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A musculoskeletal system (also known as the locomotor system) is an organ system that gives humans the ability to move. The musculoskeletal system provides form, support, stability, and movement to the body. It is made up of the body's bones (the skeleton), muscles, cartilage, tendons, ligaments, joints, and other connective tissue that supports and binds tissues and organs together. The musculoskeletal system's primary functions include supporting the body, allowing motion, and protecting vital organs.
Orthopaedics is the study of the musculoskeletal system. Orthopaedic doctors specialize in diagnosis and treatment of problems of the musculoskeletal system. Surgeons treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital disorder.
An orthopaedic nurse is a specialty nurse trained in orthopaedic problems such as fractures, trauma, sports injuries, degenerative diseases, infections, tumors, and congenital disorder and is an expert in neurovascular status monitoring, traction, casting and continuous motion therapy. Nurse's skills, interventions, attitudes, communication and continuity of care constitute the essential components of orthopaedic nurse care.
The adult skeleton is a dynamic organ that undergoes a constant process of resorption and deposition, referred to remodelling. Remodelling takes place throughout the life. Osteoporosis results when the rate of bone resorption exceeds that of deposition.
Osteoporosis is a disease of bones that leads to an increased risk of fracture. Osteoporosis literally means 'porous bones'. The two Greek words which make up the term osteoporosis are "osteon" which means bone and "poros" which means pore. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered.
Osteoporosis is defined by the World Health Organization (WHO) as a bone mineral density that is 2.5 standard deviations or more below the mean peak bone mass (average of young, healthy adults); the term "established osteoporosis" includes the presence of a fragility fracture.
The disease may be classified as either primary type 1 or type 2 and secondary osteoporosis. Osteoporosis is most common in women after menopause, and is referred to as primary type 1 or postmenopausal osteoporosis. Primary type 2 osteoporosis or senile osteoporosis occurs at age 65 years and older and is seen in both females and males in a 2:1 ratio. The onset of secondary osteoporosis is at any age, and affects both men and women equally. Type 2 osteoporosis is a result of chronic or prolonged use of certain medications and the presence of predisposing medical problems or disease states. Therefore, osteoporosis may also develop in men, and may occur in anyone in the presence of particular hormonal disorders and other chronic diseases or as a result of medications, specifically glucocorticoids, when the disease is called steroid- or glucocorticoid-induced osteoporosis. Given its influence in the risk of fragility fracture, osteoporosis may significantly affect life expectancy and quality of life.
Osteoporosis can be prevented with lifestyle changes and sometimes medication; in people with osteoporosis, treatment may involve both. Lifestyle change includes exercise and preventing falls. Medication includes calcium, vitamin D, bisphosphonates and several others. Fall-prevention advice includes exercise to tone deambulatory muscles, proprioception-improvement exercises; equilibrium therapies may be included. Exercise with its anabolic effect, may at the same time stop or reverse osteoporosis. Osteoporosis is a component of the frailty syndrome.
Osteoporosis itself has no specific symptoms; its main consequence is the increased risk of bone fractures. Osteoporotic fractures are those that occur in situations where healthy people would not normally break a bone; they are therefore regarded as fragility fractures. Typical fragility fractures occur in the vertebral column, rib, hip and wrist.
Risk factors for osteoporotic fracture can be split between non-modifiable and (potentially) modifiable. In addition, there are specific diseases and disorders in which osteoporosis is a recognized complication. Medication use is theoretically modifiable, although in many cases the use of medication that increases osteoporosis risk is unavoidable.
The most important risk factors for osteoporosis are advanced age (in both men and women) and female gender; estrogen deficiency following menopause or oophorectomy is correlated with a rapid reduction in bone mineral density, while in men a decrease in testosterone levels has a comparable (but less pronounced) effect. While osteoporosis occurs in people from all ethnic groups, European or Asian ancestry predisposes for osteoporosis. Those with a family history of fracture or osteoporosis are at an increased risk; the heritability of the fracture as well as low bone mineral density are relatively high, ranging from 25 to 80 percent. There are at least 30 genes associated with the development of osteoporosis. Those who have already had a fracture are at least twice as likely to have another fracture compared to someone of the same age and sex. A small stature is also a non-modifiable risk factor associated with the development of osteoporosis.
Small amounts of alcohol do not increase osteoporosis risk and may even be beneficial, but chronic heavy drinking (alcohol intake greater than 3 units/day), especially at a younger age, increases risk significantly.
Vitamin D deficiency is common among the elderly worldwide. Mild vitamin D insufficiency is associated with increased Parathyroid Hormone production. Parathyroid Hormone increases bone resorption, leading to bone loss. A positive association exists between serum 1,25-dihydroxycholecalciferol levels and bone mineral density, Parathyroid Hormone while is negatively associated with bone mineral density.
