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PubMed1998

[Prevalence of osteoporosis in the Czech Republic].

BACKGROUND: The objective of this study was to evaluate the prevalence of osteoporosis and osteopenia in Czech women and men aged 50 to 75 years. METHODS AND RESULTS: Bone mineral density was assessed in an age-stratified random sample of 713 women and 429 men from two cities (Prague and Litomĕrice) in the lumbar spine, proximal femur and total body by dual X-ray absorptiometry and in the distal forearm by single X-ray absorptiometry. The proportion of women and men in each age group with bone density below specified levels at any of these skeletal sites was projected to the population structure of the Czech Republic. With advancing age, in women at 55 years and in men at 65 years of age the population with normal bone mineral density becomes smaller, and a greater proportion has osteopenia or osteoporosis. Overall, an estimated 428,000 women and 195,000 men over age 50 have osteoporosis and another 680,000 women and 435,000 men have osteopenia. CONCLUSIONS: The results of this first population-based cross sectional study in the Czech Republic document a high prevalence of osteoporosis and osteopenia which is comparable with that published for the Netherlands and the United States. The results offer a basis for economical considerations in diagnosis, treatment and consequences of osteoporosis.

Adult↗
PubMed2002

Undertreatment of osteoporosis in men with hip fracture.

BACKGROUND: Women are not aggressively treated for osteoporosis after hip fracture; the treatment status of men with hip fracture has not been extensively studied. OBJECTIVE: To evaluate the outcome and treatment status of men with hip fracture. METHODS: Data from medical records were obtained for 363 patients (110 men and 253 women) aged 50 years and older with atraumatic (low-energy) hip fracture who were admitted to St Luke's Episcopal Hospital between January 1, 1996, and December 31, 2000. Surveys were mailed to surviving patients. Main outcome variables were osteoporosis treatments (antiresorptive or calcium and vitamin D) at hospital discharge, current osteoporosis treatments at 1- to 5-year follow-up, bone mineral density testing, mortality, current disability, and living arrangements (home or institution). RESULTS: The mean age for men was 80 years vs 81 years for women. Most fractures (89% for men and 93% for women) resulted from falls from a standing height. At hospital discharge, 4.5% of men (n = 5) had treatment of any kind for osteoporosis, compared with 27% of women (n = 69) (P<.001). The 12-month mortality was 32% in men, compared with 17% in women (P =.003). Surveys were usable from 168 (87%) of 194 survivors. At 1- to 5-year follow-up, 27% (12/44) of men were taking treatment of any kind for osteoporosis, compared with 71% (88/124) of women (P<.001). Of those treated, 67% (8/12) of men and 32% (28/88) of women were taking calcium and vitamin D only. At 1- to 5-year follow-up, 11% of men had a bone mineral density measurement, compared with 27% of women. After hospital discharge, the number of men and women who required wheelchairs, walkers, and canes and who lived in institutions increased significantly. CONCLUSIONS: The burden of hip fracture is illustrated by the high incidence of postfracture disability and the high mortality rate in both men and women. Nevertheless, few men receive antiresorptive treatment.

Aged↗
PubMed2004

Clinical considerations in premenopausal osteoporosis.

Osteoporosis can occur at any age. In premenopausal osteoporosis, full achievement of peak bone mass may be curtailed, and accelerated bone loss may occur in young adulthood. Premenopausal osteoporosis may be associated with chronic glucocorticoid therapy, prolonged amenorrhea, anorexia nervosa, rheumatoid arthritis, and diseases that affect calcium and vitamin D metabolism. Lesser degrees of bone loss may be associated with common conditions such as dieting, low calcium intake, smoking, and oligomenorrhea. Owing to a paucity of prospective studies on screening and treatment in younger age groups, few practice recommendations exist to guide the management of osteoporosis in young adults. We review the most important clinical concerns in premenopausal osteoporosis, including measurement of bone mass, normal bone accrual, risk factors for premature bone loss, clinical outcomes, and management issues. We emphasize clinically relevant information for primary care physicians, who are usually the first to encounter premenopausal patients with risk factors for early bone loss.

Absorptiometry, Photon↗
PubMed2004

Does this woman have osteoporosis?

