Osteoporosis

Osteoporosis Nursing Diagnosis Interventions and Care Plans

Osteoporosis Nursing Diagnosis Care Plan NCLEX Review

Nursing Study Guide on Osteoporosis

Osteoporosis is a medical condition wherein the bones become brittle and weak. Normally, bone tissues break down and get replaced constantly.

However, osteoporosis involves the inability of the new bone tissues to keep up with the loss of the old bone tissues.

Osteoporosis makes the person at a high risk for fractures. The most common sites of osteoporosis-related fractures include the wrist, spine, and hips.

Asian and white women are more at risk of osteoporosis than men, but it can affect both men and women of any race and ethnicity. The treatment for osteoporosis involves shifting to a healthy diet, proper weight-bearing exercise, and medications to promote bone strength and reduce bone loss.

Signs and Symptoms of Osteoporosis

  • Back pain
  • A stooped posture
  • Loss of height over time
  • Fractures, especially recurrent ones

Causes and Risk Factors of Osteoporosis

By age 30, most people attain their peak bone mass. Aging results to a faster rate of bone mass loss compared to the rate of bone tissue creation. Women are more prone to develop osteoporosis than men.

White or Asian people are at a higher risk than Black or Caribbean people. Having a small body frame tends to put a person at a higher risk as well. Genetics can also play a role in osteoporosis, as having a parent or a sibling with osteoporosis may mean that the person is at a greater risk.

Low sex hormones (especially estrogen in menopausal women), and excessive thyroid, adrenal, and parathyroid hormones may contribute to accelerated bone loss.

Dietary factors include a long-term low calcium intake, eating disorders, and history of gastrointestinal disorders or surgery. Having a sedentary lifestyle, smoking tobacco, and/or consuming too much alcohol contribute to the development of osteoporosis later in life.

Chronic use of corticosteroids may lead to poor bone tissue creation.

Patients with cancer, kidney or liver disease, rheumatoid arthritis, lupus, or Celiac disease are more prone to develop osteoporosis.

Complications of Osteoporosis

  1. Bone fractures, particularly involving the hip bones, are the most common complications of osteoporosis. Elderly people who suffer from a fall may have hip fractures and eventually become physically disabled, or can be at higher risk of death within a year after the fall.
  2. Poor posture. The patient’s comfort and quality of life may be affected by poor posture due to osteoporosis.

Diagnosis of Osteoporosis

  • Physical examination – to check for any bone fractures, bone pain, or stooped posture
  • Blood test – to check for serum calcium levels
  • Bone density test – using a low-level X-ray machine to measure the mineral proportion of the bones

Treatment for Osteoporosis

  1. Bisphosphonates. These medications are used to treat bone loss and can help reduce the risk of bone fractures. Examples of bisphosphonates include: alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and zoledronic acid (Reclast, Zometa).
  2. Monoclonal antibody medications. An alternative to bisphosphonates, denosumab ( (Prolia, Xgeva) also lowers the risk for fractures and helps improve bone density. Denosumab is given subcutaneously, while bisphosphonates are usually given intravenously. Both denosumab and bisphosphonates may rarely lead to osteonecrosis of the jaw, so it is important to ensure that the dentist of the patient knows that he/she will be started on these medications.
  3. Hormone-related therapy. Estrogen replacement therapy such as the use of raloxifene (Evista) in menopausal women is useful in the maintenance of bone density, but its risks (possible blood clots, increased risk of heart disease, endometrial cancer, and breast cancer) should be considered. Testosterone replacement therapy in men may also help to reduce the risk of osteoporosis.
  4. Bone-building medications. New bone-building medications can help treat osteporosis. These include teriparatide (Forteo), abaloparatide (Tymlos), and romosozumab (Evenity).
  5. Calcium and Vitamin D supplements. People age 18 to 15 requires at least 1000 mg of calcium per day, while women age 50 and above and men age 70 and above should have 1200 mg of calcium intake per day. This can be achieved by eating calcium-rich foods, or taking calcium supplements as recommended by the physician. Vitamin D rich foods or supplements help in the optimal absorption of calcium. Vitamin D can also be obtained from sunlight.
  6. Lifestyle changes. Smoking cessation, limited alcohol intake (no more than 2 units per day), and weight-bearing exercises can help reduce the risk of osteoporosis.

Nursing Care Plans for Osteoporosis

  1. Nursing Diagnosis: Impaired Physical Mobility related to bone fracture secondary to osteoporosis as evidenced by presence of hip fracture, severe hip pain rated10/10, failure to perform ADLs, and low bone density score

Desired Outcome: Patient will maintain functional mobility despite presence of fracture.

Nursing InterventionRationale
Assess the patient’s function ability to perform activities of daily living (ADLs) such as eating, bathing, oral and perineal care.To identify patient’s current strengths and problems related to performing ADLs while dealing with hip fracture and osteoporosis.
Identify the patient’s need for assistance from significant others. Educate the significant others on how to assist the patient in performing ADLs and improving physical mobility through exercise.To identify patient’s support in terms of his/her physical, social, mental, and emotional health. To support the significant others on how they can assist the patient achieve optimal physical mobility.
Encourage physical mobility and demonstrate range of motion exercises.To prevent muscle atrophy and joint contractures.
Refer the patient to the physiotherapist.To provide specialized care and individualized exercise program.
Osteoporosis Nursing Care Plan 1
  • Nursing Diagnosis: Imbalanced Nutrition Less than Body Requirements related to

inadequate calcium and vitamin D secondary to osteoporosis as evidenced by low serum calcium and vitamin D levels, stopped posture, loss of height, presence of spine fracture.

Desired Outcome: Patient will establish normal serum calcium and vitamin D levels.

Nursing InterventionRationale
Educate the patient on the relationship between osteoporosis and calcium and vitamin D levels, as well as the target dietary amounts for calcium and vitamin D.People age 18 to 15 requires at least 1000 mg of calcium per day, while women age 50 and above and men age 70 and above should have 1200 mg of calcium intake per day. This can be achieved by eating calcium-rich foods, or taking calcium supplements as recommended by the physician. Vitamin D rich foods or supplements help in the optimal absorption of calcium.  
Inform the patient on the sources of calcium and vitamin D.Aside from supplements, calcium can be obtained from milk, cheese, yogurt, seafood, legumes, dried fruit, and green leafy vegetables. Vitamin D can be obtained from fatty fish such as salmon, tuna, and mackerel. Vitamin D can also be obtained from sunlight (15 minutes per day).
Encourage the patient to stop smoking, limit alcohol intake to maximum of 2 units per day, and to improve exercise and physical activity.To reduce bone loss and to improve the absorption of calcium in the bones.
Refer the patient to the dietitian.To provide specialized care and individualized dietary program geared towards  improving bone health.
Osteoporosis Nursing Care Plan 2

Other Nursing Diagnoses:

  • Risk for Injury
  • Deficient Knowledge
  • Pain

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

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