OCM
PE
GA: compos mentis, thin, healthy woman, sitting in a chair in no distress
VS:
BP : 130/80 mmHg PR : 84x/mnt RR : 20 x/mnt afebrile
General state : Height : 165 cm, Weight : 55 kg (BMI:
20→ normal)
Lung, heart, abdominal,
neurologic exam→
normal
Local examination at right hip:
No muscular atrophy, no significant
tenderness or spasm, limited ROM.
HT:
± 2 weeks ago: she awoke with pain in her hip
Pain didn’t radiate, initially sharp and severe and limiting her activities for first 4 or 5 days
She denied fall, trauma and unusual or new activities.
The pain was occurred when she was getting out of bed
The pain has affected her sleep
Using acetaminophen regularly for the past 2 weeks with some relief.
The pain did not change with position.
She had a long history of asthma→ well controlled with a combination of corticosteroid and LABA
She had a negative mammogram 6 months ago and a normal Pap Smear.
She lived with her husband in town house
Her husband was pensioner
They had 2 children and all married (they lived abroad)
CC: right hip pain pain.
Mrs. N, 74 y.o, ♀
SE:
Lab exam:
Normal CBC and serum
chemistries.
BMD test on right hip:
T-score: -2.5 (osteoporosis)
X-ray:
Osteoporosis pain.
Osteoarthritis pain.
Herniated disc Muscular
disturbance
APGAR: 9
Elderly, menopause
Osteoporosis with right hip fracture
Management plan:
Vit D & Calcium supplement
Lifestyle (Nutrition, exercise),
Fall prevention
Pad to immobilize femur
Health care maintenance for Mrs.N and her husband
Pain relief
FCM
Mrs. N, 74 y.o, ♀
Age > 30 (Post-peak bone mass)
Postmenopause Long history of
corticosteroid use
Age-related degeneration
bone breakdown (resorption) outpaces bone
formation estrogen↓
Bone Formation↓
Anti-resorptive effect of estrogen on osteoclast ↓
Osteoblast and GF’s production
↓ Upregulate
gene expression of
osteoclast
Bone resorption↑
Osteocytes production Bone response ↓
to stress↓
Osteocyte death↑
Bone density↓
BMD test right hip bone: -2.5
D: Osteoporosis
High fracture risk
Fracture
X-ray:
CC: Right hip pain (didn’t radiate,
sharp, severe)
Negative feedback on hypothalamus
/pituitary
Took acetaminophen
Limit activity Affected her
sleep Relief
Osteoporosis with right hip fracture
Health care maintenance
Vit D & Calcium supplement
Lifestyle (Nutrition, exercise)
Fall prevention
Hip pad NSAID
BHP:
Inform consent (perhatikan cara berkomunikasi dengan lansia)
Perhatikan pemilihan obat dan tindakan yang akan dilakukan pada lansia PHOP:
Edukasi mengenai osteoporosis dan prevensi jatuh
Edukasi pemeliharaan kesehatan lansia (screening rutin, posyandu lansia, lingkungan yang baik untuk lansia, nutrisi, olahraga)
CRP:
Tahun 2009: terdapat 200 juta penderita osteoporosis di seluruh dunia
Penelitian puslitbang gizi 2005: prevalensi osteopenia→ 41.7%, osteoporosis→ 10.3% (2 dari 5 penduduk Indonesia memiiki resiko osteoporosis)
Osteoporosis di Indonesia Tahun 2013: Prevalensi osteoporosis perempuan berusia 50-80 tahun → 23%, prevalensi osteoporosis perempuan berusia 70-80 tahun → 53%
Di seluruh dunia, 1 dari 3 perempuan dan 1 dari 5 laki-laki berusia lebih dari 50 tahun akan mengalami fraktur osteoporosis (setiap 3 detik terjadi 1 fraktur karena osteoporosis)