Osteoporosis in Men - The Effects of Gender on Skeletal Health

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Osteoporosis in Men: The Effects of Gender on Skeletal Health

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Contents

Contributors

Foreword

Preface

SECTION 1 Essentials of Bone Biology

CHAPTER 1 The Biochemistry of Bone: Composition and Organization

INTRODUCTION

BONE ORGANIZATION

BONE COMPOSITION: THE BONE COMPOSITE

HOW BONES CHANGE WITH AGE

ACKNOWLEDGMENTS

References

CHAPTER 2 Bone Remodeling: Cellular Activities in Bone

INTRODUCTION

CELLULAR MECHANISM OF BONE REMODELING

PHYSIOLOGICAL FUNCTIONS OF BONE REMODELING

VARIATION IN BONE REMODELING ACTIVITY THROUGHOUT THE SKELETON

References

CHAPTER 3 Assessment of Bone Turnover in Men Using Biochemical Markers

INTRODUCTION

NEW BIOCHEMICAL MARKERS OF BONE METABOLISM AND NEW ASSAYS

NEW TECHNOLOGIES FOR DISCOVERY AND ASSAY BONE MARKERS

FACTORS INFLUENCING BTM LEVELS IN MEN

CLINICAL APPLICATIONS OF BONE TURNOVER MARKERS IN MALE OSTEOPOROSIS

EFFECT OF ANTI-OSTEOPOROTIC TREATMENT ON BTM IN MEN

CONCLUSION

References

CHAPTER 4 Fundamentals of Mineral Homeostasis

INTRODUCTION

TOTAL BODY STORES OF ESSENTIAL MINERALS

EXTRACELLULAR MINERAL METABOLISM – CIRCULATING LEVELS

INTRACELLULAR MINERAL METABOLISM

MINERAL ION BALANCE

SUMMARY

References

CHAPTER 5 The Mechanical Properties of Bone

INTRODUCTION

THE IDEA OF HIERARCHY IN BONE MECHANICS

ANATOMICAL STRUCTURAL EFFECT

ULTRASTRUCTURE AND MICROSTRUCTURE AND EFFECTS ON MECHANICAL PROPERTIES

ULTRASTRUCTURE AND BONE MECHANICAL PROPERTIES

STRAIN RATE, FRACTURE PROPAGATION TOUGHNESS AND FATIGUE

THE COMPLETE DEPENDENCE ON DAMAGE REPAIR FOR MECHANICAL FUNCTION

References

CHAPTER 6 Essentials of Bone Biology: Assessment of Bone Architecture

INTRODUCTION

DXA AND RADIOGRAPHIC IMAGING

COMPUTED TOMOGRAPHY (CT)

ASSESSMENT OF BONE MINERAL DENSITY: QUANTITATIVE COMPUTED TOMOGRAPHY (QCT)

MEASUREMENT OF STRUCTURE AND BMD USING VOLUMETRIC CT IMAGES OF THE SPINE AND HIP

FINDINGS BASED ON VOLUMETRIC QCT ANALYSES

3D QCT OF THE VERTEBRAE

FINITE ELEMENT MODELING (FEM)

