Since the publication of the first edition, the U.S. Surgeon General released the first-ever report on bone health and osteoporosis in October 2004. This report focuses even more attention on the devastating impact osteoporosis has on millions of lives. According to the National Osteoporosis Foundation, 2 million American men have osteoporosis, and another 12 million are at risk for this disease. Yet despite the large number of men affected, the lack of awareness by doctors and their patients puts men at a higher risk that the condition may go undiagnosed and untreated. It is estimated that one-fifth to one-third of all hip fractures occur in men.
This second edition brings on board John Bilezikian and Dirk Vanderschueren as editors with Eric Orwoll. The table of contents is more than doubling with 58 planned chapters. The format is larger - 8.5 x 11. This edition of Osteoporosis in Men brings together even more eminent investigators and clinicians to interpret developments in this growing field, and describe state-of-the-art research as well as practical approaches to diagnosis, prevention and therapy.
- Brings together more eminent investigators and clinicians to interpret developments in this growing field.
- Describes state-of-the-art research as well as practical approaches to diagnosis, prevention and therapy.
- There is no book on the market that covers osteoporosis in men as comprehensively as this book.
Since the publication of the first edition, the U.S. Surgeon General released the first-ever report on bone health and osteoporosis in October 2004. This report focuses even more attention on the devastating impact osteoporosis has on millions of lives. According to the National Osteoporosis Foundation, 2 million American men have osteoporosis, and another 12 million are at risk for this disease. Yet despite the large number of men affected, the lack of awareness by doctors and their patients puts men at a higher risk that the condition may go undiagnosed and untreated. It is estimated that one-fifth to one-third of all hip fractures occur in men. This second edition brings on board John Bilezikian and Dirk Vanderschueren as editors with Eric Orwoll. The table of contents is more than doubling with 58 planned chapters. The format is larger - 8.5 x 11. This edition of Osteoporosis in Men brings together even more eminent investigators and clinicians to interpret developments in this growing field, and describe state-of-the-art research as well as practical approaches to diagnosis, prevention and therapy. Brings together more eminent investigators and clinicians to interpret developments in this growing field Describes state-of-the-art research as well as practical approaches to diagnosis, prevention and therapy There is no book on the market that covers osteoporosis in men as comprehensively as this book
Front Cover 1
Osteoporosis in Men: The Effects of Gender on Skeletal Health 4
Copyright Page 5
Contents 6
Contributors 10
Foreword 14
Preface 16
SECTION 1 Essentials of Bone Biology 18
CHAPTER 1 The Biochemistry of Bone: Composition and Organization 20
