Nursing Care Plans for Osteoporosis – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plans for Osteoporosis plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Osteoporosis is a disease that thins and weakens the bones. The bones become fragile and fracture (break) easily, especially the bones in the hip, spine, and wrist. Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist, or spine.

Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone.

Symptoms of Osteoporosis

There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include:

1. Back pain, caused by a fractured or collapsed vertebra
2. Loss of height over time
3. A stooped posture
4. A bone that breaks much more easily than expected

Causes of Osteoporosis

Doctors have identified several risk factors for osteoporosis. Some are modifiable, but it is not possible to avoid others. The body continually absorbs old bone tissue and generates new bone to maintain bone density, strength, and structural integrity.

Bone density peaks when a person is in their late 20s, and it starts to weaken at around 35 years of age. As a person grows older, bone breaks down faster than it rebuilds. Osteoporosis may develop if this breakdown occurs excessively.

It can affect both males and females, but it is most likely to occur in women after menopause because of the sudden decrease in estrogen. Estrogen protects typically women against osteoporosis.

The IOF advises that once people reach 50 years of age, 1 in 3 women and 1 in 5 men will experience fractures due to osteoporosis.

Risk Factors of Osteoporosis

Several factors can increase the likelihood that you’ll develop osteoporosis — including your age, race, lifestyle choices, and medical conditions and treatments.

Unchangeable risks

Some risk factors for osteoporosis are out of your control, including:

Gender. Women are much more likely to develop osteoporosis than are men.

Age. The older you get, the greater your risk of osteoporosis.

Race. You’re at the most significant risk of osteoporosis if you’re white or of Asian descent.

Family history. Having a parent or sibling with osteoporosis puts you at greater risk, especially if your mother or father fractured a hip.

Body frame size. Men and women with small body frames tend to have a higher risk because they might have less bone mass to draw from as they age.

Hormone levels

Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies. Examples include:

Sex hormones. Lowered sex hormone levels tend to weaken bone. The fall in estrogen levels in women at menopause is one of the most vital risk factors for developing osteoporosis. Treatments for prostate cancer that reduce testosterone levels in men and treatments for breast cancer that reduce estrogen levels in women are likely to accelerate bone loss.

Thyroid problems. Too much thyroid hormone can cause bone loss. This can occur if your thyroid is overactive or if you take too much thyroid hormone medication to treat an underactive thyroid.

Other glands. Osteoporosis has also been associated with overactive parathyroid and adrenal glands.

Dietary factors

Osteoporosis is more likely to occur in people who have:

Low calcium intake. A lifelong lack of calcium plays a role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss, and an increased risk of fractures.

Eating disorders. Severely restricting food intake and being underweight weakens bone in both men and women.

Gastrointestinal surgery. Surgery to reduce the size of your stomach or to remove part of the intestine limits the amount of surface area available to absorb nutrients, including calcium. These surgeries include those to help you lose weight and for other gastrointestinal disorders.

Steroids and other medications

Long-term use of oral or injected corticosteroid medications, such as prednisone and cortisone, interferes with the bone-rebuilding process. Osteoporosis has also been associated with medications used to combat or prevent:

• Seizures
• Gastric reflux
• Cancer
• Transplant rejection
• Medical conditions

The risk of osteoporosis is higher in people who have some medical issues, including:

1. Celiac disease
2. Inflammatory bowel disease
3. Kidney or liver disease
4. Cancer
5. Multiple myeloma
6. Rheumatoid arthritis
7. Lifestyle choices

Some bad habits can increase your risk of osteoporosis. Examples include:

• Sedentary lifestyle. People who spend a lot of time sitting have a higher risk of osteoporosis than those who are more active. Any weight-bearing exercise and activities that promote balance and good posture are beneficial for your bones, but walking, running, jumping, dancing, and weightlifting seem particularly helpful.
• Excessive alcohol consumption. Regular consumption of more than two alcoholic drinks a day increases the risk of osteoporosis.
• Tobacco use. The exact role tobacco plays in osteoporosis isn’t clear, but it has been shown that tobacco use contributes to weak bones.

Complications of Osteoporosis

How osteoporosis can cause vertebrae to crumble and collapse

Compression fractures

Bone fractures, particularly in the spine or hip, are the most severe complications of osteoporosis. Hip fractures are often caused by a fall and can result in disability and an increased risk of death within the first year after the injury.