CONTEXT: Although recent US Preventive Services Task Force guidelines recommend bone densitometry for all women older than 65 years, identifying younger women at increased risk for osteoporosis and women with occult vertebral fractures remains a clinical challenge. We investigated whether physical signs are useful as a screening tool either for early referral to bone densitometry or for occult spinal fractures. OBJECTIVE: To review the accuracy and precision of physical examination findings for the diagnosis of osteopenia, osteoporosis, or spinal fracture. DATA SOURCES: We conducted a MEDLINE search for articles published from 1966 through August 2004, manually reviewed bibliographies, consulted 4 clinical skills textbooks, and contacted experts in the field. STUDY SELECTION: Studies were included if they contained adequate original data on the accuracy or precision of physical examination for diagnosing osteopenia, osteoporosis, or spinal fracture. Two authors screened abstracts found by the search. Fourteen of 191 full articles reviewed met inclusion criteria. DATA EXTRACTION: Two authors independently abstracted data from the included studies. Disagreements were resolved by discussion. DATA SYNTHESIS: No single maneuver is sufficient to rule in or rule out osteoporosis or spinal fracture without further testing. The following yielded the greatest positive likelihood ratios (LR+): weight less than 51 kg, LR+, 7.3 (95% confidence interval [CI], 5.0-10.8); tooth count less than 20, LR+, 3.4 (95% CI, 1.4-8.0); rib-pelvis distance less than 2 finger breadths, LR+, 3.8 (95% CI, 2.9-5.1); wall-occiput distance greater than 0 cm, LR+, 4.6 (95% CI, 2.9-7.3), and self-reported humped back, LR+, 3.0 (95% CI, 2.2-4.1). CONCLUSIONS: In patients who do not meet current bone mineral density screening recommendations, several convenient examination maneuvers, especially low weight, can significantly change the pretest probability of osteoporosis and suggest the need for earlier screening. Wall-occiput distance greater than 0 cm and rib-pelvis distance less than 2 fingerbreadths suggest the presence of occult spinal fracture.

Absorptiometry, Photon↗
PubMed1999

The role of vitamin D in corticosteroid-induced osteoporosis: a meta-analytic approach.

OBJECTIVE: To determine if vitamin D is more effective than no therapy or calcium alone in the management of corticosteroid-induced osteoporosis, and to determine how vitamin D compares with other osteoporosis therapies, e.g., bisphosphonates, calcitonin, or fluoride, for this condition. METHODS: We evaluated all formulations of vitamin D, including its active metabolites and analogs. A systematic search for published and unpublished studies was conducted using MEDLINE (1966-December 1997), bibliographic references, abstracts from proceedings of recent national meetings, and contact with pharmaceutical companies and content experts. We included all randomized controlled trials lasting at least 6 months (and reporting extractable results), of patients receiving oral corticosteroids, that compared vitamin D with either 1) no therapy or calcium alone, or 2) bisphosphonates, calcitonin, or fluoride. The primary outcome measure of interest was change in lumbar spine bone mineral density. RESULTS: We found a moderate beneficial effect of vitamin D plus calcium versus no therapy or calcium alone (9 trials) (effect size 0.60; 95% confidence interval [95% CI] 0.34, 0.85; P < 0.0001). In comparisons of vitamin D with other osteoporosis therapies, bisphosphonates were more effective than vitamin D (6 trials) (effect size 0.57; 95% CI 0.09, 1.05). Calcitonin was similar in efficacy to vitamin D (4 trials) (effect size 0.03; 95% CI -0.39, 0.45). Fluoride was more effective than vitamin D, but there were only 2 trials. CONCLUSION: Vitamin D plus calcium is superior to no therapy or calcium alone in the management of corticosteroid-induced osteoporosis. Vitamin D is less effective than some osteoporosis therapies. Therefore, treatment with vitamin D plus calcium, as a minimum, should be recommended to patients receiving long-term corticosteroids.

Adrenal Cortex Hormones↗
PubMed2002

Lymphoplasmacytoid lymphoma presenting as severe osteoporosis.

We report four cases presenting with severe osteoporosis which on further investigation were found to have an underlying lymphoplasmacytoid lymphoma (LPL). Common secondary causes of osteoporosis were excluded in each case. Three of the cases responded to treatment with a biphosphonate. As these lymphomas share some common pathological and clinical features with multiple myeloma (MM) an association with osteoporosis is likely to represent more than a coincidental finding. The incidence of osteoporosis occurring with LPL will become clearer if routine imaging is carried out in patients at presentation. Issues relating to the treatment of the osteoporosis as well as the lymphoma arise in patients that present in this way. Based on the model of bone disease in MM, correlating serum levels of osteoclast activating cytokines such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumour necrosis factor (TNF) with the actual finding of bone disease provides a basis for future research into the pathogenesis and management of bone disease in these rare forms of low grade non-Hodgkin's lymphoma.

