OVERVIEW
Osteoporosis resulting from a decrease in bone mass due to limited or impaired motor function of the limbs is called wasting osteoporosis. It is a secondary form of osteoporosis that is closely related to lack of exercise and is more common in clinical practice. Wasting osteoporosis is most likely to occur when there is paralysis in bed, when limbs are immobilized and activity is limited, and in weightlessness (e.g., astronauts). It can be secondary to and exacerbate primary osteoporosis.
Causes
The disease is caused by increased bone resorption due to lack of stimulation of the skeleton such as weight bearing, center of gravity force and muscle activity. In addition, the disease can also be triggered by long-term inactivity that also affects the endocrine system, increasing urinary calcium excretion, hydroxyproline excretion, and fecal calcium excretion. Long-term paralysis in bed, or cast, traction fixation and bedridden people generally have reduced digestive function, dietary intake is reduced, resulting in insufficient intake of nutrients needed for bone formation, accelerating the occurrence of osteoporosis.
Symptoms
Symptoms of wasting osteoporosis occur slowly. Bone pain and elevated skin temperature occur early in the course of a traumatic fracture. After 6 months, decreased blood flow to the skin, subcutaneous fat atrophy, and bone pain may occur, which may be limited or reflexive. Long-term bed-ridden patients may begin to show symptoms of generalized bone pain in the 2nd week of bed-ridden, especially cervical and lumbar back pain, which occurs more frequently in the thoracic and lower lumbar segments. The lesions are often extensive, and the pain is aggravated by activity.
Examination
X-ray examination
Generally speaking, it is believed that when the loss of bone calcium reaches about 25% of the total calcium of the bone, then the X-ray film can see clear signs of bone decalcification. In the spine, it is mainly characterized by decreased density of the vertebrae, blurred trabecular structure, or only vertical trabeculae are visible in the form of fenestration. The upper and lower edges of the vertebral body are relatively obvious. The vertebral body may show a biconcave shape in which the upper and lower parts of the vertebral body are concave towards the center.
Diagnosis
1. Symptoms
The patient is mostly bedridden due to illness leading to osteoporosis. Subcutaneous fat atrophy and bone pain, especially cervical and lumbar back pain, occurring more often in the thoracic and lower lumbar segments. The lesion area is often extensive, and the pain is aggravated by activities.2. Examination
X-ray examination shows that the density of vertebral bone is reduced and the structure of bone trabeculae is blurred. The vertebral body may show a biconcave shape with the upper and lower part of the vertebrae concave to the center.
Treatment
1. Exercise therapy
The therapeutic principle of exercise therapy is to exercise as early as possible, from simple to complex, from light to heavy, and step by step. Exercises in the form of sports equipment or bare hands are used to improve motor function. Bone formation loads are enhanced by increasing muscle strength, which is trained to increase bone density. For those with complete motor dysfunction, passive training should be performed first, followed by active training gradually. 2. Calcium therapy
Maintain calcium balance, when the bone loses a lot of calcium, daily calcium supplementation is needed to minimize bone decalcification and loss of calcium reserve, and reduce negative calcium balance.
Prognosis
After active and reasonable treatment, the prognosis of this disease is generally good. Osteoporosis will be significantly reduced or even normalized after resumption of daily activities and exercise.
Prevention
The prevention and treatment of osteoporosis is weight-bearing standing. If the patient is unable to stand on his/her own, he/she can be helped to stand with the help of slope standing bed. Depending on the patient’s condition, the angle of the slope can be gradually increased to stand at 70 degrees to 90 degrees for more than 30 minutes each time, or stand in the parallel bar. In addition, strength, endurance and coordination training, muscle isometric and isotonic contraction should be carried out to resume daily activities as early as possible.
Nursing care
1. Reasonable diet
Make the diet rich in nutrition, with good color, aroma and taste to stimulate appetite. At the same time, control the diet structure to avoid excessive intake of acidic substances. 2. Appropriate exercise
Muscle contraction during exercise, which directly affects the pulling of bones, helps to increase bone density. Appropriate exercise is beneficial to the prevention of osteoporosis. 3. Happy mood
Maintaining a good mood is conducive to the prevention of osteoporosis. 4. Quit Smoking and Alcohol Prohibition
Long-term bedridden patients should quit smoking, drink a small amount of alcohol and less strong coffee. Avoid excessive salt intake.