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At least 793 records · Page 44Linked to original sources
PubMed1999

A survey of the treatment of female patients with osteoporosis using drug utilization consumption parameters.

OBJECTIVE: To investigate the drug treatment of female patients who were diagnosed with osteoporosis in South Africa using drug utilization consumption parameters. METHOD: Prescription data over a 2-year period for 1655 female patients with osteoporosis were analysed retrospectively. RESULTS: A total of 157,245 products at a cost of R15,004,643.51 was prescribed. Two-thirds of the patients fell in the age group between 50 and 69 years. A quarter (25.33%) of the products prescribed were identified as products specifically for the treatment and/or prevention of osteoporosis. Calcium supplements were the most frequently prescribed therapeutic subgroup, followed by hormone replacement therapy. The most frequently prescribed product was an effervescent calcium supplement containing 500 mg elemental calcium. Alendronate 10 mg tablets accounted for the highest cost (23.57% of the total cost of products for osteoporosis), but accounted for only 7.36% of the number of products prescribed for osteoporosis. Prescribing differences were observed for patients younger than 50 years, and patients 50 years and older. The DU90% and DC90% segments consisted of 27 and 24 different trade name products, respectively. CONCLUSION: Further studies focusing on the cost of osteoporosis treatment and prevention should be conducted incorporating clinical information.

Aged↗
PubMed2003

Secondary screening for osteoporosis in patients admitted with minimal-trauma fracture to a major teaching hospital.

AIMS: The aim of the present study was to determine: (i) the prevalence of the investigation and treatment of osteoporosis in patients admitted to hospital with a minimal-trauma fracture, (ii) the prevalence of osteoporosis using bone mineral density assessment by dual X-ray absorptiometry (DEXA) in such patients and (iii) a clinical pathway for the management of osteoporosis in such patients. METHODS: A cross-sectional study was undertaken involving all patients admitted with a fracture to Westmead Hospital, Sydney, Australia, between January 1999 and June 2000 (n = 327). Of these, 264 were excluded because of: (i) the fracture following significant trauma (n = 83), (ii) unavailability of medical records for review (n = 38), (iii) nursing home status (n = 37), (iv) previous malignancy (n = 18), (v) deceased (n = 11), (vi) recent osteoporosis screening and/or treatment (n = 18), (vii) refusal to participate (n = 37), (viii) uncontactable (n = 16) and (ix) inadequate English (n = 6). The remaining 63 patients underwent DEXA assessment and the following laboratory investigations: (i) liver function tests, (ii) urea, (iii) electrolytes, (iv) calcium, (v) phosphate, (vi) full blood count, (v) 25-hydroxyvitamin D level and (vi) thyroid-function tests. In men, levels of serum free testosterone, luteinizing hormone, follicle-stimulating hormone and prolactin were also obtained. RESULTS: Of the 63 study participants, 87% of the 47 women were either osteoporotic (T <-2.5) or osteopenic (-2.5 <T <-1) at a mean of 12.7 +/- 5.4 months post-fracture. Of the 16 men screened, 75% had a T-score < or =-1. Forty-four per cent of the study sample had a low 25-hydroxyvitamin D level, 6% were biochemically hyperthyroid and 40% of the men had a low serum free testosterone. Only 16% had an effective anti-osteoporotic medication added following the fracture. CONCLUSIONS: Secondary screening and treatment of osteoporosis in patients following minimal-trauma fracture are low. The implementation of a clinical pathway for osteoporosis management in these patients may be useful.

Absorptiometry, Photon↗
PubMed2003

Immediate dual energy X-ray absorptiometry reveals a high incidence of osteoporosis in patients with advanced prostate cancer before hormonal manipulation.