INTRODUCTION 20
BONE ORGANIZATION 20
BONE COMPOSITION: THE BONE COMPOSITE 22
HOW BONES CHANGE WITH AGE 26
ACKNOWLEDGMENTS 27
References 27
CHAPTER 2 Bone Remodeling: Cellular Activities in Bone 32
INTRODUCTION 32
CELLULAR MECHANISM OF BONE REMODELING 32
PHYSIOLOGICAL FUNCTIONS OF BONE REMODELING 37
VARIATION IN BONE REMODELING ACTIVITY THROUGHOUT THE SKELETON 38
References 39
CHAPTER 3 Assessment of Bone Turnover in Men Using Biochemical Markers 42
INTRODUCTION 42
NEW BIOCHEMICAL MARKERS OF BONE METABOLISM AND NEW ASSAYS 42
NEW TECHNOLOGIES FOR DISCOVERY AND ASSAY BONE MARKERS 46
FACTORS INFLUENCING BTM LEVELS IN MEN 46
CLINICAL APPLICATIONS OF BONE TURNOVER MARKERS IN MALE OSTEOPOROSIS 48
EFFECT OF ANTI-OSTEOPOROTIC TREATMENT ON BTM IN MEN 50
CONCLUSION 53
References 53
CHAPTER 4 Fundamentals of Mineral Homeostasis 58
INTRODUCTION 58
TOTAL BODY STORES OF ESSENTIAL MINERALS 58
EXTRACELLULAR MINERAL METABOLISM – CIRCULATING LEVELS 59
INTRACELLULAR MINERAL METABOLISM 64
MINERAL ION BALANCE 65
SUMMARY 66
References 67
CHAPTER 5 The Mechanical Properties of Bone 68
INTRODUCTION 68
THE IDEA OF HIERARCHY IN BONE MECHANICS 68
ANATOMICAL STRUCTURAL EFFECT 69
ULTRASTRUCTURE AND MICROSTRUCTURE AND EFFECTS ON MECHANICAL PROPERTIES 75
ULTRASTRUCTURE AND BONE MECHANICAL PROPERTIES 75
STRAIN RATE, FRACTURE PROPAGATION TOUGHNESS AND FATIGUE 79
THE COMPLETE DEPENDENCE ON DAMAGE REPAIR FOR MECHANICAL FUNCTION 82
References 82
CHAPTER 6 Essentials of Bone Biology: Assessment of Bone Architecture 86
INTRODUCTION 86
DXA AND RADIOGRAPHIC IMAGING 87
COMPUTED TOMOGRAPHY (CT) 88
ASSESSMENT OF BONE MINERAL DENSITY: QUANTITATIVE COMPUTED TOMOGRAPHY (QCT) 89
MEASUREMENT OF STRUCTURE AND BMD USING VOLUMETRIC CT IMAGES OF THE SPINE AND HIP 89
FINDINGS BASED ON VOLUMETRIC QCT ANALYSES 90
3D QCT OF THE VERTEBRAE 91
FINITE ELEMENT MODELING (FEM) 92
MICROCT METHODS 93
CONCLUSION 94
References 95
SECTION 2 Development and Growth of the Male Skeleton 100
CHAPTER 7 Skeletal Growth in Males 102
INTRODUCTION 102
GROWTH IN STATURE 102
GROWTH IN BONE STRUCTURE 103
SKELETAL FRAGILITY HAS ITS ORIGIN EARLY IN LIFE 105
MODELING AND REMODELING – MACHINERY OF TRACKING 106
BONE GROWTH AND GH-IGF-I/SEX HORMONES 106
SUMMARY 107
References 107
CHAPTER 8 Pubertal Growth of the Male Skeleton 112
INTRODUCTION 112
SKELETAL MATURATION 112
BONE MEASUREMENT TECHNIQUES IN CHILDREN 113
SKELETAL CHANGES DURING PUBERTY 115
PEAK BONE MASS 117
CONCLUSION 117
References 118
CHAPTER 9 The Effects of Sex Steroids on Bone Growth 122
INTRODUCTION 122
LONGITUDINAL AND RADIAL BONE GROWTH 122
BONE MASS ACQUISITION DURING CHILDHOOD AND ADOLESCENCE 124
CHANGES IN BONE SIZE BY PERIOSTEAL EXPANSION DURING GROWTH 126
RELEVANT CLINICAL OBSERVATIONS ON THE SEX STEROIDS' EFFECT ON BONE GROWTH 131
CONCLUSIONS 132
References 132
CHAPTER 10 Nutritional Basis of Skeletal Growth 136
INTRODUCTION 136
ASSESSING THE ROLE OF NUTRITION IN SKELETAL ACQUISITION 136
RELATIVE ROLE OF NUTRITION IN SKELETAL REQUISITION 137
MICRONUTRIENTS AND BONE GROWTH 138
DIETARY PATTERNS AND BONE GROWTH 141
DIET AND EXERCISE INTERACTIONS 142
