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PubMed2001

Bone mineral density and osteoporosis in rural and urban women. Epidemiological study of the Lublin region (Eastern Poland).

The aim of this study was determination of the values of bone mineral density (BMD L2-L4) and evaluation of occurrence of osteoporosis (according to densitometric criteria valid until 2000) among normal women living in rural and urban environments (especially postmenopausal) in comparison to other populations. Subjects of the study were 503 normal women aged 30-79 (mean 49.5 years), all residents of Lublin Region (eastern Poland). Analysed population was divided into two subgroups: urban (n=282, 56%) and rural (n=221, 44%). 65 (12.9%) women working as farmers, 107 (21.3%) were retired; other occupations were performed by 325 (64.6%) women. The lumbar spine (L2-L4) of all subjects was examined in anterior-posterior position using the dual X-ray absorptiometry--DEXA (LUNAR Corp.) at the Densitometric Laboratory of the Institute of Agricultural Medicine in Lublin from November 1999-June 2000. No statistically significant differences were observed in mean values of BMD between urban and rural populations, nor between farmers and other occupations. Mean values of BMD in every age range were similar to the populations of North America and Northern Europe. The prevalence rates of osteoporosis according to WHO criteria in the entire analysed population were calculated as 6.9%, and osteopenia as 25.4%. The prevalence of osteoporosis and osteopenia increased with advancing age. In women younger than 45 years osteoporosis was not observed, and the prevalence of osteopenia was 12.6%. In women between 45-55 years the prevalence of osteoporosis was 5.7 % and of osteopenia 25.6%. In women older than 55 years of age osteoporosis was observed in 18.5% and osteopenia in 40.7%.

Absorptiometry, Photon↗
PubMed1995

[Osteoporosis and jaw bone reduction].

The relationship between osteoporosis and residual ridge reduction has been investigated in many studies. As a result it can be concluded that it is not easy to measure the extent of osteoporosis of the jaws. Several studies have shown that individuals with general signs of osteoporosis do not necessary have an osteoporotic mandible or maxilla. The same applies to the relationship between osteoporosis and residual ridge reduction in edentulous patients and osteoporosis and bone loss in patients with periodontal diseases. Taken into account the positive effect of healthy food intake and functional loading in the prevention and treatment of osteoporosis, it can be expected that they also influence the bone quality of the jaws. Preservation of strategic teeth or roots under the overdenture as well as the insertion of implants have a positive effect on the bone of the jaws.

Bone Resorption↗
PubMed2002

An Asian perspective to the problem of osteoporosis.

INTRODUCTION: Most research into the problem of osteoporosis has been carried out in Caucasian populations. This review highlights emerging data from research on osteoporosis among Asians, and some differences from Caucasian data. METHODS: A non-systematic review of the English-language literature on various aspects of osteoporosis among Asian populations was carried out. RESULTS: Compared to Caucasian populations, epidemiological trends in Asian populations appear to be developing along similar lines, although rates of hip fracture do differ by country and ethnicity, and are generally lower. Bone mineral density (BMD) carries similar relevance with regard to fracture risk, although hip geometry is also believed to have some impact. Risk factors for osteoporosis and fractures are somewhat similar, although dietary factors seem to play a larger role as reported in Asian studies. A uniquely Asian self-assessment tool based on clinical factors has been developed to assist in case-finding of osteoporotic patients. The few intervention trials with hormone replacement, alendronate and parathyroid hormone appear to show similar responses between Asians and Caucasians, although the response to vitamin D analogs in Asians appears better. Some differences in gene polymorphisms between Asians and Caucasians exist, and these may impact on BMD and fractures via different gene-environment relationships. CONCLUSIONS: Many aspects of osteoporosis in Asia appear similar to the West, but several interesting differences have emerged. These might lead to refinements in the strategies to manage osteoporosis within the Asian context.

Age Distribution↗
PubMed2002

Relation of vitamin D receptor FokI start codon polymorphism to bone mineral density and occurrence of osteoporosis in postmenopausal women in Taiwan.