OBJECTIVE: To examine the incidence of osteoporosis in patients with advanced prostate cancer (using forearm densitometry) before commencing androgen deprivation therapy (ADT), as osteoporotic fractures are more frequent in patients with prostate cancer who have undergone either medical or surgical castration, because of rapid loss of bone mass. PATIENTS AND METHODS: In all, 174 patients (mean age 74.6 years, range 46-90) with advanced prostate cancer presented over 2 years. Their forearm bone densitometry values were compared with those from 106 age-matched controls (mean age 74.3 years, range 66-90). RESULTS: Of the 174 patients, 73 (42%) were osteoporotic (t score <or=- 2.5) and 65 (37%) were osteopenic (t score - 1 to - 2.4). This compares with a 27% incidence of osteoporosis in the control group (P = 0.022). There were also no significant correlations between prostate specific antigen levels, Gleason score, tumour stage, biochemical markers and the presence or absence of osteoporosis risk factors. CONCLUSION: Patients with advanced prostate cancer requiring ADT have a high incidence of osteoporosis before treatment. In addition, osteoporosis in these men cannot be predicted from clinical or biochemical values. Therefore, bone densitometry should be used in all patients with advanced cancer requiring ADT, as the results have implications for the choice of cancer therapy and the prophylaxis for osteoporosis.

Absorptiometry, Photon↗
PubMed2001

Osteoporosis in men.

Osteoporosis is characterized by a reduction in bone density, associated with skeletal fragility and an increased risk of fracture after minimal trauma. Although osteoporosis is generally considered to be a condition affecting post-menopausal women, it is now clear that substantial bone loss occurs with advancing age in men, such that up to 20% of symptomatic vertebral fractures and 30% of hip fractures occur in men. This chapter highlights the incidence and prevalence of osteoporotic fractures in men and reviews the associated morbidity, excess mortality and health and social service expenditure. The determinants of peak bone mass and bone loss in men are discussed, as is the pathogenesis of osteoporosis and vertebral and hip fractures. The criteria for the diagnosis of osteoporosis in men are reviewed, together with the most appropriate investigations for secondary osteoporosis. The management of osteoporosis in men is also discussed, highlighting the most appropriate treatment options.

Aged↗
PubMed2003

Evaluation of bone mineral density with dual x-ray absorptiometry for osteoporosis in children with bladder augmentation.

BACKGROUND/PURPOSE: Osteoporosis can appear as a result of metabolic acidosis in patients with bladder augmentation and total bladder replacement. These patients must be monitored for early diagnosis and osteoporosis to avoid related complications such as fracture. The current method for diagnosis of osteoporosis mainly involves bone densitometry. Dual x-ray absorptiometry (DXA) provides bone mineral content and bone mineral density (BMD). The purpose of this report is to determine the value of BMD measurement with DXA in the diagnosis and follow-up of osteoporosis and evaluation of response to treatment in the patients with bladder augmentation and total bladder replacement. METHODS: Six patients with bladder extrophy and neurogenic bladder underwent colocystoplasty, ureterocystoplasty, and total bladder replacement. The Sigmoid colon segment was used for colocystoplasty. DXA (Hologic 2000 DXA) was used for measuring bone mineral content and density. Results for lumbar spinal BMD were expressed as the average of L1 through L4 values. Each patient's BMD was compared with the mean BMD in the young normal population (T score) and in the age- and sex-matched group (Z score). But because our patients were children, BMD was evaluated according to Z score. Arterial blood gas analysis was obtained periodically with BMD measurement. Arterial blood pH and HCO(3) levels of the patients were compared with normal values, which ranged from 7.35 to 7.45 for pH and from 22 to 27 mmol/L for HCO3. RESULTS: Arterial blood pH of 5 of 6 patients (83.3%) and HCO3 levels of all patients were low. Ten BMD measurements were obtained for 6 children. One patient underwent BMD measurement 3 times, 2 patients underwent twice, and the others once. Z scores of 4 of 6 patients (66.6%) were decreased. Blood pH, HCO3 level, and BMD of 2 patients increased after oral bicarbonate intake. Two patients had normal BMD. One of these patients had ureterocystoplasty. The other had undergone colocystoplasty but was incontinent. CONCLUSIONS: Intestinal segments have been used for bladder augmentation and total bladder replacement. Exposure of highly absorptive intestinal mucosa to urine has been associated with electrolyte abnormalities and metabolic acidosis. Hyperchloremic acidosis leads to bone demineralization. DXA provides bone mineral content and BMD for diagnosis of osteoporosis. DXA is preferred because the low radiation dose (average, 2 to 4 mrem), accuracy, low price, and short examination time. Not only can BMD confirm the diagnosis of osteoporosis, but it also can be used to monitor the course of the disease and the effectiveness of treatment.