NUTRITION AND PEDIATRIC DISORDERS 142
CONCLUSIONS 143
References 144
CHAPTER 11 Physical Activity and Skeletal Growth 148
INTRODUCTION 148
HOW DOES BONE ADAPT TO PHYSICAL ACTIVITY? 149
HOW TO MEASURE BONE ADAPTATION TO PHYSICAL ACTIVITY 150
WHAT TYPES OF PHYSICAL ACTIVITY PROMOTE BONE STRENGTH? 150
HOW DOES PHYSICAL ACTIVITY INFLUENCE THE NORMAL PATTERN OF BONE ACCRUAL IN BOYS? 150
WHAT HAVE WE LEARNED FROM CROSS-SECTIONAL STUDIES? 151
PROSPECTIVE OBSERVATIONAL STUDIES 152
WHAT HAVE WE LEARNED FROM EXERCISE INTERVENTION STUDIES? 153
DO THE BENEFITS OF PHYSICAL ACTIVITY PERSIST? 159
SUMMARY AND CONCLUSION 160
References 161
SECTION 3 Skeletal Genetics 164
CHAPTER 12 The Genetics of Peak Bone Mass 166
INTRODUCTION 166
LINKAGE STUDIES 168
ASSOCIATION STUDIES 170
ANIMAL STUDIES 175
References 177
SECTION 4 Aging and the Male Skeleton 182
CHAPTER 13 Age-related Changes in Bone Remodeling and Microarchitecture 184
INTRODUCTION 184
THE PROCESS AND PURPOSE OF BONE MODELING AND REMODELING 184
ABNORMALITIES IN BONE REMODELING DURING AGING 186
BONE LOSS DURING YOUNG ADULTHOOD, MENOPAUSE AND ADVANCED AGE 188
REDUCED PERIOSTEAL BONE FORMATION IN ADULTHOOD 190
SEX DIFFERENCES IN TRABECULAR AND CORTICAL BONE LOSS AND FRACTURE RATES 191
SUMMARY AND CONCLUSION 192
References 193
CHAPTER 14 Markers of Bone Remodeling and the Aging Skeleton 196
INTRODUCTION 196
AGE-RELATED CHANGES IN BONE MARKER LEVELS 196
BONE MARKERS, BONE LOSS AND FRACTURE RISK IN AGING MEN 198
THE RESPONSE OF BONE TURNOVER MARKERS TO PHARMACOLOGICAL INTERVENTIONS IN AGING MEN 199
CONCLUSION 199
References 199
CHAPTER 15 Alterations in Mineral Metabolism in the Aging Male 202
INTRODUCTION 202
CELLULAR CHANGES 202
AGE-RELATED HORMONAL CHANGES IN MINERAL METABOLISM 202
SUMMARY 207
References 208
CHAPTER 16 Changes in Bone Size and Geometry with Aging 210
RADIAL BONE GROWTH IN CHILDREN AND ADOLESCENTS 210
RADIAL BONE GROWTH DURING AGING 211
DETERMINANTS OF THE BONE SIZE AND AGE-RELATED CHANGES IN BONE GEOMETRY 212
AGE-RELATED CHANGES IN BONE SHAPE 216
WHY DO BONES GROW IN WIDTH AFTER CESSATION OF THE GROWTH IN LENGTH? 217
METHODOLOGICAL LIMITATIONS OF THE STUDIES ON THE AGE-RELATED CHANGES IN BONE SIZE 219
GENERAL CONCLUSIONS 220
ACKNOWLEDGMENTS 220
References 220
CHAPTER 17 Aging and Bone Loss 224
INTRODUCTION 224
UNDERSTANDING BONE LOSS WITH AGING IN MEN 224
QUANTIFYING BONE LOSS IN MEN 224
BONE LOSS WITH AGING IN MEN 227
FACTORS CONTRIBUTING TO BONE LOSS 230
PRACTICAL SCREENING FOR SIGNIFICANT MALE BONE LOSS AND OSTEOPOROSIS 233
SUMMARY 234
References 234
CHAPTER 18 The Effect of Age on Material Properties 238
INTRODUCTION 238
BIOMECHANICAL MATERIAL PROPERTIES OF THE SKELETON 238
CHANGES TO BIOMECHANICAL MATERIAL PROPERTIES WITH AGE 240
MINERAL EFFECTS IN AGE-RELATED MATERIAL PROPERTY ALTERATIONS 241
COLLAGEN EFFECTS IN AGE-RELATED MATERIAL PROPERTY ALTERATIONS 243
MICRODAMAGE EFFECTS IN AGE-RELATED MATERIAL PROPERTY ALTERATIONS 244
CONCLUSIONS 245
References 246
SECTION 5 Nutritional Issues 250
CHAPTER 19 Calcium, Bone Strength and Fractures 252
INTRODUCTION 252
CALCIUM PHYSIOLOGY 252
CALCIUM REQUIREMENTS 253
CALCIUM AND BONE STRENGTH 254
EVIDENCE OF CALCIUM'S EFFECT ON BMD IN ADULTS 254
CALCIUM AND FRACTURES 255
CHILDREN AND CALCIUM 256
CONCLUSION 257
References 257
CHAPTER 20 Vitamin D and Bone 260
INTRODUCTION 260
ORIGIN, METABOLISM, ACTION AND MODE OF ACTION 260
VITAMIN D AND BONE: BASIC MECHANISMS 261
VITAMIN D AND BONE: CLINICAL ASPECTS 263
SURROGATE ENDPOINTS 263
HARD ENDPOINTS 264
CHOICE OF VITAMIN D PRODUCT AND TREATMENT REGIMEN 266
OPTIMAL VITAMIN D STATUS VERSUS PRESENT WORLD REALITY 266
References 267
CHAPTER 21 Role of Dietary Protein in Bone Growth and Bone Loss 272
INTRODUCTION 272
DIETARY PROTEIN AND BONE GROWTH 272
DAIRY PRODUCTS AND BONE GROWTH 273
DIETARY PROTEIN AND BONE MINERAL MASS 274
DIETARY PROTEIN AND FRACTURE RISK 274
DIETARY PROTEIN AND BONE METABOLISM 275
EFFECTS OF PROTEIN INSUFFICIENCY CORRECTION 277
ACKNOWLEDGMENT 278
References 278
SECTION 6 Sex Steroids and the Skeleton in Men 284
CHAPTER 22 The Molecular Biology of Sex Steroids in Bone: Similarities and Differences among the Sexes 286
INTRODUCTION 286
GENERAL ASPECTS OF THE MECHANISMS OF SEX STEROID ACTION IN BONE CELLS 287
ESTROGEN AND ANDROGENS CONTROL OSTEOBLASTOGENESIS AND OSTEOCLASTOGENESIS 287
ESTROGEN AND ANDROGENS CONTROL BONE CELL SURVIVAL 290
OXIDATIVE STRESS AND THE CONTROL OF BONE MASS 291
ESTROGEN RECEPTOR SIGNALING AND MECHANOTRANSDUCTION 292
EFFECTS ON THE PERIOSTEUM 293
T CELLS AND THE REGULATION OF BONE RESORPTION 293
ER AND AR KNOCKOUT MODELS 294
References 294
CHAPTER 23 Estrogen and the Skeleton – Rodents 300
INTRODUCTION 300
ESTROGENS AND BONE GROWTH IN MALES 300
ESTROGENS AND BONE MAINTENANCE IN MALES 302
References 302
CHAPTER 24 Estrogen and the Skeleton – Humans 306
INTRODUCTION 306
ESTROGEN AND BONE GROWTH IN MEN 306
ESTROGEN AND BONE MAINTENANCE IN MEN 307
ESTROGEN AND FRACTURES IN MEN 308
References 309
CHAPTER 25 Androgens and Bone: Basic Aspects 312
INTRODUCTION 312
ANDROGENS AND THE ROLE OF ANDROGEN METABOLISM IN BONE 312
DHT 312
MECHANISMS OF ANDROGEN ACTION IN BONE: THE ANDROGEN RECEPTOR 315
MOLECULAR MECHANISMS OF ANDROGEN ACTION IN BONE CELLS: THE AR 315
LOCALIZATION OF AR EXPRESSION IN OSTEOBLASTIC POPULATIONS 316
REGULATION OF AR EXPRESSION 318
EFFECTS OF ANDROGENS ON THE PROLIFERATION AND DIFFERENTIATION OF OSTEOBLASTIC CELLS 320
ANDROGEN EFFECTS ON OSTEOCLASTS AND OTHER CELLS 322
ANDROGEN EFFECTS ON BONE: ANIMAL STUDIES 323
EFFECTS ON BONE GROWTH DURING SKELETAL DEVELOPMENT 323
EFFECTS ON EPIPHYSEAL FUNCTION DURING DEVELOPMENT 323
EFFECTS ON BONE MASS IN GROWING MALE ANIMALS: ANIMAL MODELS OF ALTERED ANDROGEN RESPONSIVENESS 324
EFFECTS ON THE PERIOSTEUM: THE ROLE OF AR VERSUS AROMATIZATION OF TESTOSTERONE 326
EFFECTS ON BONE MASS IN ADULTS: EFFECTS OF CASTRATION IN YOUNG AND ADULT ANIMALS 326
ANDROGENS IN THE FEMALE ANIMAL 328
EFFECTS OF REPLACEMENT SEX STEROIDS AFTER CASTRATION 328
SUMMARY 329
References 329
CHAPTER 26 Androgens and the Skeleton – Humans 336
INTRODUCTION 336
ANDROGENS AND BONE METABOLISM IN NORMAL MEN 336
BONE MINERAL DENSITY IN MEN WITH HYPOGONADISM OR OTHER DISORDERS OF ANDROGEN ACTION 341
EFFECTS OF ANDROGEN THERAPY ON SKELETAL INTEGRITY IN MEN 344