Aged↗
PubMed1995

Approach to discovering novel therapeutic agents for osteoporosis based on integrin receptor blockade.

On a global scale, osteoporosis is a major and growing public health problem. In the United States, osteoporosis is present in 24 million people (mostly women) and contributes to more than 1.3 million fractures/year. Serious morbidity and mortality result from these fractures. Current therapies for osteoporosis are few, efficacy is limited, and side effects problematic. Fundamental to the pathophysiology of osteoporosis is an imbalance between the tightly coupled processes of bone resorption and bone formation that characterize normal bone remodeling. Our laboratory is engaged in a research effort focused on elucidating the role of the osteoclast integrin in bone resorption, defining the nature of ligand-integrin interactions, and developing antagonists for cell surface adhesion molecules, particularly the alpha v beta 3 vitronectin-like integrin receptor present on the surface of human osteoclasts. Peptides containing the internal arginine-glycine-aspartic acid (RGD) motif have been shown to inhibit osteoclast-mediated bone resorption in vivo. We are now designing more potent and selective inhibitors of bone resorption as a potential new mechanism-based therapeutic approach to osteoporosis based on a novel mechanism. In an effort to rapidly identify the highest affinity ligands for the human alpha v beta 3 integrin, we have generated combinatorial peptide libraries containing substantial structural diversity. For instance, based on all possible sequence combinations of extracellular matrix proteins known to bind alpha v beta 3, we recently synthesized and chemically analyzed a library of 360,000 peptides, all of which contain RGD.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMed2003

Osteoporosis in anorexia nervosa: prevention and treatment.

BACKGROUND: Osteoporosis is a very prevalent complication of anorexia nervosa. In contrast to the many other medical complications of anorexia, osteoporosis and its sequelae of fractures, kyphosis, and pain may persist regardless of the overall treatment outcome. DISCUSSION: Traditional well-proven therapies for postmenopausal osteoporosis are not as effective against osteoporosis in anorexia nervosa. Therefore, clinicians who treat these patients must become increasingly vigilant about osteoporosis in regards to preventive, diagnostic, and treatment strategies.

Absorptiometry, Photon↗
PubMed1995

Relations between histologic indices of bone formation: implications for the pathogenesis of spinal osteoporosis.

Wall thickness, a major determinant of trabecular thickness, falls with age and falls further in osteoporosis. To estimate the importance of defective osteoblast recruitment in the pathogenesis of this defect, we compared various histologic indices of bone formation in iliac bone biopsies in three groups of subjects--healthy premenopausal women, healthy postmenopausal women, and patients with postmenopausal osteoporosis and at least one non-traumatic vertebral compression fracture. Indices that reflect the frequency of activation of bone remodeling and consequent birth rate of new teams of osteoblasts (osteoid surface, mineralizing surface, osteoblast surface, and bone formation rate, all expressed per unit of bone surface) were each higher in healthy subjects who were postmenopausal than in those who were premenopausal, but lower in osteoporotic than in normal postmenopausal women. In each group, the primary surface measurements were significantly correlated with each other, but the correlation was less close in those with osteoporosis. Indices that reflect the average collective performance of individual teams of osteoblasts (mineralizing surface and osteoblast surface per unit of osteoid surface, mineral apposition rate, adjusted apposition rate, and wall thickness) were all lower in postmenopausal than in premenopausal normal subjects, and even lower in those with postmenopausal osteoporosis. The parameters of the regression lines relating bone formation rate to osteoblast surface were essentially the same in each group, indicating that bone formation rate per unit of osteoblast surface was unaffected by age or menopause, and was the same in osteoporosis as in healthy subjects of similar age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Osteoporosis, sedentary lifestyle, and increasing hip fractures: pathogenic relationship or differential survival bias.