Absorptiometry, Photon↗
PubMed2002

Radiology of osteoporosis.

Osteoporosis is a common metabolic bone disorder that may be broadly subdivided into generalized or regional osteoporosis. This article reviews the common causes of generalized osteoporosis with emphasis on the radiological appearances, complications, and differential diagnosis. The more important causes of regional osteoporosis such as disuse osteoporosis, reflex sympathetic dystrophy, and transient regional osteoporosis are also discussed, and their imaging features are reviewed.

Humans↗
PubMed2004

Concentration of insulin-like growth factor (IGF)-I in iliac crest bone matrix in premenopausal women with idiopathic osteoporosis.

Previous studies have shown a link between low serum insulin-like growth factor-I (IGF-I) and decreased bone mass of patients with osteoporosis. However, whether serum levels are representative for the growth factor concentration or activity available in human bone tissue is controversial. In the present study, IGF-I was assessed in serum and bone matrix extracts from the iliac crest in 19 eugonadal women with idiopathic osteoporosis and in 38 age-matched controls. In addition, the relationship between the skeletal levels of IGF-I and bone mineral density (BMD) or the susceptibility to osteoporotic fractures in women with osteoporosis was examined. Bone matrix extraction was performed based on a guanidine-HCL/ethylendiamine-tetraacetic acid (EDTA) method. No significant difference in both serum and bone matrix IGF-I levels between groups was observed. Serum IGF-I concentrations failed to be associated with bone matrix IGF-I levels in osteoporotic patients. However, in premenopausal women with idiopathic osteoporosis, skeletal IGF-I positively correlated with BMD at the lumbar spine (r = + 0.58, p = 0.01). In contrast, neither femoral neck BMD nor Ward's triangle BMD was associated with bone matrix IGF-I concentrations. A tendency towards lower levels of bone matrix IGF-I in subjects with vertebral fractures as compared to those without fractures was observed in age-adjusted analyses, however the difference failed to remain statistically significant after adjustment for bone mineral density. These data provide no clear evidence for low bone matrix IGF-I as a determinant factor of age-unrelated osteoporosis. However, low skeletal IGF-I concentrations may aggravate osteoporosis in these women.

Absorptiometry, Photon↗
PubMed1989

Reduced bone mass in daughters of women with osteoporosis.

To determine whether premenopausal daughters of women with postmenopausal osteoporosis have lower bone mass than other women of the same age, we measured the bone mineral content of the lumbar spine and femoral neck and midshaft, using dual-photon absorptiometry, in 25 postmenopausal women with osteoporotic compression fractures and in 32 of their premenopausal daughters; we then compared the results with those in normal controls. As compared with normal postmenopausal women, women with osteoporosis had lower bone mineral content in the lumbar spine, femoral neck, and femoral midshaft by 33, 24, and 15 percent, respectively (P less than 0.001 for each comparison by the one-tailed t-test). As compared with normal premenopausal women, the daughters of women with osteoporosis had lower bone mineral content at these sites by 7, 5, and 3 percent, respectively (P = 0.03, 0.07, and 0.15, respectively, by the one-tailed t-test). In terms of a standardized score, we calculated that the mean (+/- SEM) relative deficits in bone mineral content in the daughters of women with osteoporosis were 58 +/- 18 percent (lumbar spine) and 34 +/- 16 percent (femoral neck) of the relative deficits in their mothers. We conclude that daughters of women with osteoporosis have reduced bone mass in the lumbar spine and perhaps in the femoral neck; this reduction in bone mass may put them at increased risk for fractures. We also conclude that postmenopausal osteoporosis may result partly from a relatively low peak bone mass rather than from excessive loss of bone.

Bone and Bones↗
PubMed2005

A novel pathophysiological mechanism for osteoporosis suggested by an in vivo gene expression study of circulating monocytes.

