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Osteoporosis in practice: treatment and advice

Cheryl I'Anson
BA(Hons)
Subeditor, Nursing in Practice

One in three women are affected by osteoporosis, and almost half of all women experience an osteoporotic fracture by the time they reach the age of 70.(1) It is estimated that 20% will subsequently die within a year of their fracture.
Osteoporosis is a condition that affects the bones, making them delicate and weak. It is particularly common in the elderly as the living bone cells are not able to effectively break down old bone and renew it with healthy, thick new bone. As a result the bones become more fragile and increasingly likely to break, particularly in the hips, spine and wrist.
There is a continual turnover of bone as it constantly repairs itself. The bone is formed by cells called osteoblasts and broken down by cells called osteoclasts. These cells continuously deposit and remove calcium and phosphorus stored in a protein network that makes up the structure of the bone. There are various factors that are known to increase the rate at which bone density is lost. These factors include:

  • A family history of osteoporosis.
  • Low body weight.
  • Inactivity.
  • A calcium-deficient diet.
  • Smoking.
  • Increased alcohol intake.

Treatments
New guidelines from the National Institute for Clinical Excellence (NICE) were released in January this year and provide advice for secondary prevention of osteoporosis. The guidance applies only to postmenopausal women who are suffering from the condition and who have already sustained a fracture.(2)
Patients who are considered to be at high risk of osteoporosis undergo tests to measure their bone density. The results will determine whether treatments such as hormone replacement therapy (HRT) are required.

Bisphosphonates
Bisphosphonates prevent the osteoclasts from breaking down bone by binding very tightly to the bone to prevent the calcium from being detached. If the calcium is removed it can seep into the blood, potentially resulting in bone cancer.

Selective oestrogen receptor modulators (SERMs)
During the menopause, blood levels of oestrogen start to decrease, which can lead to loss of bone density. SERMs work by acting on oestrogen receptors in the bone tissue, imitating the natural effects of oestrogen. This gradually reduces the excessive breakdown of bone and causes an increase in bone mineral density.

Parathyroid hormone
Produced by the parathyroid glands, this hormone is involved in the metabolism of calcium and phosphorus. Teriparatide is a synthetic version that imitates this hormone and helps to increase bone formation. 

Side-effects
Some of the side-effects associated with these types of treatment are facial flushing, nausea and vomiting, tingling of hands, an unpleasant taste, allergic reactions such as skin rash, swelling of the lips, tongue and throat (angioedema) or narrowing of the airways (bronchospasm), and inflammation at injection site.(3)
Patients should be reviewed regularly, and the decision to continue treatment should be evaluated after consideration and discussion of the benefits and risks.

Conclusion
Compliance rates for osteoporosis treatments are quite low. Various studies have shown that compliance rates are extensively increased when nurse-led follow-up clinics monitor patients and their treatment.
Elderly people are most likely to become confused about medication and should be given help to remember their medication. Nurses can contribute a great deal to patients' adherence to treatment by explaining thoroughly the dosing regimen and risks involved, as well as stressing that, with gentle exercise, a good calcium intake and a healthy lifestyle, osteoporosis can be successfully managed.

References

  1. Department of Health. National Service Framework for older people. London: DH; 2001.
  2. National Institute for Clinical Excellence. Osteoporosis: secondary prevention. NICE Technology Appraisal Guidance 87. London: NICE; 2005.
  3. NetDoctor.co.uk. Available at URL: http://www.netdoctor.co.uk

Resource
National  Osteoporosis Society
W:www.nos.org.uk