Tobacco smoking inhibits the activity of osteoblasts, and is an independent risk factor for osteoporosis. Smoking also results in increased breakdown of exogenous estrogen, lower body weight and earlier menopause, all of which contribute to lower bone mineral density.
Nutrition has an important and complex role in maintenance of good bone. Identified risk factors include low dietary calcium and/or phosphorus, magnesium, zinc, boron, iron, fluoride, copper, vitamins A, K, E and C (and D where skin exposure to sunlight provides an inadequate supply). Excess sodium is a risk factor. High blood acidity may be diet-related, and is a known antagonist of bone. Some have identified low protein intake as associated with lower peak bone mass during adolescence and lower bone mineral density in elderly populations. Conversely, some have identified low protein intake as a positive factor, protein is among the causes of dietary acidity. Imbalance of omega 6 to omega 3 polyunsaturated fats is yet another identified risk factor. Research has found an association between diets high in animal protein and increased urinary calcium loss from the bones.
Bone remodeling occurs in response to physical stress, and weight bearing exercise can increase peak bone mass achieved in adolescence. In adults, physical activity helps maintain bone mass, and can increase it by 1 or 2%. Conversely, physical inactivity can lead to significant bone loss. (Incidence of osteoporosis is lower in overweight people.) .
Excessive exercise can lead to constant damage to the bones which can cause exhaustion of the structures. There are numerous examples of marathon runners who developed severe osteoporosis later in life. In women, heavy exercise can lead to decreased estrogen levels, which predisposes to osteoporosis. In addition, intensive training without proper compensatory increased nutrition increases the risk.
A strong association between cadmium, lead and bone disease has been established. Low level exposure to cadmium is associated with an increased loss of bone mineral density readily in both genders, leading to pain and increased risk of fractures, especially in the elderly and in females. Higher cadmium exposure results in osteomalacia (softening of the bone).
Some studies indicate that soft drinks (many of which contain phosphoric acid) may increase risk of osteoporosis; Others suggest soft drinks may displace calcium-containing drinks from the diet rather than directly causing osteoporosis.
Number of clinical decision rules have been created to predict the risk of osteoporotic fractures. The QFracture score was developed in 2009. Dual energy X-ray absorptiometry is considered the gold standard for the diagnosis of osteoporosis.
The U.S. Preventive Services Task Force recommended in 2002 that all women 65 years of age or older should be screened with bone densitometry. The best risk factor for indicating increased risk is lower body weight (weight < 70 kg), with less evidence for smoking or family history. The Osteoporosis Risk Assessment Instrument may be the most sensitive strategy. Regarding the screening of men, a cost-analysis study suggests that screening may be "cost-effective for men with a self-reported prior fracture beginning at age 65 years and for men 80 years and older with no prior fracture".
Lifestyle prevention of osteoporosis is in many aspects inversions from potentially modifiable risk factors. Smoking cessation and moderation of alcohol intake are commonly recommended in the prevention of osteoporosis.
Achieving a higher peak bone mass through exercise and proper nutrition during adolescence is important for the prevention of osteoporosis. Exercise and nutrition throughout the rest of the life delays bone degeneration. Jogging, walking, or stair climbing at 70-90% of maximum effort three times per week, along with 1,500 mg of calcium per day, increased bone density of the lumbar (lower) spine by 5% over nine months.
Proper nutrition includes a diet sufficient in calcium and vitamin D. Patients at risk for osteoporosis (e.g. steroid use) are generally treated with vitamin D and calcium supplements and often with bisphosphonates. Vitamin D supplementation alone does not prevent fractures, and always needs to be combined with calcium. Calcium supplements come in two forms: calcium carbonate and calcium citrate. In addition, patients who are taking proton pump inhibitors or H2 blockers. In renal disease, more active forms of Vitamin D such as cholecalciferol or (1,25-dihydroxycholecalciferol or calcitriol which is the main biologically active form of vitamin D) is used, as the kidney cannot adequately generate calcitriol from calcidiol (25-hydroxycholecalciferol) which is the storage form of vitamin D.
High dietary protein intake increases calcium excretion in urine and has been linked to increased risk of fractures in research studies. Other investigations have shown that protein is required for calcium absorption, but that excessive protein consumption inhibits this process.
Just as for treatment, bisphosphonate can be used in cases of very high risk. Other medicines prescribed for prevention of osteoporosis include selective estrogen receptor modulator. Estrogen replacement therapy remains a good treatment for prevention of osteoporosis.
The orthopaedic clients were required more care when compared with other categories of client, thus the orthopaedic nurse must develop the "orthopaedic eye" and should have acute awareness in assessing the need of the orthopaedic clients.
NEED FOR THE STUDY:
There is an urgent need to recognize this "Silent Crippler" the population is aging, people and living longer, unhealthy dietary pattern have increased and physical activity and sun exposure have decreased.
Osteoporosis is a global problem which is increasing in significance as the population of the world both grows and ages.