Bone mineral density (BMD) is a major risk factor for osteoporosis. Circulating monocytes may serve as early progenitors of osteoclasts and produce a wide variety of factors important to bone metabolism. However, little is known about the roles of circulating monocytes in relation to the pathophysiology of osteoporosis. Using the Affymetrix HG-U133A GeneChip(R) array, we performed a comparative gene expression study of circulating monocytes in subjects with high and low BMD. We identified in total 66 differentially expressed genes including some novel as well as some already known to be relevant to bone metabolism. Three genes potentially contributing to bone metabolism, CCR3 (chemokine receptor 3), HDC (histidine decarboxylase, i.e. the histamine synthesis enzyme), and GCR (glucocorticoid receptor), were confirmed by quantitative real-time reverse transcriptase-PCR as up-regulated in subjects with lower BMD. In addition, significant negative correlation was observed between expression levels of the genes and BMD Z-scores. These three genes and/or their products mediate monocyte chemotaxis, histamine production, and/or sensitivity to glucocorticoids. Our results suggest a novel pathophysiological mechanism for osteoporosis that is characterized by increased recruitment of circulating monocyte into bone, enhanced monocyte differentiation into osteoclasts, as well as osteoclast stimulation via monocyte functional changes. This is the first in vivo microarray study of osteoporosis in humans. The results may contribute to identification of new genes and their functions for osteoporosis and suggest genetic markers to discern individuals at higher risk to osteoporosis with an aim for preventive intervention and treatment.

Aged↗
PubMed2003

Hypothalamic digoxin and hemispheric chemical dominance--relation to the pathogenesis of senile osteoporosis, degenerative osteoarthritis, and spondylosis.

The isoprenoid pathway produces three key metabolites: i) digoxin (a membrane sodium-potassium ATPase inhibitor which can regulate intracellular calcium/magnesium ratios), ii) dolichol (which regulates N-glycosylation of proteins), and iii) ubiquinone (a free radical scavenger), all of which are important in bone and joint metabolism. The pathway was assessed in senile osteoporosis, spondylosis, and osteoarthritis. Digoxin could possibly play a role in the genesis of cerebral dominance because it can regulate multiple neurotransmitter systems. The pathway was also assessed in individuals of differing hemispheric dominance for comparison and to find out the role of cerebral dominance in the pathogenesis of these diseases. The plasma/serum-activity of HMG CoA reductase, magnesium, digoxin, dolichol, ubiquinone, and tryptophan/tyrosine catabolic patterns, as well as RBC Na(+)-K+ ATPase activity, were measured in the above mentioned groups. The glycoconjugate metabolism, free radical metabolism, and membrane composition were also studied. The pathway was upregulated with increased digoxin synthesis in patients with spondylosis and osteoarthritis. In this group of patients, the glycoconjugate levels and dolichol levels were increased and lysosomal stability reduced. The ubiquinone levels were low and free radicals increased in spondylosis and osteoarthritis. On the other hand, in senile osteoporosis, the isoprenoid pathway was downregulated and digoxin synthesis reduced. The glycoconjugate and dolichol levels were low and lysosomal stability increased. The ubiquinone levels were increased and free radical production increased in senile osteoporosis. The significance of these changes in the pathogenesis of osteoarthritis, spondylosis, and osteoporosis is discussed. The hyperdigoxinemic state is seen in osteoarthritis and spondylosis and in right hemispheric dominance. The hypodigoxinemic state is seen in left hemispheric dominance and senile osteoporosis. Hemispheric dominance plays a crucial role in deciding the predisposition to bone and joint diseases. Right hemispheric chemical dominance predisposes to spondylosis and osteoarthritis. Left hemispheric chemical dominance predisposes to osteoporosis.

Digoxin↗
PubMed2003

Assessment of trabecular bone structure in postmenopausal and senile osteoporosis in women by image analysis.

OBJECTIVE: The aim of the study was to assess bone trabecular structure in postmenopausal and senile osteoporosis. METHODS: The study was performed on transiliac specimens obtained from women with postmenopausal (n=10) and senile osteoporosis (n=10) and on normal autopsy bone (n=7). Digitalized microradiographs were analysed using dedicated software allowing for selection of longitudinal and transversal elements. RESULTS: Significant differences between transversal and control, as well as between longitudinal and control trabecular areas were observed in senile osteoporosis (p<0.005). In postmenopausal osteoporosis, such differences were found for longitudinal trabeculae only (p<0.005). Mean longitudinal trabecular area loss in senile and postmenopausal osteoporosis as compared to control group was 57.2% and 25.7%, respectively. Respective values for transversal trabecular area were 35.0% and 59.4%. CONCLUSION: Structural anisotropy of trabecular bone is greater in postmenopausal than in senile osteoporosis and control group. The method developed allows the evaluation of bone structures in radiographs with uneven exposure.

