Med-Surg - Musculoskeletal System, part 5: Osteoporosis, Osteomalacia, Paget's Disease

by Cathy Parkes November 14, 2021 Updated: August 09, 2023 4 min read

Full Transcript

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.

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