SUMMARY AND FUTURE DIRECTIONS 347
References 347
CHAPTER 27 Androgen Effects on the Skeletal Muscle 352
INTRODUCTION 352
EPIDEMIOLOGICAL STUDIES DEMONSTRATING THE RELATIONSHIP OF SERUM TESTOSTERONE CONCENTRATIONS AND MUSCLE MASS AND PHYSICAL FUNCTION 352
THE EFFECTS OF EXPERIMENTAL LOWERING OF ENDOGENOUS TESTOSTERONE CONCENTRATIONS ON BODY COMPOSITION 353
THE EFFECTS OF PHYSIOLOGIC TESTOSTERONE REPLACEMENT IN MODELS OF ANDROGEN DEFICIENCY 353
TESTOSTERONE DOSE-RESPONSE RELATIONSHIPS IN YOUNG AND OLDER MEN 353
INTERACTIVE EFFECTS OF TESTOSTERONE AND RESISTANCE EXERCISE TRAINING 354
RANDOMIZED CLINICAL TRIALS OF TESTOSTERONE IN OLDER MEN WITH LOW OR LOW NORMAL TESTOSTERONE LEVELS 354
EFFECTS OF ANDROGEN REPLACEMENT ON BODY COMPOSITION AND MUSCLE PERFORMANCE IN MEN WITH CHRONIC ILLNESS 355
TESTOSTERONE EFFECTS ON FATIGUE/ENERGY, SENSE OF WELL-BEING AND QUALITY OF LIFE 357
REACTION TIME 357
MECHANISMS OF TESTOSTERONE EFFECTS ON SKELETAL MUSCLE 357
HOW TESTOSTERONE EFFECTS ON THE SKELETAL MUSCLE–BONE UNIT MAY AFFECT FRACTURE RISK 359
ACHIEVING TISSUE SELECTIVITY OF TESTOSTERONE EFFECTS 359
CONCLUSION 360
References 360
SECTION 7 Fractures in Men 366
CHAPTER 28 Epidemiology of Fractures 368
INTRODUCTION 368
OVERALL FRACTURE INCIDENCE IN MEN 368
DIFFERENCES IN FRACTURE INCIDENCE PATTERNS BETWEEN MEN AND WOMEN 368
OSTEOPOROTIC FRACTURES IN MEN 369
FRACTURES AT SPECIFIC BONE SITES 370
BONE DENSITY AND FRACTURE RISK IN MEN 373
SUMMARY 374
References 374
CHAPTER 29 Individualized Prognosis of Fracture in Men 378
MAGNITUDE OF THE PROBLEM 378
RISK FACTORS OF FRAGILITY FRACTURE 380
PROGNOSIS 382
CONCLUSION 386
References 386
CHAPTER 30 Physical Activity, Physical Function and Fall and Fracture Risk in Older Men 392
INTRODUCTION 392
PHYSICAL ACTIVITY 392
PHYSICAL FUNCTION AND PERFORMANCE 395
References 399
CHAPTER 31 Economic Impact of Osteoporotic Fractures (versus Women) 402
BACKGROUND 402
COST OF ILLNESS STUDIES 403
GENDER DIFFERENCES IN ECONOMIC IMPACT 403
METHODOLOGIC APPROACHES TO DEFINING COST OF ILLNESS 403
ECONOMIC IMPACT OF OSTEOPOROTIC FRACTURES 405
SUMMARY 409
References 409
CHAPTER 32 Adverse Health Outcomes in Men with Osteoporosis 412
INTRODUCTION 412
MORBIDITY IN MEN AFTER OSTEOPOROTIC FRACTURES 412
PSYCHOSOCIAL CONSEQUENCES OF OSTEOPOROTIC FRACTURES IN MEN 414
MORTALITY IN MEN AFTER OSTEOPOROTIC FRACTURE 415
CONCLUSIONS 416
References 416
SECTION 8 Metabolic Bone Disease in Men 420
CHAPTER 33 Idiopathic Osteoporosis 422
INTRODUCTION 422
DIAGNOSIS 422
CLINICAL PRESENTATION AND PHENOTYPE 425
PHYSIOPATHOLOGY AND GENETICS 426
TREATMENT 427
AREAS FOR FURTHER RESEARCH 428
ACKNOWLEDGMENTS 428
References 428
CHAPTER 34 Glucocorticoid-induced Osteoporosis 432
EPIDEMIOLOGY 432
PATHOPHYSIOLOGY 432
DIAGNOSIS 434
THERAPY 435
CONCLUSIONS 436
References 436
CHAPTER 35 Testicular Dysfunction 440
INTRODUCTION 440
GONADAL STEROID ACTION 440
SKELETAL HEALTH IN ANDROGEN DEFICIENCY AT VARIOUS AGES 442
References 447
CHAPTER 36 Alcohol Use and Bone Health in Men 452
INTRODUCTION 452
ALCOHOL PHYSIOLOGY 452
EPIDEMIOLOGY 452
MODERATION IS LESS MORE?