Aged↗
PubMed1998

Osteoporosis during pregnancy and its management.

Osteoporosis leading to fracture can occur during pregnancy. Bone density may be low before pregnancy due to recognised causes such as coeliac disease, osteogenesis imperfecta and previous anorexia nervosa (secondary osteoporosis). In some patients there is no identifiable cause. This condition is referred to as "pregnancy associated or pregnancy related osteoporosis"; it is not known whether pregnancy causes the osteoporosis or merely coincides with it. Typically the loss of bone leads to vertebral fracture with loss of height or pain in the hips also sometimes with fracture. Symptoms most often begin in the third trimester of the first pregnancy and improve after delivery; they do not usually recur in subsequent pregnancies. The cause is unknown and there is no specific treatment; follow up bone density measurements show that the osteoporosis slowly improves post partum. Recent research in non osteoporotic women shows that breast feeding maintains a low bone density; it is therefore contraindicated in pregnancy associated osteoporosis.

Adult↗
PubMed2006

Assessing the content and quality of information on the treatment of postmenopausal osteoporosis on the World Wide Web.

OBJECTIVE: To evaluate the content and quality of currently available Internet-based information on the treatment of postmenopausal osteoporosis. DESIGN: A sample was obtained comprising the 75 top sites retrieved with the Google search engine using 'treatment of postmenopausal osteoporosis' and then evaluated according to predefined general and specific criteria, content type, language and quality. Using a systematic scoring tool, each site was assessed for factual information provided and site quality. RESULTS: The sites studied were heterogeneous in content and quality. The most frequent type of website corresponded to non-profit organizations (n = 40), followed by commercial sites (n = 19), professional sites (n = 8) and government sites (n = 8). There were no significant differences in the popularity index, medical content score or quality score among the four groups of sites. Twelve websites were papers published in peer-reviewed medical journals. Few sites provided comprehensive medical and complete information on the treatment of postmenopausal osteoporosis oriented towards consumers. The consumer-oriented webpage with the most balanced and complete information was that of the National Osteoporosis Foundation which, at the same time, had the highest popularity index of all the resources studied. CONCLUSION: The content and quality of websites concerning the treatment of postmenopausal osteoporosis are highly varied and sometimes biased. The most frequent high-quality information corresponds to peer-reviewed medical journals. It is necessary to increase the number of resources, with rigorous language that is understandable for consumers, in relation to the treatment of postmenopausal osteoporosis.

Databases, Factual↗
PubMed2004

Osteoporosis in women with disabilities.

Women with physical and cognitive disabilities are at high risk for osteoporosis and osteoporosis-related fractures. Women with physical disabilities frequently are nonambulatory and have bone loss due to immobility. Women with cognitive disabilities have high rates of osteopenia and osteoporosis, likely partially due to high rates of anticonvulsant medication use. Women with Down syndrome are at especially high risk of osteopenia and osteoporosis, possibly because of lower peak bone density levels. Prevention of osteoporosis and related fractures in this population includes population-based measures, such as calcium and vitamin D supplementation and risk-based screening procedures. Primary care providers and specialists need to prioritize osteoporosis prevention strategies when taking care of women with disabilities. Future research is needed to determine optimal screening and prevention strategies in this very high risk population.

Body Mass Index↗
PubMed2006

The association between body mass index and osteoporosis in patients referred for a bone mineral density examination.

