5 SD or below the average value for premenopausal women warrants a diagnosis (Kanis 2002) "The same absolute value for BMD used in women can be used in men. The recommended site for diagnosis is the proximal femur with dual energy X-ray absorptiometry (DXA)" (Kanis 2002).
Management of the pathology
For younger patients in the early stages of the disease, management of the causes of the osteoporosis is essential, such as restoring the patient's normal menstrual cycles with appropriate diet; adjusting the patient's medications to reduce the risk of further bone loss; or establishing a normal endocrine balance of the patient's hormones. For patients at risk because of lifestyle factors such as inactivity, a program of weight-bearing activities may be prescribed.
No surgical treatment is specifically prescribed for osteoporosis, although due to complications from the disorder such as a hip fracture, surgical procedures may be warranted.
Action: The most common pharmaceutical treatment for osteoporosis is calcium supplementation. If this is not effective, bisphosphonate drugs like Fosamax may be prescribed (Osteoporosis, 2011, Mayo Clinic: Treatment and drugs).
Adverse effects: The most common side effects of bisphosphonates include nausea and other gastric conditions. Some women prefer the injectable form of the drugs for this reason. In some patients, the use of bisphosphonate has been linked to stress fractures in the upper femur and jaw osteonecrosis (Osteoporosis, 2011, Mayo Clinic: Treatment and drugs).
Most important nursing considerations: Treatment will vary depending on the severity of the osteoporosis, its cause, and the age and lifestyle of the patient.
Virginia Henderson: Four unmet needs and cares
"Avoid dangers in the environment and avoid injuring others:" (Virginia Henderson's need theory, 2012, Nursing Theories). For an elderly patient, avoiding dangers in the environment may entail creating a housing configuration whereby the patient is unlikely to fall and injure herself (through the use of railings by stairs and in the shower, for example); for a younger patient it may require additional weight-bearing activities and exercise to increase bone mass or reduce the rate at which bone mass is lost.
"Move and maintain desirable postures:" (Virginia Henderson's need theory, 2012, Nursing Theories). For patients of all ages, yoga or other physical therapy to strengthen postural muscles and cope with the physiological problems caused by osteoporosis (such as a slouched posture or collapsed chest) can be helpful.
"Breathe normally. Eat and drink adequately:" (Virginia Henderson's need theory, 2012, Nursing Theories). A diet high in calcium and other minerals, with supplementation may be required.
"Play or participate in various forms of recreation" (Virginia Henderson's need theory, 2012, Nursing Theories): Weight-bearing exercise appropriate to the patient's age is warranted. Weight bearing exercises include running, jumping, and weight lifting (versus non-impact activities like swimming or biking).
Unmet cares (Virginia Henderson's need theory, 2012, Nursing Theories)
Physiological: Proper nutritional and hormonal balance must be restored through dietary advice or medical treatment.
Safety: Safety must be enhanced with appropriate exercise, nutritional counseling, and changes to the patient's environment.
Belonging: Patient's ability to participate in activities can be sustained with drug treatment and nutritional supplementation, as well as dietary modification.
Esteem: Exercise can be used to boost self-esteem and conquer feelings of fragility.
Kanis JA. (2002). Diagnosis of osteoporosis and assessment of fracture risk. Lancet, 359(9321):1929-36.
Osteoporosis. (2011), Mayo Clinic. Retrieved: