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PubMed2006

Frequency of osteoporosis in 187 men with rheumatoid arthritis followed in a university hospital.

OBJECTIVE: Although there is relevant information on frequency of osteoporosis in women with rheumatoid arthritis (RA), data about male patients are limited. We evaluated the frequency of osteoporosis in a group of Spanish men with RA followed in a university hospital. METHODS: From the database of our bone densitometry unit, we searched for men with RA evaluated between January 1991 and December 2004 and identified 187 patients, 156 of whom were older than 50 years. Previously recorded demographic, disease, and treatment-related variables were collected. Bone mineral density (BMD) was measured by dual x-ray absorptiometry (DEXA). Osteoporosis was defined according to the criteria of the World Health Organization (WHO), recommended for postmenopausal Caucasian women, as a T score <or= -2.5 SD, and the International Society for Clinical Densitometry (ISCD), which indicates the same diagnostic threshold, but only in men over age 50 years. RESULTS: BMD was lower than in the general population in both lumbar spine [Z score -0.41 +/- 1.00 (95% CI -0.55 to -0.26)] and femoral neck [Z score -0.46 +/- 0.95 (95% CI -0.60 to -0.31)]. When the WHO threshold for postmenopausal women was applied, frequency of osteoporosis was 13% at lumbar spine, 12% at the femoral neck, and 21% in at least one of the evaluated sites. When ISCD criteria were applied, the frequency of osteoporosis was 13%, 14%, and 23%, respectively. CONCLUSION: Frequency of osteoporosis in men is considerably lower than that traditionally established in women with RA, independent of the diagnostic criteria applied.

Absorptiometry, Photon↗
PubMed2006

[Treatment and management of severe osteoporosis].

Because there is an extremely high probability of new fractures occurring in cases in which there are pre-existing fractures, it is easy for such patients to develop severe osteoporosis. We therefore must correctly ascertain any existence of either vertebral or hip fractures. High values of bone resorption markers reflect the existence of microfractures, so it is necessary to be careful due to the high risk of new fractures. Kinesitherapy for severe osteoporosis focuses on therapeutic exercise, walking, balance drills, and so forth with the aim of maintaining muscular strength and thus preventing falls. For severe osteoporosis such as senile osteoporosis and glucocorticoid-induced osteoporosis, bisphosphonates are currently the only medication that has been proven to be effective for preventing fractures. For the treatment of disuse osteoporosis stemming from paralysis, etc., the intravenous injection of bisphosphonates is able to suppress the decline in bone mass, but there is still very little evidence of its fracture prevention effect.

Biomarkers↗
PubMedDate not supplied

Effects of catecholamines on the intramedullary pressure in the femur in rats with prednisolone-induced osteoporosis.

Osteoporosis is a metabolic bone disease characterized by low bone mass, impaired micro-architecture and susceptibility to fracture. Osteoporosis may be, inter alia, a result of a long-term glucocorticosteroid therapy, e.g. with prednisolone. Although a number of properties of prednisolone in influencing bone metabolism have been recognized, the effect of prednisolone-induced osteoporosis on the function of blood circulation and autonomic nervous system in bones remains open. In order to clarify this problem, the present study concentrated on the effects of catecholamines on intramedullary pressure in rats with prednisolone-induced osteoporosis. Prednisolone was administered to male Wistar rats at the doses of 5 mg/kg im, for 3 weeks. Norepinephrine, epinephrine, isoprenaline as well as adrenoceptor antagonists (phentolamine and propranolol) were administered to the controls and to the rats with prednisolone-induced osteoporosis. The examinations demonstrated that rats with prednisolone-induced osteoporosis displayed a decreased intramedullary pressure. In addition, a disordered effect of catecholamines on intramedullary pressure of osteoporotic bone was observed.

Adrenergic Antagonists↗
PubMed2006

[The impact of subclinical vertebral fractures on health-related quality of life in women with osteoporosis].