Osteoporosis, although a disorder of antiquity, has become more prevalent in developed countries and is a major risk factor for skeletal fracture. Accordingly, the increasing incidence of hip fracture among the elderly within developed nations has been attributed to an increased prevalence of osteoporosis. An increasingly sedentary lifestyle has been suggested as a significant contributing factor for the increased prevalence of osteoporosis. However, differential survival, reflecting changing competing mortality risks, will alter the gene pool of a surviving population cohort. Thus, the gene pool (and hence, disease susceptibilities) of 70-year-old individuals in 1990, for example, should not implicitly be assumed to be the same as 70-year-old individuals in 1950. Consequently, differences in the prevalence of osteoporosis or incidence of hip fracture between current and past elderly cohorts do not necessarily imply differences in environmental risk factors such as levels of physical activity. Instead, variation in competing mortality risks over time may produce differential survival with selection bias and "naturally" lead to increases in the incidence and prevalence of some aging-related disorders such as osteoporosis.

Aged↗
PubMed1995

Phosphorus-31 in vivo magnetic resonance spectroscopy of bone fails to diagnose osteoporosis.

The values of in vivo T1 relaxation time (T1) of phosphorus atoms of wrist bone have been measured by phosphorus-31 magnetic resonance spectroscopy (MRS) in 65 menopausal women separated into three groups: (1) age-matched women without any paraclinical or clinical osteoporosis; (2) patients with paraclinical osteoporosis detected only by dual photonic absorptiometry; and (3) women with clinical osteoporosis with vertebral fractures. No significant differences were found in T1 values in the presence of paraclinical or clinical osteoporosis as compared to control values. No relationships were found among the T1, the value of the Z-score, the value of bone mineral content, the age of patients, the number of their children, and the age of menopause. Phosphorus-31 magnetic resonance spectroscopy of the wrist fails to separate osteoporotic from nonosteoporotic women and cannot be clinically used at this time to perform a noninvasive diagnosis of osteoporosis.

Absorptiometry, Photon↗
PubMed1994

Population screening for low bone mineral density: do non-attenders have a lower risk of osteoporosis?

Poor compliance may be detrimental to the effectiveness of a screening programme if those at greatest risk of the disease do not attend. Therefore we undertook a study to test whether non-attenders to a screening programme for low bone density, a risk factor for osteoporosis, were at a differential risk of low bone density compared with attenders. Seven hundred and eighty-nine women aged 45-49 years living within 32 km of Aberdeen were selected at random from the Community Health Index and invited to attend for screening for low bone density as a risk of factor for osteoporosis. Attenders and non-attenders were surveyed regarding their risk factors for osteoporosis. Non-attenders were significantly heavier than attenders. In addition, 6 non-attenders who subsequently chose to attend had significantly higher body weight and bone mineral density, at Ward's triangle, than initial attenders. Non-attenders to a screening service for bone density may be at lower risk of developing osteoporosis. Non-attendance, therefore, would not be detrimental to the cost-effectiveness of a screening service for bone density. However, this study indicates there is a potential for response bias in studies of bone density and osteoporosis.

Bias↗
PubMed1996

Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy.

Osteoporosis and magnesium (Mg) deficiency often occur in malabsorption syndromes such as gluten-sensitive enteropathy (GSE). Mg deficiency is known to impair parathyroid hormone (PTH) secretion and action in humans and will result in osteopenia and increased skeletal fragility in animal models. We hypothesize that Mg depletion may contribute to the osteoporosis associated with malabsorption. It was our objective to determine Mg status and bone mass in GSE patients who were clinically asymptomatic and on a stable gluten-free diet, as well as their response to Mg therapy. Twenty-three patients with biopsy-proven GSE on a gluten-free diet were assessed for Mg deficiency by determination of the serum Mg, red blood cell (RBC) and lymphocyte free Mg2+, and total lymphocyte Mg. Fourteen subjects completed a 3-month treatment period in which they were given 504-576 mg MgCl2 or Mg lactate daily. Serum PTH, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D and osteocalcin were measured at baseline and monthly thereafter. Eight patients who had documented Mg depletion (RBC Mg2+ < 150 microM) underwent bone density measurements of the lumbar spine and proximal femur, and 5 of these patients were followed for 2 years on Mg therapy. The mean serum Mg, calcium, phosphorus and alkaline phosphatase concentrations were in the normal range. Most serum calcium values fell below mean normal and the baseline serum PTH was high normal or slightly elevated in 7 of the 14 subjects who completed the 3-month treatment period. No correlation with the serum calcium was noted, however. Mean serum 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D and osteocalcin concentrations were also normal. Despite only 1 patient having hypomagnesemia, the RBC Mg2+ (153 +/- 6.2 microM; mean +/- SEM) and lymphocyte Mg2+ (182 +/- 5.5 microM) were significantly lower than normal (202 +/- 6.0 microM, p < 0.001, and 198 +/- 6.8 microM, p < 0.05, respectively). Bone densitometry revealed that 4 of 8 patients had osteoporosis of the lumbar spine and 5 of 8 had osteoporosis of the proximal femur (T-scores < or = -2.5). Mg therapy resulted in a significant rise in the mean serum PTH concentration from 44.6 +/- 3.6 pg/ml to 55.9 +/- 5.6 pg/ml (p < 0.05). In the 5 patients given Mg supplements for 2 years, a significant increased in bone mineral density was observed in the femoral neck and total proximal femur. This increase in bone mineral density correlated positively with a rise in RBC Mg2+. This study demonstrates that GSE patients have reduction in intracellular free Mg2+, despite being clinically asymptomatic on a gluten-free diet. Bone mass also appears to be reduced. Mg therapy resulted in a rise in PTH, suggesting that the intracellular Mg deficit was impairing PTH secretion in these patients. The increase in bone density in response to Mg therapy suggests that Mg depletion may be one factor contributing to osteoporosis in GSE.

