Osteoporosis, Osteomalacia, Paget's Disease - Medical-Surgical - Musculoskeletal | @LevelUpRN

Hi. I'm Cathy with Level Up RN. In this video,  we are going to talk about osteoporosis, osteomalacia, and Paget's disease.

At the end of  the video, I'm going to give you guys a little quiz to test your knowledge of some of the  key points I'll be covering in this video, so definitely stay tuned for that. And if you  have our Level Up RN medical surgical nursing flashcards, definitely pull those out so you  can follow along with me. Osteoporosis is a metabolic bone disorder that causes a decrease  in bone mass.

This leads to fragile bones and an increased risk for fractures in a patient with  osteoporosis. Osteopenia is the precursor to osteoporosis. So risk factors associated with  osteoporosis include older age, low body weight, vitamin D or calcium deficiency, smoking,  immobility, corticosteroid use, as well as hyperparathyroidism.

So your parathyroid glands  produce PTH, parathyroid hormone. Parathyroid hormone pulls calcium out of the bones into the  bloodstream. So if we have hyperparathyroidism, that's going to place the patient at risk for  osteoporosis.

In addition, white and Asian individuals are at higher risk for osteoporosis. In terms of signs and symptoms, the patient may complain of back pain. You may notice  that their height decreases over time.

They may have kyphosis, which is where they have  an exaggerated thoracic spine. So it will kind of curve outward like that. And they may also  have balance issues.

In terms of diagnosis, we would do this with a DXA, or dual-energy x-ray  absorptiometry. And then in terms of treatment, medications that can be used include calcitonin,  estrogen, alendronate, as well as raloxifene. So all of these medications, they work by  decreasing bone resorption.

So we're trying to decrease the amount of calcium that is leaving  the bones and going into the bloodstream. So I have a video in my pharmacology playlist which  goes over all the details of these medications. So definitely check that out because there's  some important patient teaching and points you need to know about these medications.

And then in terms of patient teaching, we want to make sure the patient is getting  sufficient calcium and vitamin D. So it's not enough to just get enough calcium. We need that  vitamin D to allow for absorption of that calcium.

So one way to get vitamin D is sunlight. So  we want to advise our patient to get sunlight, with appropriate sunscreen, of course. Vitamin  D supplements may also be needed.

In addition, we want to advise our patient to engage in  weight-bearing exercise. So this could be strength training. It could be walking.

Really, anything  that involves gravity will help. So swimming is a great exercise for cardiovascular, but it is not  weight-bearing. So strength training is a great way to prevent osteoporosis.

And then we also  want to advise our patient to implement safety precautions because we want to prevent falls,  which could really be bad news for the patient because they have these fragile bones,  and fractures are definitely a risk. Now let's talk about osteomalacia, which is bone  loss due to vitamin D deficiency. So this is the adult equivalent of rickets in children.

So when  an individual does not get enough vitamin D, this impairs calcium absorption. And this, in  turn, triggers the release of parathyroid hormone, which pulls calcium out of the bones into the  bloodstream. So this impairs bone mineralization and results in soft bones.

So risk factors  associated with osteomalacia include insufficient sunlight exposure or insufficient  vitamin D intake. It can also be caused by a disease or disorder which impairs vitamin  D absorption, such as Crohn's disease or celiac disease. So in terms of signs and symptoms, the  patient may complain of bone pain and weakness.

They may have a waddling gait, and they may also  have increased falls because of those soft bones. In terms of labs, we will see a decrease  in serum calcium as well as phosphorus, and then PTH levels will be increased because  the body's trying to compensate and pull calcium out of the bones. And then in terms of  diagnosis, we can do this with a bone x-ray, a DXA, as well as a bone biopsy.

And treatment  involves supplementation with vitamin D, because that is the underlying issue with this disorder. Finally, let's talk about Paget's disease, which is a metabolic disorder that causes bones to  become soft, structurally disorganized, and weak. And this places the patient at high risk for  fractures.

So with this disorder, we have excessive breakdown of bone tissue by osteoclast.  And this bone tissue is replaced with abnormal, weak bone tissue. The cause of this  disorder is unknown, so it's idiopathic.

Risk factors include older age, those  of European descent, and male gender. Signs and symptoms can include bone pain and  stiffness, abnormal spinal curvature, fractures, as well as bowing of the long bones. Sometimes  patients are asymptomatic as well.

In terms of diagnosis, we can do this using lab tests as well  as imaging, such as X-ray and a nuclear bone scan. In terms of treatment, analgesics can be used for  bone pain. We can also provide the patient with osteoporosis medications such as Calcitonin and  alendronate.

And in terms of patient teaching, we want to encourage the patient to engage  in gentle exercises to help maintain their mobility. We also want them to implement  safety precautions because we want to prevent falls. If the patient were to fall, they are  at high risk for fractures with this disorder.

All right, it's time for a quiz. I have  three questions for you. First question.

Swimming is an effective exercise to  prevent osteoporosis. True or false? The answer is false.

So swimming is not a  weight-bearing exercise, and weight-bearing exercise is the most effective type of exercise  to prevent osteoporosis. Question number two. Osteomalacia is caused by a lack of blank.

The  answer is vitamin D. Question number three. Which of the following is not a risk  factor for osteoporosis, older age, excess body weight, menopause, and smoking?

The answer is excess body weight. So if  you review our flash card, you'll see that low body weight is actually a risk factor for  osteoporosis. Okay.

Hope you enjoyed this video, and I hope you learned a lot. I'll see you  with my next musculoskeletal video. Take care.