In some cases, spinal fractures can occur even if you haven’t fallen. The bones that make up your spine (vertebrae) can weaken to the point of collapsing, resulting in back pain, lost height, and a hunched forward posture.

Prevention of Osteoporosis

Good nutrition and regular exercise are essential for keeping your bones healthy throughout your life.

Calcium

Men and women between 18 and 50 need 1,000 milligrams of calcium a day. This daily amount increases to 1,200 milligrams when women turn 50 and men turn 70.

Good sources of calcium include:

• Low-fat dairy products
• Dark green leafy vegetables
• Canned salmon or sardines with bones
• Soy products, such as tofu
• Calcium-fortified cereals and orange juice

If you find it challenging to get enough calcium from your diet, consider taking calcium supplements. However, too much calcium has been linked to kidney stones. Although yet unclear, some experts suggest that too much calcium, especially in supplements, can increase the risk of heart disease.

The Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine recommends that total calcium intake from supplements and diet combined should be no more than 2,000 milligrams daily for people older than 50.

Vitamin D

Vitamin D improves the body’s ability to absorb calcium and improves bone health in other ways. People can get some of their vitamin D from sunlight, but this might not be a good source if you live in a high latitude, if you’re housebound, or if you regularly use sunscreen or avoid the sun because of the risk of skin cancer.

Dietary sources of vitamin D include cod liver oil, trout, and salmon. Many types of milk and cereal have been fortified with vitamin D.

Most people need at least 600 international units (IU) of vitamin D a day. That recommendation increases to 800 IU a day after age 70.

People without other sources of vitamin D and especially with limited sun exposure might need a supplement. Most multivitamin products contain between 600 and 800 IU of vitamin D. Up to 4,000 IU of vitamin D a day is safe for most people.

Exercise

Exercise can help you build strong bones and slow bone loss. Exercise will benefit your bones no matter when you start, but you’ll gain the most benefits if you start exercising regularly when you’re young and continue to exercise throughout your life.

Combine strength training exercises with weight-bearing and balance exercises. Strength training helps strengthen muscles and bones in your arms and upper spine. Weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope, skiing, and impact-producing sports — affect mainly the bones in your legs, hips, and lower spine. Balance exercises such as tai chi can reduce your risk of falling, especially as you get older.

Nursing Care Plans for Osteoporosis Based on Diagnosis

Nursing Care Plans 1: Diagnosis- Impaired Physical Mobility

May be related to:

• Bone loss
• Pain
• Fracture
• Inability to bear weight

Possibly evidenced by Spontaneous fracture.

Desired Outcomes

1. Patient will maintain functional mobility as long as possible within the limitations of the disease process.
2. A patient will have a few, if any, complications related to immobility as the disease condition progresses.

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Nursing Interventions

Assess the patient’s functional ability for mobility and note changes.

Rationale: Identifies problems and helps to establish a plan of care.

Provide a range of motion exercises every shift. Encourage an active range of motion exercises.

Rationale: Helps to prevent joint contractures and muscle atrophy.

Reposition patient every 2 hours and prn.

Rationale: Turning at regular intervals prevents skin breakdown from pressure injury.

Apply trochanter rolls and pillows to maintain joint alignment.

Rationale: Prevents musculoskeletal deformities.

Assist patient with walking if at all possible, utilizing sufficient help. A one or two-person pivot transfer utilizing a transfer belt can be used if a patient has a weight-bearing ability.

Rationale: Preserves patient’s muscle tone and helps prevent complications of immobility.

Use mechanical lift for patients who cannot bear weight, and help them out of bed at least daily.

Rationale: Provides change of scenery movement and encourages participation in activities.

Avoid restraints as possible.

Rationale: Inactivity created by the use of restraints may increase muscle weakness and poor balance.

Instruct family regarding ROM exercises, methods of transferring patients from bed to wheelchair, and turning at routine intervals.

Rationale: Prevents complications of immobility, and knowledge assists family members in being better prepared for home care.

Assess the degree of immobility produced by injury or treatment and note the patient’s perception of immobility.

Rationale: Patient may be restricted by self-view or self-perception out of proportion with actual physical limitations, requiring information or interventions to promote progress toward wellness.

Encourage participation in diversional or recreational activities. Maintain stimulating environment (radio, TV, newspapers, personal possessions, pictures, clock, calendar, visits from family and friends).