The aim of the study was to evaluate the impact of subclinical vertebral fractures on health-related quality of life in women with postmenopausal osteoporosis. A disease-specific instrument, Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) questionnaire, developed to measure quality of life in patients with osteoporosis, was used. A total of 120 postmenopausal women who came for consultation were examined. Subclinical vertebral fractures were identified by standardized lateral radiographs. Patients were divided into three study groups according to bone mineral density and incident fracture status: group 1 (control group)--40 women without osteoporosis, group 2--40 women with osteoporosis, but without vertebral fracture, and group 3--40 women with subclinical osteoporotic vertebral fracture. The last group was divided into two subgroups: with one fracture and with multiple vertebral fractures. The mean total score of the QUALEFFO-41 for the control group was 34.12 (95% CI 30.27-37.96), for the group with osteoporosis, but without vertebral fracture--36.51 (95% CI 33.56-39.45), and for the group with non-clinical osteoporotic vertebral fracture--35.69 (95% CI 32.08-39.29). There were statistically significant differences in domains A (pain) and E (social function) between women with one non-clinical vertebral fracture and control group. Our results showed no statistically significant differences in health-related quality of life, assessed QUALEFFO-41, between women with subclinical vertebral fractures and control group. Women with one subclinical vertebral fracture showed statistically significant worse results in pain, social function, and general health perception domains. Significantly greater changes in body appearance were noted among women with multiple subclinical vertebral fractures.

Aged↗
PubMed2006

[Prevalence of steroid osteoporosis].

Mechanical of the bone strength decreases in both primary and steroid-induced osteoporosis. However, pathophysiology of steroid osteoporosis is different from that of primary osteoporosis, characterized by negative bone metabolic balance which is caused by both increased bone resorption and decreased bone formation. Steroid-induced osteoporosis has many clinical characteristics such as early onset after initiation of dosing, higher fracture incidence with higher bone mineral density and that most of the underlying diseases also cause osteoporosis, suggesting that steroid osteoporosis should be properly controlled from the beginning of steroid treatment.

Adrenal Cortex Hormones↗
PubMed2006

[Rheumatoid arthritis and osteoporosis: trends in their treatments].

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic synovitis and bone damages, which consist of joint destruction and systemic osteoporosis. During the pathological process, pro-inflammatory cytokines such as TNF-alpha are largely produced from inflamed synovium and cause activation of osteoclasts deviated from bone remodeling cycle, resulting in joint destruction. On the other side, systemic osteoporosis, mainly caused by glucocorticoid (GC) is often complicated in RA, in which GC decreases number of osteoblasts, reduces synthesis of bone matrix proteins from them and enhances bone resorption, resulting in impairment of bone remodeling. Thus, joint destruction and systemic osteoporosis are brought about by different mechanisms. However, recent treatment strategies have improved managements of RA-related joint destruction as well as GC-induced osteoporosis. Treatments using biologics including infliximab and etanercept, effective for treating RA disease activity, also reduce joint destruction. Also, bisphosphonate is well known to be effective for not only treatment but also prevention of GC-induced osteoporosis. Thus, it is a clinical trend that physicians treat joint destruction as an inflammatory disease and osteoporosis as a metabolic disease.

Antibodies, Monoclonal↗
PubMed1991

That old hip. The osteoporosis process.

Osteoporosis is a major health concern that will contribute to an increasing number of hip fractures as the population ages. Researchers are continuing to evaluate the role that decreased level of estrogen at menopause and prolonged calcium insufficiency play in the development of osteoporosis. In addition, many health care recommendations are aimed at maximizing peak bone mass and preventing bone loss to decrease the chance of hip fracture. New studies are evaluating the efficacy of experimental medications to rebuild bone mass once osteoporosis has developed. Current prevention guidelines include adequate calcium and vitamin D intake and moderate exercise. At menopause, estrogen replacement therapy is recommended for those younger than 50 years or considered at high risk for developing osteoporosis. All people are encouraged to decrease the risk of fracture by evaluating their home environment for hazards that might contribute to falls. Nursing needs to develop new strategies and interventions to educate the public about osteoporosis, improve the quality of life for persons with osteoporosis, and decrease the osteoporotic hip fracture mortality rate. Will it rise to the challenge?

Hip Fractures↗
PubMed1991

[The epidemiology of osteoporosis].