BACKGROUND: Osteoporosis is a common disorder with a strong genetic component. Our aim was to evaluate the correlation of the vitamin D receptor FokI start codon polymorphism to bone mineral density and the occurence of osteoporosis. METHODS: We determined the vitamin D receptor FokI start codon polymorphism using polymerase chain reaction-based restriction analysis in 163 postmenopausal women in Taiwan. The vitamin D receptor gene polymorphism was detected by the restriction enzyme FokI, where the F allele indicated the absence of the cuttable site and the f allele its presence. We then related the genotypes to bone mineral density and the occurence of osteoporosis in these women. RESULTS: The allelic frequencies for 163 postmenopausal women in Taiwan were 59.2% for F and 40.8% for f in FokI restriction fragment length polymorphisms. The prevalence of each genotype in the study population was: 42.3% FF, 33.7% Ff and 24% ff. The three genotypic groups differed significantly in bone mineral density at the lumbar spine (P = 0.029). Bone mineral density was highest in the Ff group and lowest in the ff group at the lumbar spine and the femoral neck. The FokI vitamin D receptor genotype showed a significant effect on the prevalence of osteoporosis in the subjects at the lumbar spine. That is, women with genotype ff had a 2.8 times greater risk for osteoporosis (P < 0.05), and those with genotype FF had a 0.8 times greater risk than women with genotype Ff. CONCLUSION: Our findings indicate that the vitamin D receptor FokI start codon polymorphism is associated with reduced bone mineral density and predisposes women to osteoporosis at the lumbar spine.

Alleles↗
PubMed2002

Osteoporosis in men treated with androgen deprivation therapy for prostate cancer.

PURPOSE: We surveyed the growing literature on osteoporosis secondary to androgen deprivation therapy and provide suggestions regarding its identification and treatment. MATERIALS AND METHODS: We reviewed pertinent studies of male osteoporosis, osteoporotic fracture incidence or bone mineral density loss as a possible side effect of prostate cancer treatment and potential therapies for this side effect. RESULTS: Hypogonadism is a well-known cause of secondary osteoporosis in men. There is evidence of decreased bone mineral density with all types of androgen deprivation therapy, presumably due to its anti-testosterone effect. Bone mineral density loss is 3% to 5% yearly in the first few years of androgen deprivation therapy with an increase in osteoporotic fracture incidence. There are little data on potential treatments, although bisphosphonates and intermittent androgen deprivation therapy may have salutary effects. CONCLUSIONS: Osteoporosis is an important and debilitating side effect of androgen deprivation therapy, although precise estimates of its incidence, degree and cost are not completely elucidated. Until more data are available, it is prudent for all men beginning androgen deprivation therapy to receive calcium and vitamin D, and maintain a moderate exercise regimen. Baseline and at least 1 followup bone density measurement seem appropriate with bisphosphonate treatment a possibility in those in whom osteoporosis develops. More research is needed to explore the effect of bisphosphonates, calcium and vitamin D supplementation, exercise, calcitonin, selective estrogen re-uptake inhibitors, estrogens and intermittent androgen deprivation therapy on the course of androgen deprivation therapy induced osteoporosis. The osteoporotic fracture incidence and bone mineral density should be regularly incorporated into studies involving the hormonal treatment of prostate cancer.

Androgen Antagonists↗
PubMedDate not supplied

The potential of parathyroid hormone as a therapy for osteoporosis.

