Nursing care plan

Nursing Care Plan for Osteoporosis

Also searched as: bone loss, low bone density, fragility fracture risk

A bone disease in which bone density and bone mass fall, or the structure of bone changes, so bones break more easily. It is called a silent disease because there are usually no symptoms until a bone breaks, most often the hip, a vertebra in the spine or the wrist, and sometimes after only a fall from standing height, bending, lifting or coughing. Nursing care prevents falls and fractures, supports calcium, vitamin D and safe exercise, makes sure osteoporosis medicines are taken correctly, and manages pain after a fracture.

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What do you assess in the Osteoporosis care plan?

• Subjective: previous fractures, back pain, falls or fear of falling, diet (calcium, vitamin D, protein), activity, smoking and alcohol, menstrual and menopause history, and medicines that weaken bone such as long-term glucocorticoids, some antiseizure and cancer medicines, and proton pump inhibitors
• Objective: loss of height and a stooped posture (kyphosis), balance, gait and muscle strength (for example, standing up from a chair without using the arms), bone mineral density (DXA) results, and fall hazards in the room or home

Which nursing diagnoses apply to Osteoporosis?

What are the goals and expected outcomes for Osteoporosis?

Each goal below follows the SMART format: specific, measurable, achievable, relevant, time-bound.

• The patient will remain free of falls and new fractures during the stay and will use the walking aid and fall precautions in the plan.
• The patient will report back pain at or below their acceptable level and move with less guarding within 48 hours of starting the pain plan.
• Before discharge, the patient will explain how to take the prescribed osteoporosis medicine, name food sources of calcium and vitamin D, and describe one safe weight-bearing exercise.

What are the nursing interventions for Osteoporosis, and why?

Intervention	Rationale
Assess fall risk every shift and put precautions in place: a clear path, non-slip footwear, the call light and walking aid in reach, and help with getting up.	With fragile bones a fall from standing height can break a hip or the spine, and NIAMS lists fall prevention as part of treatment.
Assess pain, move the patient with support for the back, avoid twisting and heavy lifting, and give analgesia as prescribed.	Bones weakened by osteoporosis can break with normal stresses such as bending, lifting or even coughing.
Give bisphosphonates such as alendronate exactly as directed: just after getting up in the morning, on an empty stomach, with a full glass of plain water, then upright and nothing else by mouth for at least 30 minutes.	MedlinePlus gives these steps for every alendronate dose; new heartburn, trouble or pain when swallowing, or chest pain should be reported before the next dose.
Support calcium and vitamin D intake from food (low-fat dairy, dark leafy greens, fortified foods) and give supplements as ordered.	If calcium intake is too low the body takes calcium from bone, and vitamin D is needed to absorb it; NIH lists 1,200 mg of calcium and 800 IU of vitamin D a day for adults over 70.
Encourage safe weight-bearing and strength exercise, such as walking, planned with physical therapy, and avoid high-impact exercise.	In older adults exercise builds muscle strength, coordination and balance, which lowers the chance of falling.
Teach bone-protecting habits: quit smoking, limit alcohol to no more than one drink a day for women and two for men, and review medicines that weaken bone or raise fall risk with the provider.	Smoking, heavy drinking and some medicines add to bone loss and fracture risk.

How do you evaluate the Osteoporosis care plan?

• No falls or new fractures
• Pain at the acceptable level and mobility improving
• Osteoporosis medicine taken correctly, and the patient can repeat the steps
• Patient names calcium and vitamin D sources and a safe exercise plan

Where do these Osteoporosis recommendations come from?

• NIAMS: Osteoporosis
• NIAMS: Osteoporosis Diagnosis, Treatment, and Steps to Take
• MedlinePlus: Alendronate