How To Use Bisphosphonates Safely And Optimally? . Two

You have chosen very reasonable problems that are directly related to your PICOT question. Osteoporosis is a systemic disease that can have tremendous influence on the patient’s lifestyle, daily activity, and independence. Simple acts such as coughing, twisting, and lifting can cause fractures. While APRN, collaborating physician, clinical pharmacist, radiologist, and laboratory services are appropriate team members for management of osteoporosis the patient’s frailty needs special attention. The APRN might be the first health care provider who patient will interact but I think geriatric specialist is the most appropriate expert to lead the team for determination of treatment plan in postmenopausal osteoporotic female with other co-morbidities.

Osteoporosis is the most common disease of the bone and the incidence of this condition is rising. Osteoporosis is estimated to effect 3 million people in the UK. A decreasing bone density in patient, especially in those above the age of 50, leads to bones becoming weak and therefore, there is an increased likelihood of fragility fractures. This condition is preventable and treatable however, it is often left undiagnosed and therefore, has major cost implications on the NHS. (National Osteoporosis Society, 2013a)

Before starting pharmacological medication preventive measures should be taken. For example, weight-bearing exercise, calcium and vitamin D intake, quit smoking and alcohol. After that start osteoporosis medication if it is primary, but if it is secondary treat the underlying cause first. These drugs do not treat osteoporosis, but decrease further loss of BMD which include Bisphosphonates (Alendronate- Risedronate- Ibandronate- Zoledronic acid), Raloxifene (Selective estrogen receptor modulators), Calcitonin (hormone decreases bone resorption by inhibiting osteoclast activity), Denosumab, Teriparatid(Parathyroid hormone). The first drug used is alendronate because of its high efficacy in preventing fractures and low cost. If the first line drug failed other bisphosnates or denosumab can be used. Ralaxofeine used as third line drug because it has a risk of developing blood clot diseases, yet it decreases the risk of breast cancer . Calcitonin is used for those who are contraindicated to the previous drugs because of its low efficacy. Teriparatid is the only drug that works by increasing BMD, but is the last drug used. It is taken for a maximum 2 years and expensive and contraindicated in those who have history or having a bone cancer. For those patients who complain of sever back pain surgery might be suitable for them as a last solution although the efficacy and safety

Diet and exercise are pivotal in the maintenance of bone mass density (BMD), there now several bisphosphonates that can be used to improve BMD. An increase of dietary vitamin D, K and Calcium will also help to strengthen the tight coupling relationship between osteoclasts and osteoblasts which will help to maintain healthy bone structure.

Slowing the rate of calcium and bone loss, therefore stopping the disease processes are the goals in the treatment of osteoporosis. Medications should be considered from the following selections. Bisphosphonates (e.g. alendronate, etidronate, risedronate, zoledronic acid) are the medications of choice for treating osteoporosis. Bisphosphonates help decrease the bone destruction by inhibiting hydroxyapatite breakdown, and increase bone mineralization, therefore increasing bone density (Medical Services

Osteoporosis is a treatable disease, but not a curable one. There are different types of treatment for osteoporosis. Some of the medications that can be taken for treatment of osteoporosis are estrogen, bisphosphonates, calcitionin, raloxifene, parathyroid hormone, and testosterone replacement (UCSF Medical Center, 2010). Some of the more common names for bisphosphonates are Fosamax, Actonel, Boniva, and Reclast (Mayo Clinic, 2009). These treatments are taken orally once a week or once a month. In addition to the medications, there is also the treatment of exercise and diet. With a diet high in calcium, stopping unhealthy habits, like smoking and drinking, and regular exercise can reduce the likelihood of bone fractures in people with osteoporosis (The New York Times, 2010). In Ms. Duckworth’s incident, it would be recommended that she increase the amount of calcium in her diet and exercise, and depending on the severity of the osteoporosis, medication.

As generally stated in the introduction, osteoporosis is a skeletal disorder that involves the strength and integrity of one’s bones. The WHO defines osteoporosis as, “a systemic skeletal disorder characterized by low-bone mass, deterioration of bone tissue, increased bone fragility, and its susceptibly to recurrent fractures.” 2 The most important factor to take into account when addressing osteoporosis is the mass of bone, also referred to as, bone mineral density (BMD). As bone mass begins to decline, typically in the older population, specifically postmenopausal women, individuals are at an increased risk for fractures.3 As a result of this serious condition, many people are affected by morbidity, mortality, and economic difficulty.1

Patients who are experiencing osteoporosis are most likely to be prescribed medication that will help reverse the progression of their disorder. Bisphosphonates like alendronate, also known as Fosamax, are given to these certain patients. This type of medication treats osteoporosis which can be caused from many different factors. Bisphosphate is taken orally and has some side effects that will need to be considered with certain patients.

A systemic contraindication systemic bisphosphonate therapy for malignancy. Extraction in patients receiving such therapy results in osteochemonecrosis, which is more severe than osteoradionecrosis and is more difficult to treat.

In 2008, the United States went through one of the most significant economical period in history. The housing market and banks started to fail and people were unable to pay off their loans on the houses. This lead to a giant need for government intervention in determining which investment banks and corporations were worthy of being considered “too big to fail”. If they were in this category, the government would supply them with the funds necessary to not go bankrupt. Most of the time, the corporations would put this money towards consolidating their balance sheets, rather than solving the problems. This paper looks in depth into the 2008 financial crisis: the course

Which is the symbol that describes me. My symbol contains a Colombian flag, airplane and soccer ball, I chose them because those things are what I like most and defines me as a person. I chose the Colombian flag because I was born in Medellin, Colombia in 2001. I love to travel a lot, I liked meet and discover more cultures and people all around the world, that's why I chose an airplane. And finally but not least the soccer ball, I love soccer, soccer is my passion and is the favorite sport ever. A symbol is a very important thing in life, because your symbol is the thing that represents you and how are you.

In the last few decades, globalization has opened avenues for trade, created new markets, and increased the porousness of borders; however, a feeling of national susceptibility stems from this relaxing of borders and fuels a securitization of movement along the U.S.-Mexico border. This constructed human security framework along the southern U.S. border also allows the U.S. government to exercises extraordinary, and even military means, to combat the perceived issue.

Studies have shown that both estrogen and raloxifene, a Selective Estrogen Receptor Modulator, can prevent the loss of bone mass in postmenopausal women. Alendronate, a bisphosphonate is an alternative to estrogen for bone protection. Calcitonin is another treatment used by women for osteoporosis. This drug has been shown to slow bone breakdown and also may reduce the pain associated with osteoporotic fractures. Treatments under investigation include other bisphosphonates, sodium fluoride, para-thyroid hormone, vitamin D metabolites, and other selective estrogen receptor modulators.

I think you might like to know that on my way here, I chanced upon many beggars. Being the lower class, they were not very respectable. I called the sheriff swiftly and requested him to pick up my unexpected visitors. But now, we have more pressing matters to discuss, such as your osteoporosis. I have brought over the medication needed to treat osteoporosis. Did you know SERMs are medications that have a similar effect on bone as the hormone estrogen? They help to maintain bone density and reduce the risk of fracture, particularly of the spine. My suggestion to you is to take SERMs. You are my nineteenth patient that has osteoporosis. I assure you that quality is best with me. . . .”

Osteoporosis is described by the NHS as “a condition that weakens bones” and is fairly common, affecting roughly 3 million, with more than 300,000 people receiving treatment each year. Fractures are extremely common as the weakened bones are more susceptible to damage, even coughing may cause vertebral damage. Osteoporosis can be classified as type I or II, “both type I and type II osteoporosis occur through an imbalance between total skeletal bone formation and bone resorption which is sustained over many years” (Theobald, 2005), and are related to a lack of vitamin