Osteoporosis is characterized by low bone mass, micro architectural impairment of bone tissue, and a subsequent in crease in fracture risk. Fractures or the vertebrae and distal forearm, as well as the proximal femur, or hip fracture, are included. Hip fracture is associated with high mortality, morbidity and medical expenses. There is a dramatic increase in the incidence of hip fracture with age. Hip fracture incidence is 350 times higher in women aged 85 years and over comparatively to women between 35 and 44 years of age. In recent studies in Switzerland, it was observed that the annual age adjusted incidence rate of hip fracture was comparable with similar rates for white population in industrialized countries, although in men the rates were relatively high. Among the major risk factors for osteoporosis are age, female gender, white and Asian race, and menopause. Postmenopausal estrogen replacement therapy reduces bone resorption. Family history of osteoporosis, frail constitution, as well as excessive alcohol intake, cigarette smoking, chronic insufficient nutritional calcium intake and physical inactivity are other risk factors. A cardinal element is the peak bone mass reached in the third or fourth decade of life. Independently of osteoporosis, falls are a key agent in fractures; several medical conditions and drugs increase the risk of falling. There is an enormous social and financial cost of osteoporosis; the annual cost of medical treatment only for hip fracture is close to Fr. 200 million in Switzerland. The burden of osteoporosis is likely to increase in the future because of the demographic aging of the population unless large scale preventive interventions are undertaken.

Adult↗
PubMed1991

[Calcitonin in the prevention and therapy of osteoporosis].

Main arguments for application of calcitonin in the therapy of osteoporosis are specific inhibition of osteoclasts, analgetic effect and stimulation of osteoblasts, the latter demonstrated only in vitro so far. Calcitonins are mostly used only for a short term in acute painful phases of osteoporosis. For salmon calcitonin, which has been tested most up to now, it has been demonstrated that its application in primary osteoporosis up to one year leads to a moderate but significant increase in bone mass. This metabolic effect on bone has been reached in the majority of studies in a combination with 500 to 1000 mg of calcium. The secondary clinical resistance observed after even longer application is presumably not so much a problem of antibodies than the consequence of depressed bone remodelling due to chronic inhibition of osteoclasts. The circulating antibodies during application of salmon calcitonin are only partially also neutralising. As to human calcitonin, therapeutic studies of corresponding length in manifest osteoporosis do not yet exist. Salmon calcitonin as nasal spray inhibits the increased postmenopausal skeleton breakdown in sound women during application of up to two years at present. In steroid-induced osteoporosis there are positive therapeutic results for both injectable and nasal calcitonin. Calcitonin therapy of osteoporosis in phases of some weeks to some months can be generally recommended nowadays. For a long-term therapeutic recommendation we still lack further studies in order to evaluate the effects of different dosage, mode of application and intermittent application.

Administration, Intranasal↗
PubMed1990

[Clinical aspects of osteoporosis].

The development of osteoporosis is a multifactorial process. Part of contributing factors are not to be influenced, others may be avoided or prevented. The achievement of an optimal peak bone mass as well as its maintenance require sufficient sex hormones in connection with optimal calcium supply with the nourishment and sufficient physical exercise. During the preclinical phase of osteoporosis only the analysis of risk factors is possible. There are no clinical symptoms of the condition itself. Manifestation of osteoporosis is documented by crush fractures or discontinuing fractures. In osteoporosis type I the vertebral column is involved. Back pains and loss of body height are the consequences leading to diminished quality of life. The pain syndrome is unspecific and may be caused by other diseases, too. In osteoporosis type II in addition peripheral fractures at disposed sites show up (neck of femur, distal radius = Colle's fracture). During aging the diminished bone mass presumably becomes less decisive for the fracture risk whereas the significance of impaired eye sight, loss of hearing, delayed reflexes and diminished muscle strength increases. For evaluating clinics of osteoporosis systems for grading are mandatory.

Bone Density↗
PubMed1990

The mechanism of an osteoporosis center.

The cost of osteoporosis to the quality of human life and well-being are immeasurable; its costs to society are significant. Osteoporosis affects approximately 20 million Americans and has been estimated by the National Osteoporosis Foundation to equal $7 to $10 billion in health care costs and productivity annually. Osteoporosis represents a major health problem. Clearly, a screening and bone maintenance program can be managed by nurses in a cost-effective manner and serves as an efficient facilitator in the education and care of patients. Furthermore, an osteoporosis center can provide invaluable support for professionals in various disciplines of medicine. In our experience at The Hospital for Special Surgery most of our patients come to our center as a result of a physician referral. An average of 600 to 800 patients are seen annually and about 15 per cent of these patients are referred from the screening program to a metabolic bone treatment source. Approximately 5 per cent of patients referred for treatment are hospitalized for an extensive evaluation which includes an iliac crest-bone biopsy. As the patient population in the Osteoporosis Center has grown there has been a recognition of special patient groups who have specific needs. This has resulted in the establishment of clinics which address the problems associated with patients who are renal stone formers, anorexic, and amenorheic (many of this latter group are athletes or dancers).(ABSTRACT TRUNCATED AT 250 WORDS)

Appointments and Schedules↗
PubMed1989

Exercise and osteoporosis.