MICROCT METHODS

CONCLUSION

References

SECTION 2 Development and Growth of the Male Skeleton

CHAPTER 7 Skeletal Growth in Males

INTRODUCTION

GROWTH IN STATURE

GROWTH IN BONE STRUCTURE

SKELETAL FRAGILITY HAS ITS ORIGIN EARLY IN LIFE

MODELING AND REMODELING – MACHINERY OF TRACKING

BONE GROWTH AND GH-IGF-I/SEX HORMONES

SUMMARY

References

CHAPTER 8 Pubertal Growth of the Male Skeleton

INTRODUCTION

SKELETAL MATURATION

BONE MEASUREMENT TECHNIQUES IN CHILDREN

SKELETAL CHANGES DURING PUBERTY

PEAK BONE MASS

CONCLUSION

References

CHAPTER 9 The Effects of Sex Steroids on Bone Growth

INTRODUCTION

LONGITUDINAL AND RADIAL BONE GROWTH

BONE MASS ACQUISITION DURING CHILDHOOD AND ADOLESCENCE

CHANGES IN BONE SIZE BY PERIOSTEAL EXPANSION DURING GROWTH

RELEVANT CLINICAL OBSERVATIONS ON THE SEX STEROIDS' EFFECT ON BONE GROWTH

CONCLUSIONS

References

CHAPTER 10 Nutritional Basis of Skeletal Growth

INTRODUCTION

ASSESSING THE ROLE OF NUTRITION IN SKELETAL ACQUISITION

RELATIVE ROLE OF NUTRITION IN SKELETAL REQUISITION

MICRONUTRIENTS AND BONE GROWTH

DIETARY PATTERNS AND BONE GROWTH

DIET AND EXERCISE INTERACTIONS

NUTRITION AND PEDIATRIC DISORDERS

CONCLUSIONS

References

CHAPTER 11 Physical Activity and Skeletal Growth

INTRODUCTION

HOW DOES BONE ADAPT TO PHYSICAL ACTIVITY?

HOW TO MEASURE BONE ADAPTATION TO PHYSICAL ACTIVITY

WHAT TYPES OF PHYSICAL ACTIVITY PROMOTE BONE STRENGTH?

HOW DOES PHYSICAL ACTIVITY INFLUENCE THE NORMAL PATTERN OF BONE ACCRUAL IN BOYS?

WHAT HAVE WE LEARNED FROM CROSS-SECTIONAL STUDIES?

PROSPECTIVE OBSERVATIONAL STUDIES

WHAT HAVE WE LEARNED FROM EXERCISE INTERVENTION STUDIES?

DO THE BENEFITS OF PHYSICAL ACTIVITY PERSIST?

SUMMARY AND CONCLUSION

References

SECTION 3 Skeletal Genetics

CHAPTER 12 The Genetics of Peak Bone Mass

INTRODUCTION

LINKAGE STUDIES

ASSOCIATION STUDIES

ANIMAL STUDIES

References

SECTION 4 Aging and the Male Skeleton

CHAPTER 13 Age-related Changes in Bone Remodeling and Microarchitecture

INTRODUCTION

THE PROCESS AND PURPOSE OF BONE MODELING AND REMODELING

ABNORMALITIES IN BONE REMODELING DURING AGING

BONE LOSS DURING YOUNG ADULTHOOD, MENOPAUSE AND ADVANCED AGE

REDUCED PERIOSTEAL BONE FORMATION IN ADULTHOOD

SEX DIFFERENCES IN TRABECULAR AND CORTICAL BONE LOSS AND FRACTURE RATES

SUMMARY AND CONCLUSION

References

CHAPTER 14 Markers of Bone Remodeling and the Aging Skeleton

INTRODUCTION

AGE-RELATED CHANGES IN BONE MARKER LEVELS

BONE MARKERS, BONE LOSS AND FRACTURE RISK IN AGING MEN

THE RESPONSE OF BONE TURNOVER MARKERS TO PHARMACOLOGICAL INTERVENTIONS IN AGING MEN

CONCLUSION

References

CHAPTER 15 Alterations in Mineral Metabolism in the Aging Male

INTRODUCTION

CELLULAR CHANGES

AGE-RELATED HORMONAL CHANGES IN MINERAL METABOLISM

SUMMARY

References

CHAPTER 16 Changes in Bone Size and Geometry with Aging

RADIAL BONE GROWTH IN CHILDREN AND ADOLESCENTS

RADIAL BONE GROWTH DURING AGING

DETERMINANTS OF THE BONE SIZE AND AGE-RELATED CHANGES IN BONE GEOMETRY

AGE-RELATED CHANGES IN BONE SHAPE

WHY DO BONES GROW IN WIDTH AFTER CESSATION OF THE GROWTH IN LENGTH?

