Pharmacological Management of Osteoporosis in Men and Women, and Nursing Implications

Introduction

In illustrating pharmacological management of Osteoporosis it is important to derive a full understanding of the disease and corresponding facts especially in relation to men and women. Osteoporosis is disease characterized by micro architectural deterioration of bone tissues and low bone mass. It is pragmatic to state that that people suffering from Osteoporosis have enhanced bone fragility which consequently increases chances and risk of fracture (Lehne, 2013). This condition should be diagnosed at an early stage so that proper management would be adopted. However, when diagnosed at later time, it gets complicated and difficult to manage. Most of the common cases are realized on old population, age of about 75 years and above (Lehne, 2011).

However, it is realistic that the condition could be effectively managed through two main interventions; non-pharmacological and pharmacological interventions (Spratto & Woods, 2011). The paper is based on pharmacological intervention of osteoporosis in men and women, and corresponding nursing implications (Spratto & Woods, 2011). Research indicates that patients suffering from the condition have indications that pathogenesis enters imbalance between osteoblastic (bone formation) and osteoclastic (bone breakdown) activity.  However, besides age, it is pragmatic to state that there are also other causes that are proven by research.  The other risk factors are grouped into two (Intrinsic and extrinsic) factors (Lehne, 2013).

Intrinsic Risk Factors for Osteoporosis

Among the intrinsic risks results from genetics, hormonal and reproductive, and comorbidities’ related factors that include vitamin D deficiency, history of fragility frames, Hyperthyroidism,  hyperparathyroidism, low testosterone level (experienced in male), short duration of reproductive life (exhibited in female), rheumatoid arthritis, malabsorption with intestinal diseases and low body weight (Peate, 2007).

Extrinsic Risk Factors for Osteoporosis

The extrinsic factors results from nutrition, lifestyle and medication that people often adopt, for example; inadequate dietary calcium intake, excessive alcohol intake, physical inactivity, smoking, corticosteroids, androgen deprivation therapy, diuretics, anticonvulsants and selective serotonin reuptake (Peate, 2007). In a nut shell, it is realistic that there are significant disabilities, costs and mortalities associated with fragility fractures. However, people with previous fractures are at higher risks of recurrent fractures comparatively to the others who never had fractures previously/ the non-fractured population (Spratto & Woods, 2011).

Research indicates that available therapy could effectively reduce the cases of recurrent fractures by 30% to 60% yearly from time treatment is commenced (Spratto & Woods, 2011). Despite the fact that people derive pleasure to live longer, the older population is rated high in the osteoporosis prevalence globally (Lehne, 2013). It is regrettable that this is the population that is under represented in clinical trials; this makes them less likely to be managed appropriately comparatively to the younger population. It could be presumed that osteoporosis management in older population has proved to be a therapeutic challenge to the clinicians (Orshan, 2008).

Diagnosis

It is observable that fragility or common fracture is the hallmarks of osteoporosis X-ray absorptiometry in diagnosis centres reveal that common consideration is mineral density (Peate, 2007). However, in the women cases, the International Osteoporosis Foundation and World Health Organization managed to effectively identify four main categories of diagnostics for dual energy X-ray absorptiometry to guide respective treatments based on bone mineral density. This is effective with or without fractures (Peate, 2007).

Pharmacological Management

Research indicates that women are the most beneficiaries of pharmacotherapy with osteoporosis based on results of bone mineral density for either fractured population or non-fractured populace, also the osteopenic women who actually sustained fractures. On the same point, there is little evidence for older men (Spratto & Woods, 2011).

Calcium and Vitamin D

Accelerated bone resorption has been confirmed to be associated with calcium deficiency especially in the postmenopausal period in women, this result from decline in absorption of intestinal calcium with corresponding increase in urinary calcium excretion (Spratto & Woods, 2011). According to documented research outcomes, calcium supplements are able to effectively reduce fracture risks. Physicians should ensure that men above the age of 70 years and women above the age of 50 years take 1300mg (Lehne, 2013). This is recommended especially where the recommended dietary intake is suboptimal; however, it is important to monitor the recommended calcium supplement intake since taking more than recommended dosage on daily basis is associated with increase in cardiovascular events (Spratto & Woods, 2011).

However, it is not surprising to realize both calcium and vitamin D at the same time. In metabolism, it is recommended that much concern should be based on vitamin D status; this is because vitamin D facilitates calcium metabolism (Orshan, 2008). Research indicates that level of vitamin D in the human body decreases with increase in age; this implies that older people have malabsorption of calcium with corresponding increase secretion of parathyroid hormone (Peate, 2007). This is dangerous since it increases bone loss hence predisposing the victim to risk of osteoporosis. It implies that vitamin D deficiency could be classified as independent predictor of fragility fractures that result from falls (Spratto & Woods, 2011).