Bone formation and resorption are ongoing phenomena. When bone resorption equals bone formation, bone mass remains stable. When resorption exceeds formation, bone mass is reduced--a process that leads to osteopenia or osteoporosis. Osteopenia is reduced bone mass and osteoporosis is reduced bone mass with resultant fractures. Reduced bone mass may be postmenopausal or related to ovarian failure (type I osteoporosis), it may be age-related (type II osteoporosis), or it may result from several other etiologic factors (secondary osteoporosis). Disuse and inactivity can cause bone loss, whereas weight-bearing exercises may maintain or improve bone mineral density. There is a significant correlation between muscle strength and bone mineral density. There is evidence that strengthening exercises may lead to an increase in the mineral density of the bones to which the muscles are attached. Currently, drug regimens are available to decrease or halt bone loss in osteoporotic patients. Properly designed exercise programs may prove to be effective for retarding age-related bone loss. In patients with osteoporosis, the cause should be investigated before treatment is commenced.

Adult↗
PubMed1986

Osteoporosis: significance, risk factors and treatment.

Osteoporosis is a serious metabolic bone disorder that results in fractures of the wrist, hip and vertebrae. These fractures frequently occur with little or no trauma. Osteoporosis is seen more frequently in women than men. While the pathogenesis of osteoporosis is incompletely understood at this time, certain risk factors are emerging as important. Among the more important of these are family history, low calcium intake, early menopause and sedentary lifestyle. Other suggested risk factors include high intakes of protein, alcohol and caffeine; low body weight; exercise-induced amenorrhea; and cigarette smoking. No single therapy or combination of therapies for osteoporosis has proven to be uniformly successful. Indeed, once fractures occur, full restoration of the skeleton may not be possible. Currently, calcium, exercise and estrogen form the treatment for osteoporosis. When these conservative measures are ineffective or inadequate, treatment with fluoride, calcitonin, vitamin D or anabolic steroids may be attempted. Research to clearly identify and quantify risk factors and find an effective treatment for osteoporosis continues.

Aged↗
PubMed1987

[Therapeutic choices in osteoporosis].

Precise methods of evaluating bone density or bone quality (SPA, DPA, QCT, histomorphometry) have shown that various treatments for osteoporosis are efficient. Some drugs stimulate bone formation (NaF), others inhibit bone resorption (estrogens, calcitonin), while calcium and vitamin D act as additives. The drug is chosen which corrects the prevailing defect, which in turn can be suspected on the basis of a precise diagnosis. The latter is established by classification of the different forms of osteoporosis, based upon pathophysiological mechanisms. Apart from post-menopausal osteoporosis, which responds to estrogens, the other forms of high turnover osteoporosis may respond to calcitonin. Osteoporosis with low turnover, or age-related osteoporosis usually respond to NaF. Cyclic treatments set out to stimulate the maximum number of multicellular units of the bone. In this period of investigation and fruitful development, empiric treatment should give way to controlled cooperative studies.

Aged↗
PubMedDate not supplied

[Diagnostic procedure in osteoporosis].

Osteoporosis is a very important differential diagnosis in chronic back pain. Early diagnosis of osteoporosis remains difficult, as an initial loss of skeletal mass cannot be recognized in X-ray pictures. A clear assessment can only be reached by the application of different non-invasive quantitative methods of bone mineral determination. So far as possible bone mineral content should be measured at an axial and a peripheral site of the skeleton. Crush fractures of vertebrae indicate an advanced calcipenic osteopathy. During the diagnostic procedure of osteoporosis other metabolic osteopathies (e.g. the different forms of hyperparathyroidism and osteomalacia) must be excluded by laboratory examinations or sometimes even by bone histology. If other generalised osteopathies can be excluded one has to look for etiological factors of a possible form of secondary osteoporosis because some of these allow a specific therapeutic approach. In about 80% no disturbances of calciumphosphorous metabolism can be detected, which means that a diagnosis of primary (idiopathic) osteoporosis must be made. In primary and secondary forms of osteoporosis the actual skeletal status and the activity of the osteoporotic process should be defined before beginning a differentiated treatment.