METHODOLOGICAL LIMITATIONS OF THE STUDIES ON THE AGE-RELATED CHANGES IN BONE SIZE

GENERAL CONCLUSIONS

ACKNOWLEDGMENTS

References

CHAPTER 17 Aging and Bone Loss

INTRODUCTION

UNDERSTANDING BONE LOSS WITH AGING IN MEN

QUANTIFYING BONE LOSS IN MEN

BONE LOSS WITH AGING IN MEN

FACTORS CONTRIBUTING TO BONE LOSS

PRACTICAL SCREENING FOR SIGNIFICANT MALE BONE LOSS AND OSTEOPOROSIS

SUMMARY

References

CHAPTER 18 The Effect of Age on Material Properties

INTRODUCTION

BIOMECHANICAL MATERIAL PROPERTIES OF THE SKELETON

CHANGES TO BIOMECHANICAL MATERIAL PROPERTIES WITH AGE

MINERAL EFFECTS IN AGE-RELATED MATERIAL PROPERTY ALTERATIONS

COLLAGEN EFFECTS IN AGE-RELATED MATERIAL PROPERTY ALTERATIONS

MICRODAMAGE EFFECTS IN AGE-RELATED MATERIAL PROPERTY ALTERATIONS

CONCLUSIONS

References

SECTION 5 Nutritional Issues

CHAPTER 19 Calcium, Bone Strength and Fractures

INTRODUCTION

CALCIUM PHYSIOLOGY

CALCIUM REQUIREMENTS

CALCIUM AND BONE STRENGTH

EVIDENCE OF CALCIUM'S EFFECT ON BMD IN ADULTS

CALCIUM AND FRACTURES

CHILDREN AND CALCIUM

CONCLUSION

References

CHAPTER 20 Vitamin D and Bone

INTRODUCTION

ORIGIN, METABOLISM, ACTION AND MODE OF ACTION

VITAMIN D AND BONE: BASIC MECHANISMS

VITAMIN D AND BONE: CLINICAL ASPECTS

SURROGATE ENDPOINTS

HARD ENDPOINTS

CHOICE OF VITAMIN D PRODUCT AND TREATMENT REGIMEN

OPTIMAL VITAMIN D STATUS VERSUS PRESENT WORLD REALITY

References

CHAPTER 21 Role of Dietary Protein in Bone Growth and Bone Loss

INTRODUCTION

DIETARY PROTEIN AND BONE GROWTH

DAIRY PRODUCTS AND BONE GROWTH

DIETARY PROTEIN AND BONE MINERAL MASS

DIETARY PROTEIN AND FRACTURE RISK

DIETARY PROTEIN AND BONE METABOLISM

EFFECTS OF PROTEIN INSUFFICIENCY CORRECTION

ACKNOWLEDGMENT

References

SECTION 6 Sex Steroids and the Skeleton in Men

CHAPTER 22 The Molecular Biology of Sex Steroids in Bone: Similarities and Differences among the Sexes