Over the past 10 years, therapeutic optimism in osteoporosis has been fueled by the development of agents that inhibit the resorption of bone. An increase in bone density with the bisphosphonates alendronate and risedronate, for example, is associated with significant reductions in vertebral and hip fracture incidence. Although bone is clearly stronger when these agents are used, there is no conclusive evidence that they improve the microarchitectural defects that characterize the disorder. It has been known for years that parathyroid hormone (PTH) can be an anabolic agent in animals. Recently, it has been confirmed that low-dose, intermittent administration of PTH is associated with selective anabolic effects in human subjects, whereas higher doses administered continuously are associated with catabolic effects. This observation has led to an experimental design in which PTH is administered to human subjects once daily in doses that do not regularly lead to adverse events, such as hypercalcemia. Two-year studies using PTH alone have been directed at postmenopausal osteoporosis (PMO) in women and at men with idiopathic osteoporosis. In both women and men, PTH leads to marked increases in bone density at the lumbar spine and also, significantly, in the hip. In PMO, PTH is associated with significant reductions in vertebral and nonvertebral fractures. When PTH is used in combination with an anti-resorptive agent, like estrogen, the markedly positive effects on bone mass are also seen in PMO and in those with glucocorticoid-induced osteoporosis. After PTH is withdrawn, but estrogen therapy is continued, the gains in bone mass are maintained. It is not known whether gains in bone mass are maintained if PTH is withdrawn without continuing therapy with an anti-resorptive agent; however, preliminary data suggest that the gains in bone mass begin to be lost. Bone biopsy samples in PMO and in men with idiopathic osteoporosis, before and after therapy with PTH, when subjected to histomorphometric analysis show marked increases in cortical thickness and improvements in indices of trabecular connectivity, thus allaying concerns that PTH may cause cortical thinning. It would appear that the increase in cortical wall thickness is due, in part, to stimulation by PTH of periosteal apposition at a rate greater than its effect to cause endocortical resorption. In all studies reported to date, PTH appears to be well tolerated. The era of anabolic therapy for osteoporosis is at hand, with PTH being the first to be tested with sufficient rigor to demonstrate its efficacy.

Animals↗
PubMedDate not supplied

The role of the primary care physician in diagnosis and management of osteoporosis.

It is estimated that 28,000,000 women in the United States have low bone mass (osteopenia) or osteoporosis. More than 1.5 million osteoporotic fractures occur annually. Because osteoporosis is asymptomatic until fracture occurs, early diagnosis requires both an awareness of risk and specific testing. The National Osteoporosis Foundation (NOF) has published guidelines for diagnosis and treatment, but these have important limitations. Bone mineral density (BMD) testing is the method of choice for diagnosis, and is more predictive of fracture risk than hypertension is of stroke or hypercholesterolemia is of myocardial infarction. Although the diagnosis of osteoporosis, as defined by the World Health Organization, is a T-score of < or =-2.5, the association between BMD and fracture risk is a continuous rather than threshold effect, and NOF guidelines suggest treating at higher T-scores, depending on risk factors. Important risk factors include age, current smoking, low body weight (<127 lbs.), maternal history of fracture, and personal history of fracture. Data from the National Osteoporosis Risk Assessment (NORA) study are presented, demonstrating the usefulness of peripheral BMD measurements in identifying postmenopausal women at risk of fracture. Several therapeutic options, including hormone replacement therapy, raloxifene, calcitonin, alendronate, and risendronate, are now available to the clinician. It can be argued that we currently have all necessary tools to eliminate osteoporosis and osteoporotic fracture.

Aging↗
PubMed2002

[Diagnosis of osteoporosis. How do you manage it?].

For the diagnosis of osteoporosis, conventional X-rays, densitometry and laboratory investigations are available to supplement history-taking and physical examination. The medical history should aim to identify risk factors for osteoporosis which, together with the clinical examination, can provide useful evidence for the presence of secondary osteoporosis. In the first instance, conventional X-rays serve to document osteoporotic fractures, but alone are not suitable for establishing an early diagnosis of osteoporosis. Today, the method of choice for the evaluation of osteoporosis and the fracture risk is densitometry, in particular DEXA (dual energy X-ray absorptiometry). Bone density values of > 2.5 SD (standard deviation) permit the diagnosis of osteoporosis. Currently, such biochemical markers as osteocalcin or hydroxyproline are being investigated for their diagnostic value in terms of disease activity fracture risk and the monitoring of treatment.

Absorptiometry, Photon↗
PubMed2002

[Osteoporosis in the aged male].