Back Pain↗
PubMed1984

Studies on the pathophysiology and therapy of osteoporosis.

Etiologic and pathologic factors in clinical osteoporosis are reviewed. Techniques were developed to determine total skeletal calcium content with in vivo neutron activation analysis and to induce osteoporosis (in about three months) with low calcium diet, corticosteroid or heparin treatment in experimental animals. Genetic influence was demonstrated: C3H/St (Ha) mice were more susceptible to osteoporosis by all three modalities than C57B1/6 (J) mice. Fluoride was ineffective in preventing osteoporosis induced by either of these three modalities. Heparin induced osteoporosis was prevented by conjugated estrogens, progestins or their combinations. Progestins were shown in other studies to inhibit estrogen induced metaplasia and neoplasia. Combining estrogens with progestin may result in an increased therapeutic index for the prevention of postmenopausal osteoporosis. Human and salmon calcitonin, Deca - Durabolin, an anabolic steroid, Mopidamole, a pyrimidopyrimidine derivative, Trental, a methylxanthine derivative, certain 2-thiophene carboxylic acid derivatives and imidazoquinazolines exhibited anti-osteoporotic effects.

Animals↗
PubMed1976

Pig calcitonin in the treatment of localised osteoporosis.

On the basis of positive results obtained in the treatment of Sudeck's atrophy with calcitonin, the authors extended their investigation to other forms of localised osteoporosis. Six patients were examined affected by osteoporosis secondary to immobilisation, three patients with osteoporosis of the lower limbs from paralysis of the sciatic nerve and six patients with migrant osteoporosis. Treatment was as follows: pig calcitonin (Calcitar) in doses of 160 u MRC/daily + calcium gluconate in doses of 3 gr/daily. The duration of treatment averaged forty five days. In osteoporosis from immobilisation and nerve lesions the calcitonin treatment did not influence the condition and there was no change in radiographic appearances nor was there any analgesic action. On the other hand, the results were clearly positive in migrant osteoporosis: in all the patients treated there was complete regression of pain, cutaneous trophic changes, and functional loss. At a later stage, normal radiographic appearances were restored.

Animals↗
PubMed1995

Bone mineral density in relation to medical and lifestyle risk factors for osteoporosis in premenopausal, menopausal and postmenopausal women in general practice.

BACKGROUND: Interest in the prevention of osteoporosis is increasing and thus there is a need for an acceptable osteoporosis prevention programme in general practice. AIM: A study was undertaken to identify a cohort of middle-aged women attending a general practice who would be eligible for a longitudinal study looking at bone mineral density, osteoporosis and the effectiveness of hormone replacement therapy. This study aimed to describe the relationship between medical and lifestyle risk factors for osteoporosis and the initial bone density measurements in this group of women. METHOD: A health visitor administered a questionnaire to women aged between 48 and 52 years registered with a Belfast general practice. The main outcome measures were menopausal status, presence of medical and lifestyle risk factors and bone mineral density measurements. RESULTS: A total of 358 women our of 472 (76%) took part in the study which was conducted in 1991 and 1992. A highly significant difference was found between the mean bone mineral density of premenopausal, menopausal and postmenopausal women within the narrow study age range, postmenopausal women having the lowest bone mineral density. A significant relationship was found between body mass index and bone mineral density, a greater bone mineral density being found among women with a higher body mass index. Risk factors such as smoking and sedentary lifestyle were common (reported by approximately one third of respondents) but a poor relationship was found between these two and all the other risk factors and bone mineral density in this age group. CONCLUSION: Risk of osteoporosis cannot be identified by the presence of risk factors in women aged between 48 and 52 years. In terms of a current prevention strategy for general practice it would be better to take a population-based approach except for those women known to be at high risk of osteoporosis: women with early menopause or those who have had an oophorectomy.

Bone Density↗