Osteoporosis (eBook)

Preface 5
Contents 7
Epidemiology of Osteoporosis 11
1.1 Osteoporosis: A Silent Thief! 11
1.2 Osteoporosis: The Global Scope of the Problem 12
Biology of Bone 17
2.1 Bone: An Architectural Masterpiece 17
2.2 Bone: A Permanent Building and Rebuilding Site 20
2.3 Remodelling Units 25
2.4 Some Biological Perspectives on the Mechanisms Involved in the Control and Regulation of Bone Remodelling 27
2.5 Minimodelling 28
2.6 Stimuli, Triggers and Mechanisms of Activation of Bone Remodelling 29
2.7 Control of Bone Remodelling: A Network of Complex Mechanisms 30
2.8 Osteoimmunology: A Representative of Systems Biology 33
2.9 The RANK/RANKL/Osteoprotegerin System 33
2.10 Leptin: Role of the Central Nervous System in Regulation of Bone 35
2.11 Growth of the Embryo in the Uterus 36
2.12 Peak Bone Mass: An Investment for a Healthier Life 37
Pathogenesis of Osteoporosis 39
3.1 Factors in the Development of Osteoporosis 39
3.2 Def inition of Osteoporosis 40
3.3 Osteoporosis – Which Bones are Vulnerable? 41
3.4 Osteoporosis – Also a Question of Quality! 42
3.5 Definition of “Fracture” 44
3.6 Vertebral ( Spinal) Fractures 44
3.7 Hip Fractures 46
3.8 Wrist Fractures 47
3.9 Other Fractures 47
Subgroups of Osteoporosis 48
4.1 According to Spread 48
4.2 According to Age and Sex 49
4.3 According to Extent 51
4.4 According to Histology 52
Risk Factors for Fractures 54
5.1 Risk Factors Which Cannot (yet) be Influenced 55
5.2 Risk Factors Which Can be Influenced 57
Clinical Evaluation of Osteoporosis 64
6.1 Indicative Symptoms 64
6.2 Osteoporosis and Teeth, Skin and Hair – What are the Connections? 66
6.3 Role of Conventional X- Rays in Osteoporosis 66
6.4 Other Useful Imaging Techniques 69
Bone Density in Osteoporosis 72
7.1 Why Measure Bone Mineral Density? 72
7.2 Which Instruments to Use? 72
7.3 Which Bones to Measure? 79
7.4 Who is Due or Overdue for a BMD Test? 79
7.5 Bone Densitometry in Children – Now Readily Available! 81
7.6 BMD Measurement – Not a Scary Procedure, Nothing to be Afraid of! 82
Laboratory Evaluation of Osteoporosis 83
8.1 Recommended Tests 83
8.2 Significance of Markers of Bone Turnover 83
8.3 Recommendations for Practical Use of Bone Markers 87
8.4 Potential of Bone Biopsy in Clinical Practice 87
8.5 When is a Bone Biopsy Indicated? 88
8.6 Up-to- Date Methods 89
Prevention of Osteoporosis 91
9.1 Step 1: First of all a Calcium- Rich Diet! 91
9.2 Step 2: Ensure an Adequate Supply of Vitamins! 93
9.3 Step 3: Protect the Spine in Everyday Life! 94
9.4 Step 4: Regular Physical Activity – for the Preservation of Strong Bones! 95
9.5 Step 5: No Smoking, Please! 98
9.6 Step 6: Reduce Nutritional “ Bone Robbers”! 98
9.7 Step 7: Strive for an Ideal Body Weight! 99
9.8 Step 8: Identify Drugs that Cause Osteoporosis and Take Appropriate Steps to Counteract Them When Possible and Necessary! 100
9.9 Step 9: Recognize Diseases Which Damage Bones! 100
9.10 Step 10: Management of Patients Who Have Already Sustained a Fracture 101
Physical Activity and Exercise Programs 102
10.1 Strong Muscles Make and Maintain Strong Bones! 102
10.2 The Muscle– Bone Unit and Sarcopenia 103
10.3 Exercise Programs – Preventive and Restorative 104
10.4 Implementation of a Training Program 104
Treatment Strategies in Osteoporosis 105
11.1 Evidence- Based Strategies for the Therapy of Osteoporosis 105
11.2 Comprehensive Approach to the Therapy of Osteoporosis 109
11.3 Indication for Treatment – Combining BMD with Clinical Factors 110
Management of Pain in Osteoporosis 112
12.1 Start with the Patient, not the Disease! 112
12.2 Acute Phase 112
12.3 Chronic Phase – Short Term 113
