Which finding does the nurse expect to document in a patient with osteopenia
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Feature ArticleOsteoporosis Screening and Treatment: A Collaborative ApproachAbstractOsteoporosis and poor bone health effects approximately 200 million people worldwide, with numbers expected to increase as the population ages. Increases in osteoporosis and poor bone health are associated with increased fragility fracture rates, increased morbidity and mortality, and a huge economic burden. Osteoporosis screening and treatment guideline recommendations are currently underutilized resulting in a public health concern. This article describes current osteoporosis screening recommendations, pharmacological interventions, and a collaborative approach to treatment. Section snippetsBackgroundOsteoporosis is the most common human bone disease.4 An estimated 10.2 million Americans are living with osteoporosis and 43.4 million more Americans have low bone density, which accounts for 54% of the over-age-50 population. The US prevalence of osteoporosis and osteopenia combined is 35.5 million in women and 18.2 million in men. Osteoporosis and osteoporotic fragility fractures are a growing concern worldwide and are expected to increase with the aging population,1 with an estimated Screening and DiagnosisThe diagnosis and decision to treat osteoporosis is derived from multiple factors. As primary care providers (PCPs), nurse practitioners (NPs) are tasked with screening for many diseases, including osteoporosis. It is important for the NP to understand osteoporosis can occur in patients other than the traditionally targeted postmenopausal female population and to be aware of when it is appropriate to refer a patient to be evaluated for osteoporosis. Recommendations to screen women over age 65 Management of Osteoporosis and OsteopeniaThe greatest impact on osteoporosis investigation, treatment initiation, and treatment adherence occurs when dedicated personnel are available to aid in the implementation process, which improves osteoporotic fragility fracture outcomes,8,10,17 including fewer secondary fractures, increased quality of life years, and more cost-effective care.1,10 In 2016, the National Quality Forum endorsed 2 Joint Commission measures monitoring percentages of patients with fracture risk assessment, laboratory ConclusionScreening, diagnosing, and treating osteoporosis are multifaceted endeavors. The population of at-risk individuals is far more widespread than postmenopausal women and men over age 70. Understanding the risk factors will lead to improved screening and preventative services. In recent years, many pharmaceutical agents have been approved for treating osteoporosis giving health care providers the ability to tailor treatment to achieve the best outcomes for affected patients. Primary care providers Sarah C. Goode DNP, FNP-BC, is a nurse practitioner and Bone Health Specialist at Alabama Orthopedic Clinic, Mobile, AL. Cited by (7)Recommended articles (6)Sarah C. Goode DNP, FNP-BC, is a nurse practitioner and Bone Health Specialist at Alabama Orthopedic Clinic, Mobile, AL. Theresa F. Wright, DNP, RN, is chair and associate professor of adult health nursing, College of Nursing, University of South Alabama, Mobile, AL. She can be contacted at [email protected]. Colleen Lynch, DNP, RN, is an Assistant Professor, College of Nursing, University of South Alabama, Mobile, AL. View full text© 2019 Elsevier Inc. All rights reserved. This medication is used to treat a certain type of bone disease (Paget's disease) that causes abnormal and weak bones. Zoledronic acid is also used to treat bone loss (osteoporosis) in men and in women after menopause who are at high risk of having broken bones (fractures). It may also be used to treat or prevent osteoporosis in people who are taking corticosteroid medications (such as prednisone) for long periods. It works by slowing the breakdown of bone and keeping bones strong. It also helps to reduce the risk of broken bones (fractures). This medication belongs to a class of drugs known as bisphosphonates.Another zoledronic acid product is used to treat bone problems that may occur with cancer. The 2 products should not be used together. How to use Reclast Bottle, InfusionRead the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start using this product and each time you get a refill. If you have any questions, ask your doctor or pharmacist. This medication is given as a single dose as directed by your doctor. It is given slowly into a vein over at least 15 minutes. The dosage is based on your medical condition and response to treatment. Eat and drink normally on the day of treatment. Drink at least 2 glasses of fluid before treatment unless otherwise directed by your doctor. It is very important that you get plenty of fluids when you are given this medication. If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely. Avoid mixing zoledronic acid with IV fluids that have calcium in them (such as Ringer's solution, Hartmann's solution, parenteral nutrition-TPN/PPN). Talk to your pharmacist for more details. Your doctor may direct you to take calcium and vitamin D each day. If you have Paget's disease, it is especially important that you take the directed amount of calcium and vitamin D during the 2 weeks after your zoledronic acid dose. Vitamin D and calcium are very important to prevent low levels of calcium in the blood. Tell your doctor right away if you have any symptoms of low calcium such as numbness/tingling (especially around the lips/mouth) and muscle spasms. For the treatment of Paget's disease, this medication is given as a single dose and may be repeated based on your symptoms. For the treatment of osteoporosis, this medication is given as a single dose once a year. Talk to your doctor about the risks and benefits of long-term use of this medication.