PURPOSE: Osteoporosis affects 4-6 million (13%-18%) postmenopausal white women in the United States. Most studies to date on risk factors for osteoporosis have considered body mass index (BMI) only as a possible confounder. In this study, we assess the direct relationship between BMI and osteoporosis. METHODS: We conducted a cross-sectional study among women aged 50-84 years referred by their physicians for a bone mineral density (BMD) examination at Baystate Medical Center between October 1998 and September 2000. BMI was determined prior to the BMD examination in the clinic. Information on other risk factors was obtained through a mailed questionnaire. Ordinal logistic regression was used to model the association between BMI and osteoporosis, controlling for confounding factors. RESULTS: BMI was inversely associated with BMD status. After adjustment for age, prior hormone replacement therapy (HRT) use, and other factors, odds ratios (OR) for low, high, and obese compared with moderate BMI women were 1.8 (95% CI 1.2-2.7), 0.46 (95% CI 0.29- 0.71), and 0.22 (95% CI 0.14-0.36), respectively, with a significant linear trend (p < 0.0001) across BMI categories. Evaluating BMI as a continuous variable, the odds of bone loss decreased 12% for each unit increase in BMI (OR = 0.88, 95% CI 0.85-0.91). CONCLUSIONS: Women with low BMI are at increased risk of osteoporosis. The change in risk associated with a 1 unit change in BMI ( approximately 5-8 lb) is of greater magnitude than most other modifiable risk factors. To help reduce the risk of osteoporosis, patients should be advised to maintain a normal weight.

Absorptiometry, Photon↗
PubMed2005

Determining the prevalence of osteoporosis and related factors using quantitative ultrasound in Vietnamese adult women.

In 2003, the authors conducted a population-based, cross-sectional survey to determine the prevalence of osteoporosis and related factors in Vietnamese adult women by using quantitative ultrasound at the heel bone (calcaneus). A total of 2,232 adult women aged > or =20 years, living in Hanoi City, and free of illnesses affecting bone metabolism were randomly selected to participate in the study. Subjects' bone mass was assessed by speed of sound at the calcaneus, referred to as quantitative ultrasound measurement. The T-score threshold, defined as < or =-1.8, was used to identify subjects with osteoporosis. The crude prevalence of osteoporosis in Hanoi City was 15.4%; after adjustment for age, it was 9.0%. Among premenopausal women, the crude prevalence of osteoporosis was higher in the urban areas compared with the rural areas. By contrast, postmenopausal women in the rural areas had a higher prevalence of osteoporosis. Multiple logistic regression analysis revealed that factors associated with low speed of sound were age, menopause, educational level, lifelong occupation, recreational weight-bearing exercise, number of births, and height. Results suggest that osteoporosis is a noteworthy problem in Vietnam, and intervention strategies should be considered to control it, especially in high-risk populations.

Adult↗
PubMed2000

Geriatrics grand rounds: Eve's rib, or a revisionist view of osteoporosis in men.

It is widely accepted that estrogen withdrawal following menopause predisposes women to accelerated bone loss and increased risk of developing osteoporosis. Although osteoporosis is a significant public health problem for aging men as well as women, the cause of osteoporosis in men remains largely unknown. A substantial number of men with osteoporosis present with bone loss secondary to conditions associated with reduced gonadal steroid hormone levels. Although hypogonadism is related to bone loss in men, and androgen levels decline with age in men, it is not at all clear that reduced androgen levels are related to bone loss in older men. What, then, is the role of gonadal steroids in osteoporosis in men? This review focuses on recent research--including clinical investigations of men with genetic disorders of estrogen action, basic biomedical studies of estrogen receptor "knockout" mice, and population-based comparisons of bone density with gonadal steroids in older men--leading to the surprising conclusion that estrogen plays a vital role in maintenance of bone in men as well as in women. Possible mechanisms whereby reduced estrogen levels might result in bone loss in both sexes are also reviewed, as are potential therapeutic implications of a role for estrogen in osteoporosis in men.

Aged↗
PubMed1987

Exercise in the prevention and management of osteoporosis.

Osteoporosis, characterized by bone loss, is a serious disease affecting millions of elderly women. Current research suggests that regular exercise plays an important role in its prevention. Physical therapists treat many patients who are at risk for developing osteoporosis or who already have the disease. To provide optimum patient care, physical therapists must be knowledgeable about the disease process and the role of exercise in its prevention and management. To meet this need, I have provided a brief overview of the literature on osteoporosis. The structure and dynamic nature of bone are discussed. Factors influencing the development of osteoporosis are identified. Studies dealing with the response of bone to mechanical stress in athletes, in addition to the role of exercise in the prevention of osteoporosis, are reviewed. Finally, recommendations are made for postural training and for extension and weight-bearing exercises in the management of the patient with symptomatic osteoporosis.

Aged↗