The value of optimal level of serum 25- hydroxyl vitamin D remains unknown, but research indicates that any value between 50 to 100mmol/L, could be regarded as optimal. The population at risk is commonly the people with known cases of osteoporosis (Spratto & Woods, 2011). The main care is supposed to enhance reduction of serum 25- hydroxyl vitamin D, so that the minimum be rated at 25mmol/L, which could be achieved on a daily basis through intake of vitamin D  800IU, and an optimal of 75mmol/L. It is recommended that affected populace should have high dose of intermitted vitamin D is capable of correcting deficiency sooner hence achieving compliance (Lehne, 2013).

However, research indicates that combination of calcium and vitamin D are effective in reducing rates of fractures that treatment alone. This is due to the fact that combination of the two has minimal adverse effects even though compliance rates are confirmed as limitation (Lehne, 2011). All patients diagnosed with osteoporosis should use a combination of vitamin D and calcium unless it is realistic to recommend other non- pharmacological measures which are affirmed and deemed adequate (Peate, 2007).

There are also concerns that excessive calcium dosage increases cardiovascular events, it is yet to be proved risks in patients taking combination of vitamin D and calcium, with or without administering antiresorptive drugs in patients diagnosed with osteoporosis (Peate, 2007).

Bisphonates

In preventing fractures, the most commonly used medication is referred to as bisphonates. However, alendronate, clodronate and risedronate are recommended to be taken orally when patients are in fasting states as a result of low bioavailability (Lehne, 2011). There is also a precaution that should be taken since it could lead to adverse effects in the gastrointestinal system. The intravenous bisphosphonate, zolendronic acid have been approved to effectively treat cases of osteoporosis with an advantage of taking the drugs only once a year. This is effective since it is characterized by reduced adverse effects in gastrointestinal system (Lehne, 2013).

Alendronate

This medication is confirmed to be effective in treating vertebral fractures only. There are still no realistic or confirmed results that indicate its effectiveness in treating non-vertabral fractures like hip fracture. It is evidenced that alendronate has a fracture reduction risk (RRR 38%; p<0.05) (Peate, 2007).  However, it could be explained that there are evidenced increase in hip and spine bone mineral density in older women who takes alendronate without fracture endpoints. According to research, there are no side effects or adverse outcomes associated with alendronate dosage in older age groups (Spratto & Woods, 2011).

Residronate

In administering residronate to determine ventral efficacy, on women, it was illustrated that effects of the drug on postmenopausal osteoporosis and hip intervention indicated that there are significant vertebral fracture (RRR) relative risk reduction at one year.  (RRR 81%; p< 0.001), while at three years (RRR 44%; p<0.003) (Peate, 2007).  In the older cohort, there was not benefit on non- vertebral fracture risk reported.  But according to research, it is possible to use the drug on people with mean age of (72 years; range 41 to 97) which showed benefit associated with (HR 0.8; 9%CI 0.7- 0.97; p=0.03). This implies that, for vertebrate fracture, there was no significant treatment considering age group interaction for vertebrates, since (p=0.7). While for the non-vertebrate fracture there were significance for patients below the age of 80 years, while above the 80 years and over there were no patients (Lehne, 2011).

This implied that in effecting treatment for people between the age of 70 and 100, residronate had lower risks associated with hip fracture (RR 0.7; 95%C0.6-0.9, p=0.02). However, further post hoc analysis in reation to  hip study for people between age of (70 to 100; mean 77_+ 5% according to WHO and International Osteopolosis Foundation) with severe cases (T score _<-2.5 incuding one or more prior vertablar fracture) effectivey demonstrated eficacy in using residronate to reduce hip fracture risks especially at three years (RR 0.5; 95%CI 0.3-0.9; p=0.02) (Spratto & Woods, 2011).

References

Lehne, R. A. (2011). Pharmacology for Nursing Care: Pharmacology for Nursing Care. London- UK: Elsevier Health Sciences .

Lehne, R. A. (2013). Pharmacology for Nursing Care:Pharmacology for Nursing Care. London- UK- France: Elsevier Health Sciences .

Orshan, S. A. (2008). Maternity, Newborn, and Women’s Health Nursing: Comprehensive Care Across the Lifespan . New York- USA: Lippincott Williams & Wilkins.

Peate, I. (2007). Men’s Health: The Practice Nurse’s Handbook: Volume 15 of Wiley Series in Nursing . Paris- France: John Wiley & Sons.

Spratto, G., & Woods, A. (2011). 20th Edi. Delmar Nurse’s Drug Handbook 2011: Special 20 Year Anniversary. London- UK: Cengage Learning.

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