ALCOHOL IMPACTS ON BONE AND CALCIUM HOMEOSTASIS 453
BONE MINERAL DENSITY (BMD) 454
ALCOHOL, FALLS AND FRACTURES IN MEN 455
ISSUES CONFOUNDING STUDIES OF ALCOHOL USE 456
CONCLUSION 457
References 457
CHAPTER 37 Transplantation Osteoporosis 460
INTRODUCTION 460
SKELETAL EFFECTS OF IMMUNOSUPPRESSIVE DRUGS 460
EFFECT OF TRANSPLANTATION ON BONE AND MINERAL METABOLISM 461
EVALUATION AND MANAGEMENT OF CANDIDATES FOR TRANSPLANTATION 464
PREVENTION OF TRANSPLANTATION OSTEOPOROSIS (TABLE 37.3) 465
SUMMARY AND CONCLUSIONS 466
References 467
CHAPTER 38 Management of Fractures in Men with Impaired Renal Function 470
INTRODUCTION 470
DIAGNOSIS OF OSTEOPOROSIS IN STAGE 1–3 CHRONIC KIDNEY DISEASE 470
DIAGNOSIS OF OSTEOPOROSIS IN STAGE 5–5D CKD 472
BIOCHEMICAL MARKERS OF BONE METABOLISM 472
QUANTITATIVE BONE HISTOMORPHOMETRY 473
TREATMENT OF OSTEOPOROSIS IN CKD 474
CONCLUSIONS 478
References 478
CHAPTER 39 Primary Hyperparathyroidism in Men 482
INTRODUCTION 482
EPIDEMIOLOGY 482
ETIOLOGY 484
PATHOLOGY 484
SIGNS AND SYMPTOMS 484
CLINICAL PRESENTATION 486
EVALUATION AND DIAGNOSIS 486
PARATHYROID IMAGING 487
NATURAL HISTORY OF MILD PHPT 488
SURGICAL TREATMENT 488
CLINICAL COURSE AFTER SURGERY 490
MEDICAL MANAGEMENT 491
SUMMARY 493
References 493
CHAPTER 40 Hypercalciuria 496
INTRODUCTION 496
CLINICAL BONE DISEASE 496
DEFINITION OF HYPERCALCIURIA 497
SERUM 1,25D LEVELS 497
RELATIONSHIP BETWEEN URINE CA AND BONE LOSS 498
BONE PATHOGENESIS 499
CALCIUM METABOLISM 500
DIETARY FACTORS 501
TREATMENT 502
References 504
CHAPTER 41 The Skeletal Phenotype of the Male Athlete 508
INTRODUCTION 508
PRINCIPLES OF LOADING 508
MEASUREMENT OF BONE LOADING AND BONE MASS 508
HORMONAL DETERMINANTS OF SKELETAL MASS 509
ENVIRONMENTAL AND NUTRITIONAL DETERMINANTS OF SKELETAL HEALTH IN MALE ATHLETES 511
COMPARISON OF MALE ATHLETES TO THE FEMALE TRIAD 513
USE OF ANDROGENIC AND ANABOLIC STEROIDS IN ATHLETICS 514
BONE MASS AND STRESS FRACTURES IN MALE ATHLETES: A REVIEW OF THE LITERATURE 514
CONCLUSIONS 518
References 518
CHAPTER 42 Inherited and Related Disorders of Bone Matrix Synthesis in Men 522
INTRODUCTION 522
INHERITED DEFECTS IN COLLAGEN SYNTHESIS (TABLE 42.2) 523
MARFAN SYNDROME AND OSTEOPOROSIS 529
HYPOPHOSPHATASIA IN THE ADULT MALE 531
FIBROUS DYSPLASIA IN ADULT MALES 532
OSTEOPOROSIS RELATED TO INHERITED DEFECTS IN COPPER TRANSPORT: MENKES' DISEASE, OCCIPITAL HORN SYNDROME, WILSON DISEASE 533
HEMOCHROMATOSIS AND OSTEOPOROSIS IN MEN 534
HOMOCYSTINURIA 535
INHERITED DEFECTS IN NEUROTROPIC FACTORS RELATED TO BONE 535
References 536
SECTION 9 Diagnostic Approach 540
CHAPTER 43 Dual-Energy X-ray Absorptiometry (DXA) in Men 542
INTRODUCTION/ BACKGROUND 542
DUAL-ENERGY X-RAY (DXA) TECHNOLOGY 542
UNDERSTANDING DXA RESULTS 543
WHAT SKELETAL SITES TO MEASURE 544
PITFALLS IN DXA 544
DXA NORMATIVE DATABASES 546
CLINICAL USE OF DXA: DIAGNOSIS, MONITORING AND FRACTURE RISK ASSESSMENT 548
INDICATIONS FOR DXA TESTING IN MEN 552
VERTEBRAL FRACTURE ASSESSMENT 553
SUMMARY 554
References 555
CHAPTER 44 Quantitative Ultrasound Diagnosis of Osteoporosis in Men 558
PRINCIPLES OF QUANTITATIVE ULTRASOUND 558
USE OF QUS TO PREDICT FRACTURE IN MEN 558
USE OF QUS TO PREDICT WHEN TO OBTAIN DXA IN MEN 559
MONITORING THERAPY WITH QUS 560
CONCLUSIONS 560