Rationale: Provides an opportunity to release energy, refocuses attention, enhances patient’s sense of self-control and self-worth, and aids in reducing social isolation.

Instruct patient or assist with active and passive ROM exercises of affected and unaffected extremities.

Rationale: Increases blood flow to muscles and bone to improve muscle tone, maintain joint mobility, prevent contractures or atrophy, and calcium resorption from disuse.

Encourage the use of isometric exercises starting with the unaffected limb.

Rationale: Isometrics contract muscles without bending joints or moving limbs and help maintain muscle strength and mass. Note: These exercises are contraindicated while acute bleeding and edema are present.

Provide footboard, wrist splints, trochanter, or hand rolls as appropriate.

Rationale: Useful in maintaining the functional position of extremities, hands, and feet and preventing complications (contractures, footdrop).

Place in supine position periodically if possible, when traction is used to stabilize lower limb fractures.

Rationale: Reduces risk of flexion contracture of hip.

Instruct and encourage the use of trapeze and “postposition” for lower limb fractures.

Rationale: Facilitates movement during hygiene or skincare and linen changes; reduces the discomfort of remaining flat in bed. “Post position” involves placing the uninjured foot flat on the bed with the knee bent while grasping the trapeze and lifting the body off the bed.

Assist with self-care activities (bathing, shaving).

Rationale: Improves muscle strength and circulation, enhances patient control in the situation and promotes self-directed wellness.

Provide and assist with mobility by means of wheelchair, walker, crutches, canes as soon as possible. Instruct in the safe use of mobility aids.

Rationale: Early mobility reduces complications of bed rest (phlebitis) and promotes healing and normalization of organ function. Learning the correct way to use aids is important to maintain optimal mobility and patient safety.

Monitor blood pressure (BP) with a resumption of activity. Note reports of dizziness.

Rationale: Postural hypotension is a common problem following prolonged bed rest and may require specific interventions (tilt table with gradual elevation to an upright position).

Reposition periodically and encourage coughing and deep-breathing exercises.

Rationale: Prevents or reduces the incidence of skin and respiratory complications (decubitus, atelectasis, pneumonia).

Auscultate bowel sounds. Monitor elimination habits and provide for a regular bowel routine. Place on bedside commode, if feasible, or use fracture pan. Provide privacy.

Rationale: Bed rest, use of analgesics, and changes in dietary habits can slow peristalsis and produce constipation. Nursing measures that facilitate elimination may prevent or limit complications. Fracture pan limits flexion of hips and lessens the pressure on lumbar region and lower extremity cast.

Encourage increased fluid intake to 2000–3000 mL per day (within cardiac tolerance), including acid or ash juices.

Rationale: Keeps the body well hydrated, decreasing the risk of urinary infection, stone formation, and constipation

Provide a diet high in proteins, carbohydrates, vitamins, and minerals, limiting protein content until the first bowel movement.

Rationale: In the presence of musculoskeletal injuries, nutrients required for healing are rapidly depleted, often resulting in a weight loss of as much as 20 to 30 lb during skeletal traction. This can profoundly affect muscle mass, tone, and strength. Note: Protein foods increase contents in the small bowel, resulting in gas formation and constipation. Therefore, gastrointestinal (GI) function should be fully restored before increased protein foods.

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Nursing Care Plans2: Diagnosis- Imbalanced Nutrition

May be related to inadequate calcium and vitamin D

Possibly evidenced by:

• Deformity
• Kyphosis
• Loss of height
• Fractures

Desired Outcomes

• A patient will demonstrate adequate intake of calcium and vitamin D.

Nursing Interventions

Instruct recommended daily intake for calcium.

Rationale: Premenopausal women (19-50 years old) need 1,500 mg of calcium daily. After menopause, the requirement is 1,200 mg daily. Getting enough vitamin D is equally important as getting enough calcium because vitamin D aids in absorbing calcium and improves muscle strength.

Instruct on the importance of adequate exposure to sunlight to prevent vitamin D deficiency.

Rationale: The patient should be outside for 15 minutes daily.

If a patient has limited exposure to sunlight, encourage vitamin D supplementation.

Rationale: Supplementation will ensure adequate vitamin D intake.

Instruct patient to perform gentle exercises.