A MAJOR PROBLEM: Osteoporosis in elderly men is a public health problem. However, the criteria for its diagnosis remain to be defined. With the aging of the male population, the number of osteoporotic fractures is increasing together with the incidence of fractures per age range. These fractures create handicaps and an excess of mortality and generate great expense for the health budget. VARIOUS PHYSIOPATHOLOGICAL MECHANISMS: In the pathogenesis of osteoporosis of the elderly men, various elements must be taken into account: hormone factors (decreased testicular secretion, vitamin D deficiency), life style (chronic alcoholism, smoking, lack of exercise), certain diseases (rheumatoid arthritis) and certain drugs (corticosteroids, anti-androgenes). THE PROGRESSION OF BONE MINERAL DENSITY (BMD) WITH AGE: Depending on the area measured, the BMD peak is reached before the age of 30 in the hip and in the trabecular bone areas, whilst it is reached around the age of 40 in the cortical bone areas. Bone loss accelerates after the age of 70. After the age of 80, the BMD peak is around 16 to 20% lesser, except for the lumbar spine where the arthrosic calcifications artificially increase the BMD value. Bone formation marker blood levels remain stable in elderly men whereas the urinary excretion of deoxypyridinoline (bone resorption marker) increases after the age of 60. THE DIAGNOSIS OF OSTEOPOROSIS IN ELDERLY MEN: Osteoporosis must be evoked when confronted with a recent fracture, notably of the vertebra, or following moderate trauma and the diagnosis is confirmed by the measurement of a low BMD score (T-score < -2.5). WITH REGARD TO TREATMENT: There are few studies on the treatment of male osteoporosis. In the elderly man, documented hypogonadism justifies testosterone replacement therapy, although its anti-fracture efficacy has not been studied. In elderly men, particularly those living in homes, vitamin D deficiency and the subsequent hyperthyroidism justify treatment with vitamin D and calcium. The new bisphosphonates appear promising. In a randomised study, alendronate increased BMD and reduced the incidence of vertebral fractures. Alendronate and risedronate were also effective in the prevention and treatment of cortisone-induced osteoporosis in men.

Adult↗
PubMedDate not supplied

Diagnosis, prevention, and treatment of osteoporosis in men.

Though commonly seen as a disease afflicting only women, osteoporosis affects more than 5 million men in the United States with significant morbidity and mortality. Alcohol abuse, glucocorticoid excess, and hypogonadism are the principle risk factors for osteoporosis in men. Radiographs alone are insufficient in detecting the presence of the disease. Examining bone mineral density is the diagnostic standard used to detect the disease in both men and women. Unfortunately, diagnostic parameters and screening recommendations for bone mineral density testing have not been firmly established in men. The treatment and prevention of osteoporosis has been well studied in women, thus many of the treatments for men with the disease were extrapolated from studies predominantly involving women. Prevention of osteoporosis in men is best directed toward risk-factor modification and supplementation with calcium and vitamin D. The mainstay of treatment is bisphosphonates such as alendronate that have demonstrated both efficacy and safety in studies. Vitamin D and calcium supplementation also has some benefit in treating men with osteoporosis. Parathyroid hormone, thiazide diuretics, and calcitonin may also have a role in the prevention and treatment of osteoporosis in men, although this is not yet firmly established.

Benzothiadiazines↗
PubMed2001

Knowledge, beliefs, and risk factors for osteoporosis among African-American and Hispanic women.

The purpose of this work was to develop and conduct a needs and risk instrument to assess knowledge of osteoporosis risk factors, identify beliefs and attitudes about this disease, and delineate the presence and/or absence of healthy behaviors associated with osteoporosis among African American and Hispanic women. The survey findings suggest that African-American and Hispanic women are not well-versed in behaviors that would promote and maintain optimal bone mass. Consequently, they are not practicing appropriate lifestyle and dietary habits to decrease their risk of osteoporosis. Such behaviors include inadequate physical activity, inadequate calcium intake, cigarette smoking, and long-term steroid use. Less than 10% of women in the study were getting adequate daily dietary calcium intake, with only 13% taking daily calcium supplements to augment this deficit and less than one-half of women exercising at a minimal level (20 minutes/3 times a week). Women in this study also had limited knowledge about osteoporosis, perceived this condition to be less of a health threat as compared to breast cancer, heart disease, diabetes, and Alzheimer's disease, and very few had the perception that being Hispanic or African American was a factor to consider in assessing their risk of osteoporosis. Our findings suggest that osteoporosis education and prevention initiatives are needed, specifically for African-American and Hispanic women, to promote healthy behaviors, identify women at-risk, and encourage early diagnosis and treatment.

Adolescent↗
PubMedDate not supplied

Calcium, vitamin D and etidronate for the prevention and treatment of corticosteroid-induced osteoporosis in patients with rheumatic diseases.