Absorptiometry, Photon↗
PubMed1998

[Vertebral deformity as an index of osteoporosis-induced spinal fracture--an external validity construct based on bone density data].

BACKGROUND: In order to test the validity of vertebral morphometry for the assessment of prevalent vertebral osteoporotic fractures, we examined the association between vertebral deformities and bone mineral density (BMD). METHOD: The study population consisted of 595 postmenopausal women and 581 men aged 50 to 82 years who participated in the baseline survey of the European Vertebral Osteoporosis Study (EVOS) in Germany and received BMD measurements by dual-X-ray-absorptiometry (DXA) at the femur and the lumbar spine. RESULTS: In both sexes only vertebral deformities defined by more stringent morphometric criteria (McCloskey; Eastell 4 SD criterion) were significantly and inversely related to BMD (odds ratios 1.42 to 3.21 for a 1 SD [standard deviation] reduction in BMD; p < 0.05). The strength of the association depended on the stringency of the morphometric algorithm applied, and on the site of BMD measurement. The strongest associations were observed with femoral neck BMD in women and with BMD at the lumbar spine in men. In contingency analyses between vertebral deformities and osteoporosis (WHO criteria; European young female BMD reference values), vertebral deformities proved to be highly specific by all methods, even slightly more so in men (87.8 to 97.5%) than in women (86.3 to 96.7%). The predictive value of a positive test with respect to vertebral osteoporosis reached a maximum value of about 50% in both sexes. It further increased up to 72%, when the definition of osteoporosis was based on low BMD values at either the spine or the femoral neck, but only in women. CONCLUSIONS: In conclusion, for both men and women the likelihood of vertebral deformities to be related to osteoporosis increases with the stringency of the morphometric method, with a similar probability of major deformities to represent vertebral osteoporotic fractures in men as in women. Nevertheless, even the most stringent morphometric criteria are not sufficiently valid instruments for the assessment of the prevalence of vertebral osteoporotic fractures in epidemiological studies.

Aged↗
PubMed1998

Musculoskeletal challenges of osteoporosis.