Rationale: Exercise can help build strong bones and slow bone loss. Strength-training exercises should be combined with weight-bearing exercises. Strength training helps in bone and muscle strength.

Limit alcohol intake

Rationale: Consuming more than two alcoholic drinks a day may decrease bone formation and reduce the body’s ability to absorb calcium.

Provide a balanced diet.

Rationale: A diet high in nutrients that support skeletal metabolism: vitamin D, calcium, and protein.

Limit caffeine intake

Rationale: Limit the amount of caffeinated beverages to about two to three cups of coffee a day. As long as the diet contains adequate calcium, moderation in caffeine consumption won’t harm the patient. Note also caffeine-containing beverages like colas and some teas.

Nursing Care Plans3: Diagnosis- Risk for Poisoning

May be related to:

• Drug toxicity, interactions with prescribed medications
• Polypharmacy
• Analgesic abuse
• Physiologic changes associated with the aging process
• Cognitive limitations

Possibly evidenced by:

• Usage of numerous medications
• Adverse medicine effects
• Drug toxicity levels
• Inability to take medication correctly
• Pain
• Use of analgesic in doses sufficient to cause toxicity or interact with other medicines
• Disorientation
• Impaired vision
• Multiple health care providers
• Multiple pharmacies
• Inability to understand drug interactions or usage

Desired Outcomes

1. A patient will
2. accurately verbalize understanding of the need for one medical provider to control care.
3. Patient and family will accurately verbalize understanding of all medications, their effects, side effects, and potential drug interactions.
4. A patient and family will be compliant with providing a safe environment by keeping medications in a secure location.
5. A patient will be able to accurately verbalize understanding of appropriate medication administration.
6. The patient will exhibit no signs or symptoms of drug toxicity or suffer problems with drug interactions.

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Nursing Interventions

Evaluate the patient’s entire collection of medications, including over-the-counter drugs, vitamin and mineral supplements, herbal remedies, and dietary regimens.

Rationale: Provides information as to what drugs and substances are being utilized concurrently and what drug interactions may occur with concurrent use, as well as with dietary consumption. Incorrect administration of medications to be taken on an empty stomach may cause inhibition of the appropriate action of the drug. Concurrent use of other medications can result in potentiation of action and create drug toxicity.

Encourage patient and family to utilize one primary doctor to coordinate care.

Rationale: Prevents utilization of several physicians who are unaware of each other’s treatment regimens and may duplicate medication or prescribe medication that may affect other drugs.

Administer drugs as ordered, being cognizant of any interactions that might be possible.

Rationale: Most of the time, elderly patients are on several medications, and the medicines used in the treatment of osteoporosis can interact with other drugs, causing either a decrease or potentiation of other actions.

Provide instructions for the use of medications, quantity, frequency, number of doses and times, and under what conditions they are to be taken.

Rationale: Facilitates understanding of medication regimen and provides reference material once a patient is discharged.

Ensure medication labels are inscribed in large print with dosage instructions.

Rationale: Prevents medication errors for patients with visual impairments.

Assist patient and family to establish a system of following medication regimen accurately, such as the use of calendars, charts, medication boxes that are labeled for each day of the week, and so forth.

Rationale: Assists in the reduction of medication errors and assists families to be involved in patient care.

Discuss medications with a physician about the potential for using alternative long-acting drugs that require only one daily dosage.

Rationale: May help to decrease the number of medications per day, simplify the patient’s regimen and facilitate compliance.

Monitor lab work for toxicity levels, imbalances of electrolytes, and other factors pertinent to the patient’s medication profile.

Rationale: Helps to reduce the risk of toxicity. Age-related changes in the body, such as renal or liver impairment, decrease the metabolism of drugs, so what may be considered a normal dosage may become toxic for patients with impaired function.

Instruct patient/family regarding all medications, their use, effects and side-effects, and adverse reactions that should be reported to the physician.

Rationale: Helps to promote knowledge and facilitates compliance.

Instruct patient and family to store drugs in a secure area away from the bedside.

Rationale: Elderly patients may have some memory loss, forgetting that they’ve already taken medicine and double the dose taken. Frequently, elderly patients keep their medications at their bedside table to prevent the need to get up at night.

Instruct patient and family regarding interactions that may occur with concurrent medication usage.