INTRODUCTION: Long-term glucocorticoid therapy, a major risk factor for the development of osteoporosis, is often necessary in chronically ill patients. At present there are no generally accepted guidelines for the prevention or treatment of steroid-induced osteoporosis. METHODS: In an open prospective study we investigated 99 patients with chronic rheumatic diseases receiving > or = 5 mg/day of prednisolone or the equivalent for at least one year. The objective was to identify osteoporosis risk factors in addition to glucocorticoid therapy and to evaluate the efficacy of prevention with calcium/vitamin D (group 1--patients with osteopenia) and treatment with cyclical etidronate (group 2--patients with osteoporosis). Biochemical markers of bone turnover, clinical parameters and bone mineral density (BMD) were measured. RESULTS: Increasing age and postmenopausal status were associated with more advanced manifestations of steroid-induced osteoporosis (p < 0.05). One year after the start of therapy parameters of bone metabolism increased significantly in group 1, while BMD did not change. In group 2, lumbar spine BMD increased significantly (p < 0.05) whereas femoral neck BMD and bone metabolism parameters remained constant. The intensity of back pain decreased in both groups (p < 0.05). There were fewer new fractures in group 2 than in group 1. CONCLUSION: Treatment with etidronate is effective in patients with glucocorticoid-induced osteoporosis.

Adult↗
PubMed2003

Postmenopausal osteoporosis risk management in primary care: how well does it adhere to national practice guidelines?

OBJECTIVE: The National Osteoporosis Foundation (NOF) practice guideline provides explicit recommendations for postmenopausal osteoporosis risk assessment and management. This study evaluated primary care adherence to the recommendations and factors associated with such adherence. METHOD: Postmenopausal women 40 years old and older were sampled in the primary care clinic of a US tertiary hospital. We received 469 completed questionnaires that measured the respondent's demographics and osteoporosis risk factors; current and historical osteoporosis counseling, testing, and treatment; and whether or not she had a primary care clinician. Based on information provided, we determined whether each woman was receiving care that followed the NOF guideline. Univariate and multivariate analyses identified factors associated with guideline adherence. RESULTS: Mean age was 69 years; 53% were white and 38% black; 15% had prior fractures. Using NOF criteria, 19.8 % were at moderate risk and 80.2 % were at high risk for osteoporosis. Overall, 57.6% (95% confidence interval 53.1, 62.1) of patients received risk management in accordance with the NOF guideline. The adherence rate was higher in the high-risk group (60.9% v 44.1%, p=.003), in those who had primary care clinicians (62.0% v 43.5%, p=.006), and in nonblack patients (white v black 67.1% v 43.0%, p<.001; other v black 65.0% v 43.0%, p=.012). These associations remained statistically significant after multivariate adjustments. Adherence was not associated with the sex of the primary care clinician. CONCLUSIONS: More than half of postmenopausal women in our study were receiving osteoporosis risk management that followed the NOF practice guideline. Those who were at higher risk, who were not black, or who had primary care clinicians were more likely to receive care in accordance with the NOF guideline, regardless of the sex of the clinician.

Adult↗
PubMed2003

Are Wisconsin physicians knowledgeable about male osteoporosis?

It is unknown if recent research defining the relatively frequent occurrence and pathophysiology of male osteoporosis has been conveyed to clinicians. To assess if physicians have incorporated such information, 5646 licensed Wisconsin physicians received a 1-page survey consisting of 14 statements regarding general knowledge, diagnosis, and treatment of osteoporosis in men. Twenty-six percent (1488) responded; 69% (1033) were family physicians or internists, 7% (106) orthopedic surgeons, and 5% (63) endocrinologists or rheumatologists. Of these physicians, 61% to 78% recognized that osteoporosis is not rare in men. Most (68%-97%) agreed that low-trauma fracture or corticosteroid therapy initiation are indications for bone mass measurement. Treating osteoporosis at a T-score of -2.5 was accepted by 79% to 89% of responders. Overall these physicians: (1) recognize osteoporosis as an important disease in men; (2) accept corticosteroid therapy and prior low-trauma fracture as indications for bone mass measurement; and (3) utilize T-scores in treatment decisions. These data suggest that knowledge regarding male osteoporosis has been conveyed to practicing physicians. Evaluation of methods by which physicians will translate this knowledge into action, thereby optimizing patient care, are needed.