Side EffectsNausea, tiredness, flu-like symptoms (such as fever, chills, muscle/joint aches), dizziness, headache, or pain/redness/swelling at the injection site may occur. Most of these side effects are mild and occur within 3 days of treatment. Flu-like symptoms may be reduced by taking acetaminophen or ibuprofen after the treatment. If any of these effects worsen or last more than 4 days, tell your doctor or pharmacist promptly. Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor right away if you have any serious side effects, including: increased or severe bone/joint/muscle pain, new or unusual hip/thigh/groin pain, jaw/ear pain, unusual weakness, eye problems (such as redness/itching/swelling, sensitivity to light), muscle spasms, numb/tingling skin, irregular heartbeat, sores in jaw/mouth. Get medical help right away if you have any serious side effects, including: signs of kidney problems (such as change in the amount of urine), seizures. A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. PrecautionsBefore using zoledronic acid, tell your doctor or pharmacist if you are allergic to it; or to other bisphosphonates such as alendronate or risedronate; or if you have trouble breathing (wheezing) after taking aspirin; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney problems, low calcium levels in the blood, problem taking calcium/vitamin D supplements, recent or planned dental surgery (such as tooth removal), certain gut problems (malabsorption, surgery on the small intestine), treatment with zoledronic acid (such as for cancer), parathyroid/thyroid problems (such as hypoparathyroidism, thyroid/parathyroid surgery), dehydration. Some people using zoledronic acid may have serious jawbone problems. Your doctor should check your mouth before you start this medication. Tell your dentist that you are using this medication before you have any dental work done. To help prevent jawbone problems, have regular dental exams and learn how to keep your teeth and gums healthy. If you have jaw pain, tell your doctor and dentist right away. Before having any surgery (especially dental procedures), tell your doctor and dentist about this medication and all other products you use (including prescription drugs, nonprescription drugs, and herbal products). Your doctor or dentist may tell you to stop using zoledronic acid before your surgery. Ask for specific instructions about stopping or starting this medication. This medication may cause severe kidney problems, especially in the elderly. Consult your doctor or pharmacist for more information. To help prevent harm to your kidneys, drink plenty of fluids unless otherwise directed by your doctor. (See also How to Use section.) This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis). This medication must not be used during pregnancy. It may harm an unborn baby. Discuss the use of reliable forms of birth control (such as condoms, birth control pills) while using this medication and after stopping treatment with your doctor. This medication may stay in your body for many years. If you become pregnant or think you may be pregnant, tell your doctor right away. It is unknown if this drug passes into breast milk. Because it may harm a nursing infant, breast-feeding while using this drug and after stopping treatment is not recommended. This medication may stay in your body for many years. Consult your doctor before breast-feeding. InteractionsDrug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval. Some products that may interact with this drug include: calcium-containing IV fluids, mineral supplements (especially those containing calcium, magnesium, or phosphorus), "water pills" (diuretics such as bumetanide, furosemide). Also tell your doctor or pharmacist of drugs that may be harmful to your kidneys such as: aminoglycoside antibiotics (such as gentamicin, tobramycin), amphotericin B, nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen), tacrolimus. Does Reclast Bottle, Infusion interact with other drugs you are taking? Enter your medication into the WebMD interaction checker OverdoseIf someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Lifestyle changes that help promote healthy bones include increasing weight-bearing exercise, stopping smoking, limiting alcohol, and eating well-balanced meals that contain adequate calcium and vitamin D. Since you may also need to take calcium and vitamin D supplements and make lifestyle changes, consult your doctor for specific advice. Laboratory and/or medical tests (such as calcium/phosphate/magnesium blood levels, bone density tests, kidney tests) will be performed before you start treatment, periodically to monitor your progress, or to check for side effects. Consult your doctor for more details. Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company. Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use. CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment. What osteopenia means?(OS-tee-oh-PEE-nee-uh) A condition in which there is a lower-than-normal bone mass or bone mineral density (the amount of bone mineral contained in a certain amount of bone). Osteopenia is a less severe form of bone loss than osteoporosis.
How is osteopenia best described?Osteopenia is when your bones are weaker than normal but not so far gone that they break easily, which is the hallmark of osteoporosis. Your bones are usually at their densest when you're about 30. Osteopenia, if it happens at all, usually occurs after age 50.
What is the bone density associated with osteopenia?+1 to –1 indicates normal bone density. –1 to –2.5 indicates osteopenia. –2.5 or lower means osteoporosis.
What is the most common cause of osteopenia?Causes and risk factors of osteopenia
Aging is the most common risk factor for osteopenia. After your bone mass peaks, your body breaks down old bone faster than it builds new bone. That means you lose some bone density. Women lose bone more quickly after menopause, due to lower estrogen levels.
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