Osteoporosis Nursing Guide

Content Created by: Tiffany Fields, RN, BSN, MSN, DNP, CRNP

Overview: Osteoporosis

This content is intended as a Quick Reference for Osteoporosis and will cover an overview and nursing considerations utilizing the nursing process.

Osteoporosis Etiology and Epidemiology

Osteoporosis weakens the bones, causing them to break easily. The common places to break are the hip bone, backbone, and wrist. Osteoporosis is also known as the “silent disease” because the changes are not known until the bone breaks, though it has been losing strength for many years.

The body breaks down old bones and replaces them with new bone tissue to maintain strength. Around the age of 30, the bone mass will begin to cease and, as people age, more of the bone may be broken down without being replaced (Greenstein & Gorczyca, 2019). The goal of bone health is to maintain as much bone as possible throughout life.

Osteoporosis Diagnosis

To diagnose for osteoporosis providers may do the following diagnostic testing:

• Lower levels of X-ray
• CT-scan
• Bone density test

Osteoporosis Management

Treatment recommendations are based on the prognosis of breaking a bone in the next decade. The goals for treatment are to (Kanis et al., 2018):

• Improve or maintain quality of life
• Decrease risk for falls
• Promote safe environment
• Modify the risk for bone loss
• Improve or maintain functioning of daily living

If the individual is at risk for bone loss, the provider will prescribe medication to assist with decreasing the chances of bone loss. The medications may include bisphosphonates, such as:

• Alendronate (Binosto®, Fosamax®)
• Risedronate (Actonel®, Atelvia®)
• Ibandronate (Boniva®)
• Zoledronic acid (Reclast®, Zometa®)

The risk for bone loss grows as the individual gets older. Women tend to lose bone density quickly for several years during the time of menopause. After that, the loss will tend to decrease but continues. In men, it tends to be slower than women, but after the age of 65 both genders are losing bone density at the same rate.

Therefore, it is important to take steps to prevent bone weakening. This will include modifying the diet and eating foods rich in calcium and Vitamin D. Lastly, the individual should include in daily activities weight-bearing exercises such as (Kanis et al., 2018):

• Weight training
• Walking
• Hiking
• Jogging
• Climbing stairs
• Tennis
• Dancing

Osteoporosis Nursing Care Plan & Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and education for individuals with Osteoporosis are listed below.

Assessment

Signs and Symptoms:

• Back pain
• Loss of height overtime
• A stooped position
• A bone that breaks easier than expected

Osteoporosis Nursing Diagnosis/Risk For

• Impaired mobility
• Falls
• Knowledge deficit
• Imbalance diet
• Injury

Interventions

• Assessing physical ability
• Encouraging weight-bearing exercise
• Assisting with activities for daily living and self-care, as needed
• Allowing for rest time
• Providing ambulatory aid, as needed
• Educating on the following:
  • Dietary needs
  • Smoking cessation
  • Limiting alcohol
  • Medication regimen

Expected Outcomes

• Remain safe and free from injury
• Maintain range of motion
• Maintain bone density levels
• Compliance with plan of care
• Maintain or improve level of function

Individual/Caregiver Education

• Regular checkups
• Eating a healthy, balanced diet
• Getting enough rest
• Getting screened early for signs of osteoporosis
• Keeping a daily schedule
• Maintaining an exercise regimen
• Getting assistance with activities of daily living
• Finding local support

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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2024

Content Contributor

The content was created by Relias staff writer Tiffany Fields, RN, BSN, MSN, DNP, CRNP. Tiffany has been a clinical nurse for over 20 years. She was educated and trained as a Licensed Practical Nurse in Alabama, where she practiced as a Gerontological Nurse at the local Nursing Homes. She earned her Associate, Bachelor’s and Master’s degrees in Nursing and a Doctorate in Nursing Practice. She also as a Certified Family Nurse Practitioner degree. Her clinical expertise is Adult-Geriatric Nursing and Medical-Surgical medical complexity. She is currently Assistant Director of Nursing at a Rural Hospital as well as a writer for Relias.

Resources

• Osteoporosis and Related Bone Diseases National Resource Center www.bones.nih.gov
• National Institute of Arthritis and Musculoskeletal and Skin Diseases www.niams.nih.gov
• National Osteoporosis Foundation www.nof.org

References

• Greenstein, A. S., & Gorczyca, J. T. (2019). Orthopedic surgery and the geriatric patient. Clinics in geriatric medicine, 35(1), 65-92. https://doi.org/10.1016/j.cger.2018.08.007
• Kanis, J. A., Johansson, H., Harvey, N. C., & McCloskey, E. V. (2018). A brief history of FRAX. Archives of osteoporosis, 13(1), 1-16. https://doi.org/10.1007/s11657-018-0510-0
• Khadka, B., Tiwari, M. L., Gautam, R., Timalsina, B., Pathak, N. P., Kharel, K., ... & Acharya, D. (2018). Correlates of Selected Biochemical Markers of Bone turnover among Post-Menopausal Women. Journal of the Nepal Medical Association, 56(212). https://pubmed.ncbi.nlm.nih.gov/30387463/
• Lewiecki, E. M. (2018). New and emerging concepts in the use of denosumab for the treatment of osteoporosis. Therapeutic advances in musculoskeletal disease, 10(11), 209-223. https://doi.org/10.1177%2F1759720X18805759
• Prince, R. L., Lewis, J. R., Lim, W. H., Wong, G., Wilson, K. E., Khoo, B. C., ... & Schousboe, J. T. (2019). Adding lateral spine imaging for vertebral fractures to densitometric screening: improving ascertainment of patients at high risk of incident osteoporotic fractures. Journal of Bone and Mineral Research, 34(2), 282-289. https://doi.org/10.1002/jbmr.3595

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