References 561
CHAPTER 45 Advanced Structural Assessment of Bone Using CT and MRI 564
INTRODUCTION 564
QCT AND MDCT-BASED STRUCTURAL ANALYSES IN THE DIAGNOSTICS AND MONITORING OF OSTEOPOROSIS PATIENTS 565
?CT IMAGING AND INDIVIDUAL TRABECULAE SEGMENTATION (ITS)-BASED MORPHOLOGICAL ANALYSIS 568
HIGH RESOLUTION PERIPHERAL QUANTITATIVE CT (HR-PQCT) 571
MAGNETIC RESONANCE IMAGING (MRI) 572
IMAGE-BASED FEA 575
CONCLUSION 577
ACKNOWLEDGMENTS 577
References 578
CHAPTER 46 Diagnostic Approach: Vertebral Fracture Assessments 582
INTRODUCTION 582
PROBLEMS ASSOCIATED WITH IDENTIFICATION OF PREVALENT AND INCIDENT VF 582
WHY ARE VERTEBRAL FRACTURES RELEVANT IN MEN? 583
ESTABLISH THE PRESENCE OF VF: WHEN IS A DEFORMITY A TRUE OSTEOPOROTIC FRACTURE? 584
IMAGING APPROACHES FOR THE IDENTIFICATION OF VF 584
ADDITIONAL AREAS FOR RESEARCH 590
CONCLUSIONS 590
References 590
CHAPTER 47 The Use of Bone Biopsies in the Diagnosis of Male Osteoporosis 594
INTRODUCTION 594
AGE-DEPENDENT CHANGES IN BONE PROPERTIES IN FEMALES 594
CHANGES IN BONE REMODELING WITH AGE IN MALES 595
CHANGES IN BONE STRUCTURE WITH AGING IN MALES AND FEMALES 595
HISTOMORPHOMETRY IN MALE OSTEOPOROSIS 595
SECONDARY OSTEOPOROSIS 597
INDICATIONS FOR BONE BIOPSIES IN MALE OSTEOPOROSIS 601
FUTURE ASPECTS 601
CONCLUSION 601
References 602
CHAPTER 48 Overall Approach to the Evaluation and Treatment of Osteoporosis in Men 606
DIAGNOSTIC CONSIDERATIONS 606
TREATMENT CONSIDERATIONS 611
References 615
SECTION 10 Therapy 620
CHAPTER 49 Diagnostic Thresholds for Osteoporosis in Men 622
INTRODUCTION 622
DIAGNOSIS OF OSTEOPOROSIS 622
DIAGNOSTIC CRITERIA FOR MEN 623
NORMATIVE REFERENCE RANGES 624
LIMITATIONS 627
References 627
CHAPTER 50 Cost-Effectiveness of Interventions to Reduce Osteoporosis-Related Fractures in Men: Current Data, Controversies, and Challenges 630
INTRODUCTION 630
CHARACTERISTICS OF GOOD HEALTH ECONOMIC MODELING STUDIES 631
REVIEW OF COST-EFFECTIVENESS STUDIES IN MEN 632
CONTROVERSIES AND CHALLENGES IN HEALTH ECONOMIC MODELING OF FRACTURE PREVENTION STRATEGIES 640
CONCLUSIONS 642
References 642
CHAPTER 51 Nutritional Therapy for Skeletal Health in Men 646
INTRODUCTION 646
MACRONUTRIENTS 646
CALCIUM AND VITAMIN D 647
OTHER NUTRIENTS 649
CONCLUSION 649
References 649
CHAPTER 52 Exercise Programs for Patients with Osteoporosis 652
GOALS OF EXERCISE IN PATIENTS WITH OSTEOPOROSIS 652
PITFALLS IN ASSESSING EXERCISE INTERVENTIONS 653
THE ROLE OF PHYSICS, ANATOMY AND PHYSIOLOGY FOR DESIGNING AND ASSESSING EXERCISE INTERVENTIONS 653
BONE STRENGTH AND FALL RISK: TWO DIFFERENT GOALS, TWO DIFFERENT RELATIONSHIPS TO MUSCLE 655
BIPEDAL LOCOMOTION AND ONE-LEG-STANDING 656
THE SKELETON AS TENSEGRITY STRUCTURE 656
DXA–BMD AS OUTCOME PARAMETER OF EXERCISE INTERVENTIONS 657
RELATIONSHIPS BETWEEN MUSCLE AND BONE: THE MUSCLE–BONE UNIT 657
CORRELATIONS OF PHYSICAL ACTIVITY AND LOCOMOTOR PERFORMANCES WITH FRACTURES, FALLS AND ONSET OF DISABILITY 658
SARCOPENIA AND AGE-ASSOCIATED FUNCTIONAL DECLINE 659
OSTEOPOROSIS-RELATED FRACTURES AND FALLS 660
EXERCISE INTERVENTIONS AND BONE STRENGTH 661
EFFECT OF EXERCISE INTERVENTION ON MUSCLE STRUCTURE AND MUSCLE FUNCTION 662
EFFECT OF EXERCISE INTERVENTIONS ON RISK FACTORS FOR FALLS, FRACTURES AND ONSET OF DISABILITY 662