12.4 Chronic Phase – Long Term 114
12.5 Electric Potentials in Bone 114
Calcium and Vitamin D 115
13.1 Calcium: A Lifelong Companion 115
13.2 The Concept of Vitamin D in the 21st Century 117
13.3 Vitamin D: Don’t Rely on Sunshine, Take Supplements 118
13.4 Rickets 119
13.5 Other Vitamins Involved in Skeletal Health 121
Hormones for Replacement Therapy 122
14.1 Hormone Replacement Therapy for Women – Now Recommended for Symptoms Only! 122
14.2 Which Oestrogens and Progestins, and How to Take Them? 123
14.3 Which Women to Treat? 124
14.4 How Long to Treat? 124
14.5 How to Monitor HRT? 124
14.6 What are the Risks and Adverse Events of HRT? 125
14.7 What are the Main Contraindications? 125
14.8 Natural Oestrogens – How Effective are They? 125
14.9 Dehydroepiandrosterone (DHEA) – Is it Useful for the Prevention of Bone Loss? 127
14.10 Testosterone – Good for Bones and Well- Being in Men! 127
14.11 Anabolic Steroids – Strong Muscles for Healthy Bones! 127
Bisphosphonates 129
15.1 A Brief Survey of Bisphosphonates 130
15.2 Pharmacokinetics 133
15.3 Toxicity and Contraindications 134
15.4 Osteomyelitis/Osteonecrosis of the Jaw ( ONJ) 135
15.5 Contraindications 137
15.6 Oral Bisphosphonates Currently Used in Osteoporosis 137
15.7 Alendronate 137
15.8 Risedronate 138
15.9 Etidronate 139
15.10 Ibandronate 139
15.11 Intravenous Bisphosphonates for the Treatment of Osteoporosis 140
15.12 Ibandronate 140
15.13 Zoledronate 140
15.14 Clodronate and Pamidronate 141
15.15 Recommendations for Intravenous Therapy 141
15.16 Duration of Therapy with Bisphosphonates and Long- Term Studies 141
15.17 A Summary of Results Achieved to Date 142
15.18 Meta-analyses of Antiresorptive Substances 144
Selective Oestrogen- Receptor Modulators 146
16.1 A Brief Overview of SERMs – New Selective Antiresorptive Agents 146
16.2 Raloxifene – Utilization of Physiological Eff ects on Bone 146
Peptides of the Parathyroid Hormone Family 149
17.1 Osteoanabolic Action of PTH – Paradoxical Eff ects Depend on Type of Administration 149
Strontium Ranelate 152
Calcitonin and Fluoride 154
Combination and Sequential Therapies 156
Future Directions 158
22.1 Adherence to Treatment 160
22.2 Monitoring Treatment 160
Adherence and Monitoring of Osteoporosis Therapy 160
22.3 Monitoring Antiresorptive Therapy 162
22.4 Monitoring Osteo-anabolic Therapy 163
Osteoporotic Fractures 164
23.1 Fragility Fractures 164
23.2 Fractures and the Healing Process 165
23.3 Effects of Drugs and Lifestyle on Fracture Healing 166
23.4 Risk Factors for Osteoporotic Fractures 167
23.5 Management of Osteoporotic Fractures 170
23.6 Prevention of Further Fragility Fractures with Specific Drugs 170
23.7 Fracture Sites and Their Clinical Significance 170
Pregnancy and Lactation 178
Osteoporosis in Men 181
25.1 Clinical Evaluation of Osteoporosis in Men 181
25.2 Special Features in Men 184
25.3 Prevention and Treatment in Men 184
25.4 Therapy of Osteoporosis in Men 185
Osteoporosis in Children 187
26.1 First Clarification – Hereditary or Acquired? 187
26.2 Idiopathic Juvenile Osteoporosis, Idiopathic Juvenile Arthritis, and Other Conditions 192
26.3 Osteogenesis Imperfecta Must Not Be Overlooked! 193
26.4 Turner Syndrome and Charge Syndrome 195
26.5 X- Linked Hypophosphatemic Rickets 195
26.6 Gaucher’s Disease 195
Immobilization Osteoporosis 197
27.1 Examples of Bone Loss 197
27.2 Space Travel and the Force of Gravity 198
27.3 Therapy of Immobilization Osteoporosis 198
Osteoporosis in Medical Disciplines 200
28.1 Assessment of Secondary Osteoporoses 200
28.2 Cardiology 200
28.3 Dermatology 202
28.4 Endocrinology 202
28.5 Gastroenterology 204
28.6 Genetics 204
