicines to strengthen your bones. These medicines can include:
- Bisphosphonates — to slow down the natural bone density loss process, which are either taken as pills or injected once a year.
- Denosumab — an injection given twice a year which can also slow down the development of osteoporosis.
- selective estrogen receptor modulators (SERMs) — these are used to replace oestrogen in post-menopausal women (those who no longer have periods).
- menopause hormonal treatment (MHT) — can be given to women under 60 or those who have stopped getting their period in the past 10 years.
- Teriparatide — this can be helpful if you have tried other medicines but your bones are still vulnerable to breaking or fracturing easily.
Sometimes osteoporosis can be painful. Your doctor or pharmacist will be able to help you choose a pain medicine that is suitable for you.
Can osteoporosis be prevented?
Osteoporosis cannot be entirely prevented, but there are some things you can do to reduce your risk of developing the disease. Men over the age of 50, and post-menopausal women (those who no longer have periods ) should discuss their calcium and vitamin D levels with their doctor to check if they could benefit from more calcium or vitamin D. Your doctor may also suggest:
- stopping smoking: this can decrease your risk of osteoporosis and of lung cancer, starting from the first day you don’t smoke
- maintaining a healthy weight: this can mean losing or gaining weight, depending on your BMI.
- cutting back on alcohol: drinking no more than 2 standard size drinks a day or less will help prevent osteoporosis.
- bone strengthening exercises: weight-bearing exercises, like brisk walking, and muscle-building activities such as strength training can help fragile bones heal themselves and become denser and stronger.
- balance training: if you are at risk of falling, balance training can help you stay stable.
When should I see my doctor?
If you feel concerned that you are at risk of or are experiencing osteoporosis, you should arrange to see your doctor. By treating osteoporosis early, you have the best chance of avoiding broken bones as you get older. Osteoporosis can run in families, so you should mention to your doctor if you have a close family member with the disease, or if you have ever had a bone fracture or break due to a minor injury.
What are the complications of osteoporosis?
Osteoporosis causes your bones to become fragile and more likely to break or fracture from even a minor injury or fall. The hip is one of the bones most likely to be affected and unfortunately, hip fractures or breaks can make it hard to walk. They can also take a long time to heal, even preventing someone from being able to continue living independently at home.
Resources and support
For more information and support, try these resources:
Last reviewed: December 2020
This is a quiz that contains NCLEX review questions for osteoporosis. As a nurse providing care to a patient with osteoporosis, it is important to know the signs and symptoms, pathophysiology, nursing management, patient education, and treatment for this condition.
In the previous NCLEX review series, I explained about other musculoskeletal disorders you may be asked about on the NCLEX exam, so be sure to check out those reviews and quizzes as well.
Don’t forget to watch the osteoporosis lecture before taking this quiz.
(NOTE: When you hit submit, it will refresh this same page. Scroll down to see your results.)
1. Bones play an important role in the body. Which of the following in NOT a function performed by the bones?
A. Provide protection and support for the organs.
B. Give the body shape.
C. Secrete the hormone calcitonin and store blood cells.
D. Store calcium and phosphorus.
The answer is C. Bones (specifically bone marrow) are responsible for red blood cell, platelet, and white blood cell production. In addition, it stores blood cells and minerals, such as calcium and phosphorous. Calcitonin is secreted by the thyroid gland NOT the bones. However, calcitonin causes osteoclast activity to be inhibited, but is not secreted by the bone.
2. True or False: Osteoporosis is a disease process that results in the thinning of the matrix of pore-like structures within the compact bone.
The answer is FALSE: Osteoporosis is a disease process that results in the thinning of the matrix of pore-like structures within the SPONGY (not compact) bone. The compact bone is the outside part of the bone, and the spongy bone is found inside the compact bone. It contains a matrix of pore-like components such as protein and minerals…this starts to thin and becomes more porous in osteoporosis.
3. ________ are found within the spongy bone and are responsible for building up the bone matrix. While ________, which are also found in the spongy bone, breakdown the bone matrix.
A. Osteocytes, osteoclasts
B. Osteoclasts, osteoblasts
C. Osteocytes, osteoblasts
D. Osteoblasts, osteoclasts
The answer is D. OsteoBLASTS are found within the spongy bone and are responsible for building up the bone matrix, while osteoCLASTS, which are also found in the spongy bone as well, breakdown the bone matrix.
