Osteoporosis as a Porous Bone - Case Study Example

Endocrinology Case Study: Osteoporosis Student’s Name Institution Endocrinology Case Study: Osteoporosis How Osteoporosis Is Characterised and Defined In fact, the literal meaning of Osteoporosis is porous bone, which has a meaning of that the bone density are small and the bones turn to be thin (Bartl & Frisch, 2004). However, fracturing of bones does not occur due to bones’ thinness. In simple words, osteoporosis is an ailment characterised by little bone mass together with micro-architectural bone tissue deterioration. Subsequently, it leads to the enhanced fragility of bone and a subsequent augment in fracture jeopardy (Bartl & Frisch, 2004). Risk Factors Applicable to Mrs Chan’s Condition The risk factors for osteoporosis that apply to Mrs Chan are; age, nulliparity, medications use, race, low body mass, osteoporosis’ family history, smoking, excessive use of alcohol, sedentary lifestyle, deficient states of estrogens, rheumatoid arthritis, female gender, hyperthyroidism, posttransplantation, primary hypogonadism, Crohn’s disease, corticosteroid therapy, ankylosing spondylitis, untreated early menopause, or lengthened secondary amenorrhea, poor diet or malabsorption syndromes for instance, coeliac disease, acute renal failure, primary hyperparathyroidism, and lengthened immobilisation (Skugor, 2010). ‘Special X-ray’ and Indication of the Results The ‘special x-ray’ is utilised in measuring the bone mineral density (BMD). Most commonly, it is carried out employing dual-energy x-ray absorption (DXA or DEXA). The x-rays amount absorbed by bone and tissues turn to be quantified by the DXA apparatus and compares with mineral density of the bone (Grampp & Adams, 2008). The DXA machine changes raw density data to the patient’s Z and T-score. Thus, the T-score would measure the Chan’s bone amount in comparison to the typical younger people’s populace and would be used to approximate her risk of building up a fissure. The Z-score would measure the bone amounts that Mrs Chan would be having in comparison to her age mates. That figure would aid in showing whether extra medical tests would be required. In addition, the special x-ray would help in diagnosing fractured bones that might have been caused by osteoporosis. After discussing the need for ‘special X-ray’ with Mrs Chan, she subsequently has it done. The result is confirmation of osteoporosis. Goals of Therapy for Mrs Chan The goal of therapy for Mrs Chan is curing and averting fracture. The preventive approaches comprise of suitable nutrition, (calcium, protein, and vitamin D), prevention of falls, smoking cessation, appropriate handrails, lighting, proper shoes and anchored rugs. The treatment comprises of zoledronate, calcitonin, risedronate, ibandronate, raloxifene, as well as rhPTH. The First-, and Second- Line Treatments Available and Their Advantages and Disadvantages for Mrs Chan The first-line treatment available would be the use of bisphosphonates. In this case, bisphosphonates like, ibandronic acid, risedronate and alendronic acid would lessen fracture risks. Orally prescribed bisphosphonates after a lengthened fast (typically morning’s initial thing) and swallowed with plenty water would be used to avoid the tablet from sticking within the oesophagus (Bartl & Frisch, 2004). Nothing else apart from water ought to be ingested for the next 30 minutes (for risedronate and alendronate) or an hour (for the ibandronate). Under suitable conditions, the orally prescribed bisphosphonates turn to be below 1%. Thus, ingesting whichever bisphosphonate in combination with any beverage, or food apart from plain water or particular other prescriptions in 2 hours after eating might significantly eliminate or lessen the drug absorption. Some of the bisphosphonates’ contraindications comprise of hypocalcaemia or hypersensitivity. The second-line treatments available would be the use of raloxifene, denosumab, strontium ranelate and risedronate. The prescription of risedronate would be 35 mg once in every week. Risedronate is associated with reduced risk of hip, and spine fractures together with nonvertebral sites within women having postmenopausal osteoporosis (Bartl & Frisch, 2004). It also augments the hip and spine’s BMD and also averts forearm’s loss of bones. On the hand, denosumab prescription would be a subcutaneous injection of 60 mg once in six months. It would reduce the menace of nonvertebral sites, hip and spine fractures in women possessing postmenopausal osteoporosis. Denosumab disadvantages include causing skin infections that include eczema, rashes, and dermatitis. The dosage for raloxifene would be taking a tablet of 60 mg every day. In fact, raloxifene advantages include lessening the spine fractures within women having postmenopausal osteoporosis. It also increases the hip and spine’s BMD. Its disadvantages include an estimated 3-fold augment in taking the place of thromboembolic venous ailments (akin to oestrogen) though the absolute danger turn to be slow (Grampp & Adams, 2008). The other disadvantage is menopausal signs like night sweats and hot flashes as well as the leg cramps. Strontium ranelate, being in powder form, is mixed with water and is taken every day. It both increases the formation of bones and hampers resorption though there is uncertainty in its major action’s manner. Its advantage includes little-augmented menace of myocardial infarction within sick people on medication with it, and patients ought to be assessed for cardiovascular jeopardy ahead of starting using this drug together with during medication. How Fosamax Prescription Works In fact, Fosamax (alendronate) fits in the collection of medicines referred as bisphosphonates (Grampp & Adams, 2008). Fosamax works by changing the bone formation cycle and breakdown within the body. As such, Fosamax decelerates losing of bones while augmenting the mass of bones