28.7 Haematology and Storage Disorders 205
28.8 Infectious Disorders 207
28.9 Nephrology 208
28.10 Neurology and Psychiatry 209
28.11 Oncology 209
28.12 Pulmonology 210
28.13 Rheumatology and Immunology 210
Osteoporosis and Drugs 212
29.1 Corticosteroid- Induced Osteoporosis 212
29.2 Transplantation Osteoporosis 214
29.3 Tumour Therapy- Induced Osteoporosis 216
29.4 Drug- Induced Osteoporomalacia 219
29.5 Antiepileptic Drug- Related Osteopathy, a Pressing Need for Better Understanding 219
AIDS Osteopathy 221
30.1 Manifestations of AIDS Osteopathy 222
30.2 Diagnosis 223
30.3 Treatment Strategies 224
Renal Osteopathy 225
31.1 Definition 225
31.2 Pathophysiology 225
31.3 Symptoms 226
31.4 Biochemical Investigation 226
31.5 Radiological Investigation 226
31.6 Treatment Strategies 227
Localized Osteopathies 229
32.1 Complex Regional Pain Syndrome ( CRPS) 229
32.2 Transient Osteoporosis and the Bone Marrow Oedema Syndrome ( BMOS) 231
32.3 Vanishing Bone Disease ( Gorham- Stout Syndrome) 235
32.4 Fibrous Dysplasia 237
32.5 Paget’s Disease of Bone 238
Periprosthetic Osteoporosis and Aseptic Loosening of Prostheses 242
33.1 Pathogenesis 242
33.2 Diagnosis 244
33.3 Treatment Strategies 244
33.4 Bisphosphonates 244
Oral Bone Loss, Periodontitis and Osteoporosis 246
34.1 Oral Bone Loss and Systemic Osteoporosis 246
34.2 Pathogenesis of Periodontitis 246
34.3 Clinical Findings 246
34.4 Treatment Strategies 247
34.5 Bisphosphonates 247
Disorders of Bone Due to Tumours 248
35.1 Links Between Osteoporosis and Cancer 248
35.2 Tumour-Induced Hypercalcaemia (TIH) 248
35.3 Tumour- Induced Bone Pain (TIBP) 249
35.4 Skeletal Manifestations in Multiple Myeloma ( MM) 251
35.5 Skeletal Metastases – The Fundamental Problem in Clinical Oncology 252
35.6 Skeletal Metastases of Breast and Prostate Cancer 254
The Metabolic Syndrome – A Major Cause of Osteoporosis in the World Today 259
Bibliography 264
Introduction 264
Books on Osteoporosis 264
Selected Articles in Journals 266
Chapter 1 Epidemiology of Osteoporosis 266
Chapter 2 Biology of Bone 268
Chapter 3 Pathogenesis of Osteoporosis 272
Chapter 4 Subgroups of Osteoporosis 273
Chapter 5 Risk Factors for Fractures 273
Chapter 6 Clinical Evaluation of Osteoporosis 275
Chapter 7 Bone Density in Osteoporosis 276
Chapter 8 Laboratory Evaluation of Osteoporosis 277
Chapter 9 Prevention of Osteoporosis 278
Chapter 10 Physical Activity and Exercise Programs 278
Chapter 11 Treatment Strategies in Osteoporosis 280
Chapter 12 Management of Pain in Osteoporosis 280
Chapter 13 Calcium and Vitamin D 281
Chapter 14 Hormones for Replacement Therapy 283
Chapter 15 Bisphosphonates 283
Chapter 16 Selective Oestrogen- Receptor Modulators 287
Chapter 17 Peptides of the Parathyroid Hormone Family 287
Chapter 18 Strontium Ranelate 288
Chapter 19 Calcitonin and Fluoride 288
Chapter 20 Combination and Sequential Therapies 289
Chapter 21 Future Directions 289
Chapter 22 Adherence and Monitoring of Osteoporosis Therapy 289
Chapter 23 Osteoporotic Fractures 290
Chapter 24 Pregnancy and Lactation 292
Chapter 25 Osteoporosis in Men 292
Chapter 26 Osteoporosis in Children 293
Chapter 27 Immobilization Osteoporosis 295
Chapter 28 Osteoporosis in Medical Disciplines 295
Chapter 29 Osteoporosis and Drugs 297
Chapter 30 AIDS Osteopathy 298
Chapter 31 Renal Osteopathy 299
Chapter 32 Localized Osteopathies 299
Chapter 33 Periprosthetic Osteoporosis and Aseptic Loosening of Prostheses 300
Chapter 34 Oral Bone Loss, Periodontitis and Osteoporosis 301
Chapter 35 Disorders of Bone due to Tumours 302
Chapter 36 The Metabolic Syndrome – A Major Cause of Osteoporosis in the World Today 302
Subject Index 305