4. Parathyroid hormone plays an important role in bone health. When the parathyroid gland secretes PTH (parathyroid hormone) it causes:
A. the body to increase the calcium levels by stimulating the osteoclast activity
B. the body to decrease the calcium levels by inhibiting osteoclast activity
C. the body to increase the calcium levels by stimulating osteoblast activity
D. the body to decrease the calcium levels by inhibiting osteoblast activity.
The answer is A. When the calcium levels are low this stimulates the parathyroid gland to secrete PTH, which stimulates osteoCLAST activity. Remember osteoCLASTS break down the bone matrix within the spongy bone. This will cause calcium to enter the blood stream, hence increasing calcium levels.
5. Which patient below is NOT at risk for osteoporosis?
A. A 50 year old female whose last menstrual period was 7 years ago.
B. A 45 year old male patient who has been taking glucocorticoids for the last 6 months.
C. A 30 year old male who drinks alcohol occasionally and has a BMI of 28.
D. A 35 year old female who has a history of seizures and takes Dilantin regularly.
The answer is: C. All these patients are at risk for osteoporosis except the patient in option C. Remember the risk factors include: older age (45+), being a woman, Caucasian or Asian, post-menopause, glucocorticoids therapy, anticonvulsants (Dilantin), REGULAR alcohol usage, smoking, sedentary lifestyle, BMI <19, family history. Option C is not at risk.
6. Your patient is scheduled for a DEXA scan this morning. The patient is having heartburn and requests a PRN medication to help with relief. Which medications can the patient NOT have at this time?
A. Calcium Carbonate
B. Bismuth Salicylate
C. Milk of Magnesia
d. Famotidine
The answer is A. Before a DEXA scan, which is a bone density test, the patient should not take any type of calcium supplements (calcium carbonate (TUMs) or vitamins containing calcium.
7. During an outpatient visit you are assessing the patient’s understanding about the signs and symptoms associated with osteoporosis. Select all of the signs and symptoms stated by the patient that are correct:
A. Dowager’s Hump
B. Loss of 0.5 inches in height compared to young adult height
C. Swelling and warmth at the bone site
D. Some patients are asymptomatic
E. Fractures most commonly in the hips, wrist, and spine
The answers are A, D, and E. Option B is wrong because there is normally a loss of 2-3 inches in height compared to the patient’s height in young adulthood. Option C is wrong because the bone site will not present as warm or swollen (most patients are asymptomatic).
8. During discharge teaching to a patient at risk for developing osteoporosis, you discuss the types of exercise the patient should perform. Which type of exercise is not the best to perform to prevent osteoporosis?
A. Tennis
B. Weight-lifting
C. Walking
D. Hiking
The answer is C. Low-impact exercises are not as beneficial in building bone mass as compared to weight-bearing exercises such as tennis, lifting weights, and hiking etc. The patient should perform exercises that put stress on the bones against gravity, which will help increase bone strength and build muscle.
9. You’re caring for a patient who has a health history of severe osteoporosis. On assessment you note the patient has severe kyphosis of the upper back. Which nursing diagnosis takes priority for this patient’s care?
A. Risk for skin breakdown
B. Knowledge deficient regarding disease process
C. Limited mobility
D. Risk for falls
The answer is D. When assessing the options you want to select the option that is a priority for this patient and risk for falls is the priority. The patient is at risk for falls due to severe kyphosis, which is common in severe osteoporosis (also called Dowager’s Hump). This deformity of the spine limits mobility and increases the chances of falls In addition, it is important the nurse takes precautions in preventing falls because the patient will most likely experience a fracture due to severe osteoporosis.
10. A patient is prescribed Alendronate (Fosamax) at 0800 for the treatment of osteoporosis. As the nurse you know you must administer this medication:
A. on an empty stomach with a full glass of water and keep the patient upright for 30 minutes.
B. right after breakfast and to lay the patient flat (as tolerated) for 30 minutes.
C. with food but to avoid giving this medication with dairy products.
D. on an empty stomach with a full glass of juice or milk.
The answer is A. Alendronate (Fosamax) is a bisphosphonate which is known for causing GI upset, especially inflammation of the esophagus. These medications should be taken with a full glass of water in morning on empty stomach with NO other medication. The patient should sit up for 30 minutes (60 minutes with Boniva) after taking the medication, and not eat anything for 1 hour after taking (helps the body absorb more of the medicine.)
11. A patient is taking Calcitonin for osteoporosis. The patient should be monitored for?
A. Hyperkalemia
B. Hypokalemia
C. Hypocalcemia
D. Hypercalcemia
The answer is C. Calcitonin is made from salmon calcitonin and acts like the hormone calcitonin which is produced naturally by the thyroid gland. It decreases osteoclast activity, which can decrease calcium levels. Therefore, the patient is at risk HYPOcalcemia.
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