Rationale: SERMS decreases the action of anticoagulants and ampicillin; bisphosphonates can result in hypercalcemia; estrogens can decrease the action of anticoagulants and oral hypoglycemics, and other drugs; calcium can decrease the action of estrogens.

Nursing Care Plans 4: Diagnosis-Deficient Knowledge

It may be related to a lack of exposure to information regarding medications, dietary modifications, or a safe activity program.

Possibly evidenced by:

• Verbalization of the problem and request for information
• Fear of further bone loss and fractures
• Presence of preventable complication

Desired Outcomes

1. A patient will achieve increased knowledge and compliance with a medical regimen to minimize bone demineralization and injury.
2. A patient will be compliant with medication and dietary instructions.
3. The patient will be able to perform daily exercises within identified limitations and to prevent further bone loss or deterioration.
4. The patient will exhibit no injury, fall, or trauma that might predispose to a fracture.
5. A patient will be independent in performing ADLs with modifications.
6. Patient and family will be able to accurately verbalize understanding of medications and methods of administration.

Nursing Interventions

Assess patient’s knowledge of disease, diet, medication, and exercise program to arrest the progression of bone deterioration.

Rationale: Provides a basis for teaching and techniques to promote compliance. The disease is not usually detected until 24-40% of the calcium in bone is lost.

Assess the patient’s understanding of osteoporosis.

Rationale: Most individuals with osteoporosis are not diagnosed until an acute fracture occurs.

Provide support for body image and lifestyle changes.

Rationale: Assists patient to cope with chronicity of the disease and potential fractures causing pain and immobility.

Assist in planning exercise program according to capabilities; to avoid flexion of the spine and wear a corset if appropriate (walking is preferred to jogging).

Rationale: Exercise will strengthen the bone. Vertebral collapse is common, and a corset provides support.

Teach the patient about nutrition and calcium intake.

Rationale: Adequate calcium helps to prevent osteoporosis in women with a small frame, increased age, Asians, and Caucasians.

Teach the patient that calcium carbonate is the most effective form of calcium.

Rationale: Calcium carbonate is best absorbed in an acidic stomach. Adults 19-50 years of age should take 1000mg of elemental calcium daily, and individuals 51 years above should take 1,200 mg daily.

Instruct patient that vitamin D supplementation is indicated for patients with limited sun exposure.

Rationale: Vitamin D supplements are needed for people living in the extreme northern or southern latitudes with limited sun exposure. Recommended vitamin D is 200 IU through age 50; 400 IU for 51-70-year-olds, and 600 IU for >70 yr.

Instruct patient in methods to perform activities of daily living and to avoid lifting, to bend, or carrying heavy objects.

Rationale: Prevents injury that can occur with osteoporosis with minimal trauma.

Instruct patient and family in administration of calcium, vitamin D, estrogens, and other drug therapy for osteoporosis.

Rationale: Provides replacement of calcium and helps to decrease bone loss.

Instruct patient about medication for osteoporosis, adverse effects, administration, and need for follow-up tests.

Rationale: An informed patient is likely to adhere to the medication regimen and report adverse effects.

Instruct patient and family regarding potential referrals to therapy as warranted.

Rationale: May help to provide exercise and the development of an activity program to maintain the bone condition and encourage independence in ADLs.

Teach patient and family regarding the use of assistive devices and safety precautions that are available to maintain mobility.

Rationale: Prevents further trauma or fractures from falls resulting from lack of support.

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Related FAQs

1. What is the main cause of osteoporosis?

A lifelong lack of calcium plays a role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss and an increased risk of fractures. Eating disorders. Severely restricting food intake and being underweight weakens bone in both men and women.

2. Can a person be cured of osteoporosis?

The short answer is no, osteoporosis cannot be completely reversed and is not considered curable, but there are a number of health and lifestyle adjustments you can make to improve bone loss. Your provider may also prescribe you medications to help rebuild and slow down bone loss.

3. What is the best treatment for osteoporosis?

Bisphosphonates are usually the first choice for osteoporosis treatment. These include: Alendronate (Fosamax), a weekly pill. Risedronate (Actonel), a weekly or monthly pill.

4. What is the life expectancy of a person with osteoporosis?

This excess risk is more pronounced in the first few years on treatment. The average life expectancy of osteoporosis patients is in excess of 15 years in women younger than 75 years and in men younger than 60 years, highlighting the importance of developing tools for long-term management.

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