Worldwide, lifetime risk for osteoporotic fractures in women is 30-50%. In men risk is 15-30%. Three main types of osteoporosis fractures are wrist fracture, vertebral fracture and hip fracture.
1 in 3 women over 50 will suffer a fracture due to osteoporosis; this increases to 1 in 2 over 60. 1 in 5 men over 50 will suffer a fracture due to osteoporosis; this increases to 1 in 3 over 60.
Approximately 1.6 million hip fractures occur each year worldwide, the incidence is set to increase to 6.3 million by 2050.
The highest risk of hip fractures are seen in Norway, Sweden, Iceland, Denmark and the USA. Currently, there is an increasing incidence of hip fractures in the developed cities in Asia. 1 out of 4 hip fractures occur in Asia and Latin America. This number of hip fractures will increase to 1 in 2 by 2050.
In the Middle East, the burden of osteoporosis in the general population is expected to increase and is becoming a heavy financial burden.
The annual incidence rate of osteoporotic fractures in women is greater than the combined incidence rates of heart attack, stroke and breast cancer.
According to World Health Organization (WHO), osteoporosis is second only to cardiovascular disease as a global healthcare problem and medical studies show a 50-year-old woman has a similar lifetime risk of dying from hip fracture as from breast cancer. Since osteoporosis affects the elderly population which is growing, it will put a bigger burden to the healthcare system as treatment is expensive. Unless swift action is taken, it can escalate into an economic threat.
SOURCE: International Osteoporosis Foundation (2010)
International Osteoporosis Foundation estimates that the annual direct cost of treating osteoporosis fractures of people in the workplace in the USA, Canada and Europe alone is approximately 48 billion. The worldwide cost burden of osteoporosis (for all ages) is forecast to increase to 131.5 billion by 2050. Osteoporosis also results in huge indirect costs that are rarely calculated and which are probably at least 20% of the direct costs. Once a woman suffers a first vertebral fracture, there is a five-fold increase in the risk of developing a new fracture within one year.
In India, 1 out of 8 males and 1 out of 3 females in India suffers from osteoporosis, making India one of the largest affected countries in the world. Expert groups peg the number of osteoporosis patients at approximately 26 million (2003 figures) with the numbers projected to increase to 36 million by 2013. Two points worth noting about osteoporosis in India - the high incidence among men and the lower age of peak incidence compared to Western countries. The incidence of hip fracture is 1 woman to 1 man in India. In most Western countries, while the peak incidence of osteoporosis occurs at about 70-80 years of age, in India it may afflict those 10-20 years younger, at age 50-60.Over 300 million people suffer from osteoporosis in India without realizing that every osteoporosis related fracture double the risk of death.
India women were to have lower bone density than that in North Americans, Germans, Hispanic, Japanese and Korean. Osteoporosis occur 10- 20 years earlier in Indians when compared to Western countries. Prevalence of osteoporosis in Tamil Nadu is 257 that is, 42.2% (The Hindu, September 1, 2008)
SOURCE: International Osteoporosis Foundation (2010)
STATEMENT OF THE PROBLEM:
EFFECTIVENESS OF NURSING CARE ON CLIENTS WITH OSTEOPOROSIS AT MELMARUVATHUR ADHIPARASAKTHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH.
to assess the health status of clients with osteoporosis.
to evaluate the effectiveness of selected nursing care on clients with osteoporosis.
to associate the effectiveness of nursing care on clients with osteoporosis and with selected demographic variables.
Effectiveness: It refers to excellency in nursing care and promotes the health status of clients with osteoporosis. Assessed and evaluated by standardized tool.
Nursing Care: It refers to selected nursing care such as assessment of pain, vital parameters, physiological status, based on that nursing care provided like providing pain relieving measures such as heat application, providing comfortable measures like extra pillows, supportive rolls, drug administration, nutritional status, ambulation, teaching exercise such as muscle strengthening, co- ordination and balance, preventing complications such as fractures of hip, vertebra, wrist, health education on life style modification and rehabilitation by the investigator to the client with osteoporosis from the time of admission.
Client: Refers to those who are with osteoporosis and certified by physician for treatment purpose.
Osteoporosis: Is defined by the World Health Organization (WHO) as a bone mineral density that is 2.5 standard deviations or more below the mean peak bone mass. Those with standard deviation of 1- 2.5 below the norm as said to have osteoporosis.
Clients who are with osteoporosis are functionally limited.
Close monitoring and continuous care is valuable in determining the progress of client with osteoporosis.
Timely nursing intervention will promote health and prevent life threatening complications.
The sample size was limited to 30, who were admitted with osteoporosis.
The period of study was limited to 6 weeks.
The study was limited to Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur.
The findings of the study cannot be generalized.
Nursing intervention for clients with osteoporosis will promote comfort, prevent complications and will improve the quality of life. It will be very helpful to strengthen the responsibilities of health personnel in improving the quality of care.