Metabolic Diseases of the Bone

•Osteoporosis

•Osteomalacia

•Paget’s

•Gout

•Bone Tumors

Osteoporosis

•Characteristics•Decrease in bone mass

•Bone Fracture

•Women

Osteoporosis

Osteoporosis

Predisposing Factors• Family history

• Intake of caffeine, alcohol, sodium, protein, some medications

• Inactivity

• Diseases including hyperthyroidism, diabetes

Assessment• Back pain, loss of height, Dowagers hump

• Diagnosis: normal lab studies; decreased bone density

• Prevention: Calcium to 1000 mg/day; avoid alcohol; calcitonin, Fosamax, Actonel

Osteoporosis treat, prevention

Osteomalacia

Characteristics• Vitamin D Deficiency, like rickets in children

Predisposing Factors• Lack of UV light

• GI malabsorption

• Kidney disease

Assessment• Skeletal pain

• Bowing of legs, kyphosis,

Osteomalacia help

Osteomalacia

Diagnosis• Decreased serum calcium

• X-ray show bone demineralization

• Increased serum alkaline phosphatase

• Increased urinary hydroxyproline

• WHY? Treatment

• Increase Vit D , normal diet, UV , exercise

Paget’s Disease

Characteristics• Bone deformities due to abnormal regeneration and

reabsorption of bone

• Affects pelvis, lone bones, spine, cranium

Predisposing factors• White male over 50

Assessment • Small hat syndrome, pathologic fractures, bone pain

• May lead to osteosarcoma, chondrosarcoma

Paget’s disease help

Paget’s Disease

Diagnosis• Increased serum alkaline phosphatase

• X-ray shows thickened bone, curved, abnormal structure

Nursing diagnosis Treatment

• Supportive

• Calcitonin, EHDP, Mithramycin

• Exercises

What nursing problems can you identify from this slide?

Gout

Caused by disturbed uric acid metabolism

• Urate salts deposited in articular, periarticular and subcutaneous tissue

Primary result of genetic defect purine metabolism Secondary due to increased cell turnover

• ? Who gets secondary gout?

Gout help

Assessment Gouty Arthritis

Manifestations• Swollen, tender red

joints

Diagnostic Tests Nursing Diagnosis

Interventions• Acute: alleviate

pain, inflammation

• Bedrest

• Medications including ASA, NSAID, Colchicine IV or orally (GI symptoms)

Assessment Gouty Arthritis

Manifestations• Swollen, tender red

joints

Diagnostic Tests Nursing Disgnosis

Interventions• Acute: alleviate pain,

inflammation

• Bedrest

• Medications including ASA, NSAID, Colchicine IV or orally (GI symptoms)

Management of Gout

Uricosuric Agents

• Probenecid (ASA an antagonist); inhibits resportion of uric acid thus increases excretion of uric acid

• Sulfinprazone (anturan) to block resorption uric acid

• Need high fluid intake, alkaline urine

Xanthine-oxidase inhibitors decrease uric acid production

• Allopurinal (zyloprim); may cause agranucytosis

• Need high fluid intake, and alkaline urine