Bone Density↗
PubMed2003

Current approaches to the prevention and treatment of postmenopausal osteoporosis.

Current approaches to the prevention, detection, treatment, and monitoring of postmenopausal osteoporosis are discussed. In the United States, 44 million men and women ages 50 years or older have low bone mass or osteoporosis. The most devastating consequence of this disease is fractures. The assessment of osteoporosis risk includes determining risk factors, conducting laboratory and physical examinations, and measuring bone density and bone-turnover markers. Once risk has been established, nonpharmacologic strategies, such as exercise, appropriate dietary habits, and discontinuing tobacco and alcohol use, are helpful. Fall prevention and adequate intake of calcium and vitamin D are critical. When pharmacologic therapy is warranted, bisphosphonates have shown the greatest benefit in preventing bone loss and lowering fracture rates. Selective estrogen-receptor modulators and calcitonin are also options for prevention or treatment of osteoporosis. Estrogen should not be used for the sole purpose of osteoporosis prevention; however, short-term use is acceptable for women with vasomotor symptoms or in whom the benefits outweigh the risks. Parathyroid hormone may offer another treatment alternative. A variety of pharmacologic options are available for patients with osteoporosis in whom lifestyle modifications have proven insufficient. Bisphosphonates are the mainstay of drug therapy.

Accidental Falls↗
PubMed2003

Osteoporosis prevention in primary care.

Osteoporosis is a devastating disease that is increasing in prevalence as our population ages. Prevention of osteoporosis is important to decrease osteoporosis-related fractures. Primary care practitioners are in the ideal position to actively screen women for osteoporosis and counsel them on risk reduction. This paper reviews population-based strategies for osteoporosis prevention and identification of high-risk women in a primary care practice. Practical methods of incorporating osteoporosis prevention counseling into a busy practice are presented.

Female↗
PubMed2003

Osteoporosis associated with the treatment of paraphilias: a clinical review of seven case reports.

Osteoporosis and long-term androgen suppression in the treatment of paraphilias has been documented with surgical castration and the use of gonadotropin-releasing hormone agonists. The literature has suggested that the use of cyproterone acetate (CPA) may be protective against osteoporosis, although there are case reports of osteoporosis in men treated with CPA. This pilot study represents a case series of seven patients diagnosed with severe paraphilias and treated with CPA, leuprolide, or surgical castration. Two of the four patients treated with CPA developed significant osteoporosis, while the other two had normal bone density studies. The remaining three patients, one treated with leuprolide and two with surgical castration, had osteopenia. Based upon the current literature, the finding of significant osteoporosis in two of four patients treated with CPA, but not those treated with leuprolide or castration, is surprising. Monitoring of all patients treated with long-term androgen suppression for osteoporosis is suggested.

Adult↗
PubMed1992

[Biochemical markers of bone remodelling and their usefulness in the diagnosis of osteoporosis].

In 65 subjects (42 women and 23 men) aged from 40 to 80 years, at risk for primary or secondary osteoporosis development without concomitant diseases affecting renal and hepatic function and vitamin D metabolism, alkaline phosphatase activity (F.A.s) and total calcium level (Cas) were determined in the blood serum, and also the excretion in the morning urine portion of hydroxyproline and calcium was measured in relation to creatinine excretion (FUHpr/kr; FUCa/kr). In each patient an X-ray was done of the thoracolumbar spine, and on its basis the X-ray vertebral index was calculated. The study has been undertaken in order to elucidate whether the above stated compounds regarded as biochemical markers of bone remodelling, and the X-ray vertebral index are useful in the diagnosis of osteoporosis. An increased F.A.s activity in the blood serum, and higher values of the X-ray vertebral index were found both in the group of patients with primary and secondary osteoporosis, in relation to normal values. It was found that FUHpr/kr and FUCa/kr were increased in patients with secondary osteoporosis in comparison to patients with primary osteoporosis. A statistically significant correlation was also noted between FUHpr/kr and FUCa/kr, and F.A.s in patients with primary and secondary osteoporosis. In both studied groups no relationship was found between the value of the X-ray vertebral index, and the levels of biochemical markers of bone remodelling.

Adult↗