that might prevent fracturing of the bones. Further, it turns to be utilised in increasing mass of bones within men who suffer from osteoporosis, as well as in treating Paget’s illness of bone within women and men. The Usual Dose for Medication In fact, Fosamax is taken exactly as the doctor tells someone. The usual dosages for Fosamax turn to be once every week or once daily. In those cases, the first thing after one wakes up in the morning involves taking the tablet. In case, one is taking the tablet once on weekly basis, the tablet ought to be taken on the same day every week (Royal College of Physicians of London, & Bone and Tooth Society, 2000). In essence, this must always be the initial thing after waking up at daybreak. Fosamax is taken with water being filled in the water glass. While taking the tablet, plain water is recommended instead of the mineral water, juices, teas or coffee. The tablet is never sucked, chewed or crushed. As such, the tablet is only wholly swallowed. Counselling To Mrs Chan Regarding the Use of This Medication First, Mrs Chan should always read medicine’s medication guide before beginning taking the medicine (Bartl & Frisch, 2004). Before taking Fosamax, it would be better Mrs Chan would tell her doctor if she is allergic to it; if she possesses other types of allergies; or if she is allergic to types of bisphosphonates. Secondly, Mrs Chan should also disclose to her doctor her medical history; particularly of oesophagus’ disorders like achalasia or oesophagal stricture. She should also disclose whether she possesses difficulty sitting or standing erect for a minimum of thirty minutes, kidney problems, and low levels of calcium.Additionally difficulties in swallowing, intestinal /stomach disorders, and malabsorption syndrome (possessing difficulty absorbing minerals within one’s intestines or stomach) should be declared (Grampp & Adams, 2008). She should inform her doctor whether she takes Nonsteroidal Anti-Inflammatory (NSAID) tablets, aspirin and antacids. Mrs Chan should also tell her doctor before taking Fosamax medication all the medicines that she takes including non-prescription and prescription herbal supplements, vitamins and medications. The other counselling is that Mrs Chan should ensure that ahead of having whichever surgery (particularly dental processes), she should inform her dentist and doctor about that medication together with the entire products that she use. Monitoring Required After Mrs Chan Starts Fosamax Therapy In order to make sure that Mrs Chan is being helped by the therapy; her bone mineral density would require regular tests by her doctor (Royal College of Physicians of London, & Bone and Tooth Society, 2000). Additionally, if Mrs Chan would forget to take the medicine immediately she wakes up, she would not take it the time that she realises that she did not swallow the medicine. In this scenario, she would wait for the next morning to ingest the tablet and omit the skipped dose. Similarly, if she would be taking the medicine weekly and she forgets taking it on her scheduled day, she would wait for the morning of the scheduled following week and take the dose. Subsequently she should resume her regular weekly schedule. In case Mrs Chan overdoses, she ought to phone the poison help, find urgent medical help, or drink a glass full of milk and phone the emergency room or local centre for poison control. Other Strength of Alendronate Available For Osteoporosis, the Usual Dose and Main Disadvantage of the Formulation In fact, alendronate’s power is its effectiveness at augmenting the BMD of the entire hip and spine and also its capability of lessening vertebral fractures within sick people on continuing therapy of glucocorticoid (Prinsloo & Hosking, 2006). The usual dose of the medicine is 5 mg every day or 35 mg weekly for a particular period like a year. The disadvantage of this formulation is that there is a direct match between tablets in terms of end points and fracture. Available Combinations of Alendronate with Other Drugs and the Usual Doses The available combinations of alendronate with other drugs are acetaminophen, aspirin, anaflex, bextra, betamed, BC Arthritis, certavite, cystex, century, diclofenac, and dolobid among others (Prinsloo & Hosking, 2006). The dosage for osteoporosis within postmenopausal women is once 10 mg daily or once 70 mg every week. Other Measures to Be Advised To Mrs Chan Regarding minimising risk factors, Mrs Chan should ensure inclusion of dietary having enough calcium, vitamin D, proteins, phosphorous, vitamin K and C, manganese and zinc. Also, she should also engage herself in careful physical activities. Moreover, she should quit smoking and also stop consuming alcohol if she involves herself in both activities. Further, she can also use mineral supplements to ensure her body is getting all the required minerals. On the preventing falls measure, Mrs Chan should ensure that she is always wearing comfortable shoes. As such, flat shoes are right for her to wear as she would be capable of balancing her body well. Importantly, she should avoid walking on slippery floors. References Bartl, R., & Frisch, B. (2004). Osteoporosis; Diagnosis, Prevention, Therapy: A Practical Guide for All Physicians – From Paediatrics to Geriatrics. Berlin: Springer. Grampp, S., & Adams, J. (2008). Radiology of Osteoporosis. Berlin: Springer. Prinsloo, P, J, J & Hosking, D, J. (2006). Alendronate Sodium in the Management of Osteoporosis. Therapeutics and Clinical Risk Management Journal. 2(3). 235-249. Royal College of Physicians of London, & Bone and Tooth Society. (2000). Osteoporosis: Clinical Guidelines for Prevention and Treatment: Update on Pharmacological Interventions and an Algorithm for Management. London: Royal College of Physicians: Bone and Tooth Society of Great Britain. Skugor, M. (2010). Osteoporosis. 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