EXERCISE INTERVENTIONS AND FALL PREVENTION 663
WHOLE BODY VIBRATION 663
RISK OF EXERCISES 663
RECOMMENDATIONS FOR DESIGNING AND PRESCRIBING EXERCISE PROGRAMS FOR PATIENTS WITH OSTEOPOROSIS 663
FUTURE DEVELOPMENTS AND DEMANDS 664
References 665
CHAPTER 53 Calcitonin: History, Physiology, Pathophysiology and Therapeutic Applications 670
INTRODUCTION 670
SYNTHESIS AND LOCALIZATION 670
STRUCTURE OF CALCITONIN AND ITS MEASUREMENTS 670
PHYSIOLOGICAL ROLE OF CALCITONIN 671
BIOLOGICAL EFFECTS OF CALCITONIN 673
CLINICAL PHARMACOLOGY 673
COMMERCIALLY AVAILABLE CALCITONIN PREPARATIONS 674
THERAPEUTIC USES 676
References 680
CHAPTER 54 Treatment of Male Osteoporosis with Bisphosphonates 684
INTRODUCTION 684
PHARMACOLOGY OF BISPHOSPHONATES 684
DO MEN RESPOND DIFFERENTLY TO BISPHOSPHONATES? 685
BISPHOSPHONATES IN MEN WITH PRIMARY OSTEOPOROSIS 687
BISPHOSPHONATES IN MEN WITH SECONDARY OSTEOPOROSIS 692
SPECIAL ISSUES RELATED TO TREATMENT OF MALE OSTEOPOROSIS WITH BPS 693
CONCLUSIONS 694
References 694
CHAPTER 55 Treatment of Male Osteoporosis with Parathyroid Hormone 698
INTRODUCTION 698
ANABOLIC ACTIONS OF PARATHYROID HORMONE 698
INDICATIONS FOR TERIPARATIDE USE 699
TERIPARATIDE IN MALE OSTEOPOROSIS 700
COMBINATION OR SEQUENTIAL THERAPY WITH PTH AND AN ANTI-RESORPTIVE AGENT 701
ANTI-RESORPTIVE USE PRIOR TO PTH THERAPY 702
CONSEQUENCES OF DISCONTINUING PTH THERAPY 702
SAFETY OF PTH 703
FUTURE CONSIDERATIONS 703
CONCLUSIONS 703
References 704
CHAPTER 56 Testosterone Therapy for Osteoporosis in Men 708
INTRODUCTION 708
THE MAGNITUDE OF THE PROBLEM 708
MARKERS OF FRACTURE RISK 708
MECHANISMS BY WHICH TESTOSTERONE INFLUENCES MUSCLE AND BONE 709
STUDIES ON THE ASSOCIATION BETWEEN TESTOSTERONE AND MUSCLE AND BONE IN MEN 709
DIAGNOSIS OF HYPOGONADISM/ANDROGEN DEFICIENCY 716
EPIDEMIOLOGY OF ANDROGEN DEFICIENCY AND CO-PREVALENCE WITH OSTEOPOROSIS 718
TESTOSTERONE PREPARATIONS 718
STRATEGIES TO MINIMIZE RISK OF ADVERSE EFFECTS 720
TESTOSTERONE ADMINISTRATION AND MONITORING 721
BMD 721
USE OF TESTOSTERONE THERAPY IN MEN AT RISK FOR OSTEOPOROSIS AND FRACTURE 722
SELECTIVE ANDROGEN RECEPTOR MODULATORS (SARMS) 723
ACKNOWLEDGMENTS 723
References 723
CHAPTER 57 Future Therapies: Strontium, SERMs, SARMs and New Therapies on the Horizon 730
INTRODUCTION 730
STRONTIUM 730
SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS) 733
SELECTIVE ANDROGEN RECEPTOR MODULATORS (SARMS) 736
NEW THERAPIES ON THE HORIZON 739
CONCLUSION 745
ACKNOWLEDGMENTS 745
Glossary of abbreviations 746
References 746
Index 750
A 750
B 751
C 751
D 752
E 752
F 752
G 753
H 753
I 754
K 754
L 754
M 754
N 754
O 755
P 755
Q 756
R 756
S 756
T 757
U 757
V 757
W 758
Y 758
Color Plates 760
| Erscheint lt. Verlag | 30.11.2009 |
|---|---|
| Sprache | englisch |
| Themenwelt | Medizinische Fachgebiete ► Innere Medizin ► Endokrinologie |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Orthopädie | |
| Medizin / Pharmazie ► Physiotherapie / Ergotherapie ► Behandlungstechniken | |
| Studium ► 1. Studienabschnitt (Vorklinik) ► Biochemie / Molekularbiologie | |
| ISBN-10 | 0-08-092346-1 / 0080923461 |
| ISBN-13 | 978-0-08-092346-8 / 9780080923468 |
| Haben Sie eine Frage zum Produkt? |
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