Osteoporosis Nursing Care Plan Notes


  1. Osteoporosis is an age-related metabolic disease that is defined as low bone mass with a normal ratio of mineral to osteoid, the organic matrix of bone.osteoporosis-2
  2. Bone demineralization results in the loss of bone mass, leading to fragile and porous bones and subsequent fractures.
  3. Greater bone resorption than bone formation occurs
  4. Occurs most commonly in the wrist, hip, and vertebral column.
  5. Osteoporosis can occur postmenopausally or as a result of a metabolic disorder or calcium deficiency.
  6. Client may be asymptomatic until the bones become so weak that a sudden injury causes a fracture.
  • The exact cause of osteoporosis is unknown. A mild but prolonged negative calcium balance, resulting from an inadequate dietary intake of calcium, may be an important contributing factor.osteoporosis
  • Declining gonadal adrenal function, faulty protein metabolism because of estrogen deficiency, and a sedentary lifestyle may also contribute. Risk factors that increase the likelihood of osteoporosis also include smoking, advanced age, heavy caffeine consumption, vitamin D deficiency, excess alcohol consumption, long-term heparin or corticosteroid use, and the use of laxatives or antacids. In addition, patients who are postmenopausal are more susceptible to osteoporosis.
  • Patients who have Cushing’s disease or Parkinson’s disease, rheumatoid arthritis, scoliosis, or anorexia or who have had bilateral oophorectomy are also at greater risk. Paradoxically, both a sedentary lifestyle and excessive exercise are thought to be risk factors for osteoporosis.
Risk Factors
  1. Cigarette smoking
  2. Excessive use of alcohol
  3. Insufficient intake of calcium
  4. Sedentary lifestyle
Non- modifiable
  1. Early menopause
  2. Family history
  3. Female gender
  4. Increasing age
  5. Thin, small frame
  6. White (European descent) or Asian race
  1. Possibly asymptomatic
  2. Back pain after lifting, bending, or stooping
  3. Back pain that increases with palpation
  4. Pelvic or hip pain, especially with weight bearing
  5. Problems with balance
  6. Decline in height from venebral compression
  7. Kyphosis of the dorsal spine.
  8. Constipation, abnormal distention, and respiratory impairment as a result of movement restriction and spinal deformity
  9. Pathological fractures
  10. Appearance of thin, porous bone on x-ray film.
Primary Nursing Diagnosis
  • Pain (acute) related to fracture
Diagnostic Evaluation
  • Bone mineral density (BMD) reported as a T-score:
  • (Osteopenia: T-score of –1 to –2.5 SD Osteoporosis: T-score of <–2.5 SD Severe osteoporosis: T-score of <–2.5 SD with fragility fracture(s)). BMD is the best predictor of fracture risk.
  • Dual energy x-ray absorptiometry (DXA) reveals bone loss >3%.
  • Bone x-rays shows bone loss( cannot determine bone loss until 25%–40% has occurred).
  • Other Tests: Complete blood count, chemistry screening, thyroid-stimulating hormone level, urinalysis, serum protein electrophoresis, serum and urine calcium levels, vitamin D level, serum phosphorus levels, alkaline phosphatase, computed tomography (CT) scan
Medical Management
  • Adequate, balanced diet rich in calcium and vitamin D
  • Increased calcium intake in adolescents and elderly, or prescribe a calcium supplement with meals or beverages high in vitamin C.
  • Regular weight-bearing exercise to promote bone formation (20-30 minutes aerobic exercises 3 days/week)
  • Other medications; the bisphosphonates alendronate (Fosamax), risedronate (Actonel), and ibandronate, selective receptor modulators (SERMs), raloxifene (Evista), calcitonin
Pharmacologic Highlights
  • Calcium supplements (1000–1500 mg/day PO; 1500 recommended for postmenopausal women and men over 50) to prevent bone loss and supplements calcium.
  • Alendronate (Fosamax) [Bone resorption inhibitor; similar preparations with different doses are risedronate (Actonel),etidronate (Didronel),and ibandronate (BONIVA)] to prevent bone loss and inhibits bone resorption.
  • Estrogen hormone such as conjugated estrogen (Provera) is given to prevent bone loss and reduces number of fractures; needs to be initiated within 3–5 yr of menopause; long-term therapy is no longer recommended when menopausal symptoms abate.
  • Other Drugs: Androgens, calcitonin, and vitamin D metabolites may be ordered to decrease bone resorption. Analgesics may also be needed to manage the pain.
Nursing Interventions
  1. Assess risk for injury.
  2. Provide a safe and hazard-free environment, and assist the client to identify hazards in the home environment.
  3. Use side rails to prevent falls.
  4. Move the client gently when turning and repositioning.
  5. Encourage ambulation; assist with ambulation if the client is unsteady.
  6. Instruct in the use of assistive devices such as a cane or walker.
  7. Provide range of motion exercises.
  8. Instruct the client in the use of good body mechanics.
  9. Instruct the client in exercises to strengthen abdominal and back muscles to improve posture and provide support for the spine.
  10. Instruct the client to avoid activities that can cause vertebral compression.
  11. Apply a back brace as prescribed during an acute phase to immobilize the spine and provide spinal column support.
  12. Encourage the use of a firm mattress.
  13. Provide a diet high in protein, calcium, vitamins C, D and iron.
  14. Encourage adequate fluid intake to prevent calculuses.
  15. Advise the client to avoid alcohol and coffee.
  16. Administer estrogen or androgens to decrease the rate of bone resorption as prescribed.
  17. Administer calcium, vitamin D, and phosphorus as prescribed for bone metabolism.
  18. Administer calcitonin as prescribed to inhibit bone loss.
  19. Administer analgesics, muscle relaxants, and anti-inflammatory medications as prescribed.
Documentation Guidelines
  • Physical findings of musculoskeletal assessment: Pain, mobility, numbness, curvature of the spine
  • Response to pain medications
  • Reaction to exercise plan and orthotic devices
Discharge and Home Healthcare Guidelines
  • Reinforce the medication, exercise, and diet plan.
  • Provide a hazard-free environment to prevent falls. Apply orthotic devices correctly. Remove scatter rugs, provide good lighting, and install handrails in the bathroom.
  • Be sure the patient understands all medications, including the dosage, route, action, and side effects. If the patient is placed on estrogen therapy, she needs routine gynecologic checkups to detect early signs of cervical cancer.
  • Consider placement in a nursing home if a patient cannot return home. Communicate the special needs of the patient on the transfer chart. The need for physical or occupational therapy, social work, and homemaking personnel is determined by the home care nurse. Facilitate the procurement of needed orthotic devices or ambulation aids before the patient goes home. The Osteoporosis Foundation provides information to clients regarding the disease and its treatment.