Reduction in the biomechanical competence of the axial skeleton can result in challenging complications. Osteoporosis consists of a heterogeneous group of syndromes in which bone mass per unit volume is reduced in otherwise normal bone, which results in more fragile bone. The geriatric population has an increased risk for debilitating postural changes because of several factors. The two most apparent factors are involutional loss of functional muscle motor units and the greater prevalence of osteoporosis in this population. Obviously, the main objective of rehabilitation is to prevent fractures rather than to treat the complications. These complications can vary from "silent" compression fractures of vertebral bodies, to sacral insufficiency fractures, to "breath-taking" fractures of the spine or femoral neck. The exponential loss of bone at the postmenopausal stage is not accompanied by an incremental loss of muscle strength. The loss of muscle strength follows a more gradual course and is not affected significantly by a sudden hormonal decline, as is the case with bone loss. This muscle loss may contribute to osteoporosis-related skeletal disfigurations. In men and women, the combination of aging and reduction of physical activity can affect musculoskeletal health, and contribute to the development of bone fragility. The parallel decline in muscle mass and bone mass with age is more than a coincidence, and inactivity may explain some of the bone loss previously associated with aging per se. Kyphotic postural change is the most physically disfiguring and psychologically damaging effect of osteoporosis and can contribute to an increment in vertebral fractures and the risk of falling. Axial skeletal fractures, such as fracture of the sacral alae (sacral insufficiency fracture) and pubic rami, may not be found until radiographic changes are detected. Management of chronic pain should include not only improvement of muscle strength and posture but also, at times, reduction of weight bearing on the painful pelvis with insufficiency fractures. Axial skeletal health can be assisted with improvement of muscular supportive strength. Disproportionate weakness in the back extensor musculature relative to body weight or flexor strength considerably increases the risk of compressing porous vertebrae. A proper exercise program, especially osteogenic exercises, can improve musculoskeletal health in osteoporotic patients. Exercise not only improves musculoskeletal health but also can reduce the chronic pain syndrome and decrease depression. Application of a proper back support can decrease kyphotic posturing and can expedite the patient's return to ambulatory activities. Measures that can increase safety during ambulatory activities can reduce risk of falls and fractures. Managing the musculoskeletal challenges of osteoporosis goes hand in hand with managing the psychological aspects of the disease.

Adult↗
PubMed1990

High turnover osteoporosis in acro-osteolysis (Hajdu-Cheney syndrome).

Acro-osteolysis with diffuse osteoporosis in the absence of other associated diseases is named Hajdu-Cheney syndrome. Reduced bone formation rather than enhanced bone resorption has been indicated as the mechanism of osteoporosis. On the assumption that in this syndrome the active bone resorption which produces distal osteolysis must also predominate in generalized osteoporosis, we investigated bone histology, calcium kinetics, calciotropic hormones and bone markers in a patient suffering from sporadic Hajdu-Cheney syndrome. A radius bone biopsy taken far from the osteolytic lesions showed severe osteoporosis with a marked increase in osteoclastic bone resorption and reduced bone formation. Total body calcium clearance, performed through an analysis of the kinetics of calcium infusion, was 2.8 times higher than in normal controls, indicating the presence of active osteoclastic bone resorption. Serum parathormone, 1,25-dihydroxycholecalciferol, alkaline phosphatase and urinary hydroxiproline were in the normal range. These data indicate that in Hajdu-Cheney syndrome trabecular osteoporosis is produced by the same mechanism that induces distal osteolysis, which suggests that it may be sustained by local acting factors stimulating osteoclastic resorption.

Adult↗
PubMed1999

[Osteoporosis in anorexia nervosa. New aspects of pathogenesis and therapy].

Osteoporosis has been shown to be a relatively common complication of anorexia nervosa (AN). So far the exact mechanisms which are implicated are not fully clarified. Several factors such as malnutrition, reduced body weight, amenorrhea, and hypercortisolaemia seem to be involved. There is a strong relationship with the duration of amenorrhea and--in some studies--with the age of onset. Osteoporosis is for a long time a "silent" disease and the first symptoms such as back pain, loss of height, kyphosis, and fractures are late complications. Therefore, routine screening methods for bone density measurements should be established. The most accurate is the dual energy X-ray absorptiometry (DEXA). Therapeutically the primary aim should be to reach restoration of both normal body weight and regular menses. As AN is a chronic disease clinicians should be aware of the dangers of osteoporosis and start with the treatment and/or prevention of osteoporosis early. However, at this stage it is difficult to provide an evidence-based management plan for osteoporosis in AN. Hormone replacement therapy (HRT) as well as calcium and vitamin D-supplementation are under discussion, however, further controlled investigations are warranted.

Absorptiometry, Photon↗
PubMed1999

[Pathophysiology and therapy of osteoporosis].

Osteoporosis is a heterogeneous disease of significant socioeconomic importance. In this paper the pathogenesis of postmenopausal and senile osteoporosis, osteoporosis in men and secondary osteoporosis is reviewed. Moreover, several aspects of the diagnosis and the treatment of osteoporosis (including calcium, vitamin D, vitamin D metabolites, estrogens, SERMs, bisphosphonates, calcitonin and fluorides) are discussed.

Estrogen Replacement Therapy↗