INTRODUCTION

GENERAL ASPECTS OF THE MECHANISMS OF SEX STEROID ACTION IN BONE CELLS

ESTROGEN AND ANDROGENS CONTROL OSTEOBLASTOGENESIS AND OSTEOCLASTOGENESIS

ESTROGEN AND ANDROGENS CONTROL BONE CELL SURVIVAL

OXIDATIVE STRESS AND THE CONTROL OF BONE MASS

ESTROGEN RECEPTOR SIGNALING AND MECHANOTRANSDUCTION

EFFECTS ON THE PERIOSTEUM

T CELLS AND THE REGULATION OF BONE RESORPTION

ER AND AR KNOCKOUT MODELS

References

CHAPTER 23 Estrogen and the Skeleton – Rodents

INTRODUCTION

ESTROGENS AND BONE GROWTH IN MALES

ESTROGENS AND BONE MAINTENANCE IN MALES

References

CHAPTER 24 Estrogen and the Skeleton – Humans

INTRODUCTION

ESTROGEN AND BONE GROWTH IN MEN

ESTROGEN AND BONE MAINTENANCE IN MEN

ESTROGEN AND FRACTURES IN MEN

References

CHAPTER 25 Androgens and Bone: Basic Aspects

INTRODUCTION

ANDROGENS AND THE ROLE OF ANDROGEN METABOLISM IN BONE

DHT

MECHANISMS OF ANDROGEN ACTION IN BONE: THE ANDROGEN RECEPTOR

MOLECULAR MECHANISMS OF ANDROGEN ACTION IN BONE CELLS: THE AR

LOCALIZATION OF AR EXPRESSION IN OSTEOBLASTIC POPULATIONS

REGULATION OF AR EXPRESSION

EFFECTS OF ANDROGENS ON THE PROLIFERATION AND DIFFERENTIATION OF OSTEOBLASTIC CELLS

ANDROGEN EFFECTS ON OSTEOCLASTS AND OTHER CELLS

ANDROGEN EFFECTS ON BONE: ANIMAL STUDIES

EFFECTS ON BONE GROWTH DURING SKELETAL DEVELOPMENT

EFFECTS ON EPIPHYSEAL FUNCTION DURING DEVELOPMENT

EFFECTS ON BONE MASS IN GROWING MALE ANIMALS: ANIMAL MODELS OF ALTERED ANDROGEN RESPONSIVENESS

EFFECTS ON THE PERIOSTEUM: THE ROLE OF AR VERSUS AROMATIZATION OF TESTOSTERONE

EFFECTS ON BONE MASS IN ADULTS: EFFECTS OF CASTRATION IN YOUNG AND ADULT ANIMALS

ANDROGENS IN THE FEMALE ANIMAL

EFFECTS OF REPLACEMENT SEX STEROIDS AFTER CASTRATION

SUMMARY

References

CHAPTER 26 Androgens and the Skeleton – Humans

INTRODUCTION

ANDROGENS AND BONE METABOLISM IN NORMAL MEN

BONE MINERAL DENSITY IN MEN WITH HYPOGONADISM OR OTHER DISORDERS OF ANDROGEN ACTION

EFFECTS OF ANDROGEN THERAPY ON SKELETAL INTEGRITY IN MEN

SUMMARY AND FUTURE DIRECTIONS

References

CHAPTER 27 Androgen Effects on the Skeletal Muscle

INTRODUCTION

EPIDEMIOLOGICAL STUDIES DEMONSTRATING THE RELATIONSHIP OF SERUM TESTOSTERONE CONCENTRATIONS AND MUSCLE MASS AND PHYSICAL FUNCTION

THE EFFECTS OF EXPERIMENTAL LOWERING OF ENDOGENOUS TESTOSTERONE CONCENTRATIONS ON BODY COMPOSITION

THE EFFECTS OF PHYSIOLOGIC TESTOSTERONE REPLACEMENT IN MODELS OF ANDROGEN DEFICIENCY

TESTOSTERONE DOSE-RESPONSE RELATIONSHIPS IN YOUNG AND OLDER MEN

INTERACTIVE EFFECTS OF TESTOSTERONE AND RESISTANCE EXERCISE TRAINING

RANDOMIZED CLINICAL TRIALS OF TESTOSTERONE IN OLDER MEN WITH LOW OR LOW NORMAL TESTOSTERONE LEVELS

EFFECTS OF ANDROGEN REPLACEMENT ON BODY COMPOSITION AND MUSCLE PERFORMANCE IN MEN WITH CHRONIC ILLNESS

TESTOSTERONE EFFECTS ON FATIGUE/ENERGY, SENSE OF WELL-BEING AND QUALITY OF LIFE

REACTION TIME

MECHANISMS OF TESTOSTERONE EFFECTS ON SKELETAL MUSCLE

HOW TESTOSTERONE EFFECTS ON THE SKELETAL MUSCLE–BONE UNIT MAY AFFECT FRACTURE RISK

ACHIEVING TISSUE SELECTIVITY OF TESTOSTERONE EFFECTS

CONCLUSION

References

SECTION 7 Fractures in Men

CHAPTER 28 Epidemiology of Fractures

INTRODUCTION

OVERALL FRACTURE INCIDENCE IN MEN

DIFFERENCES IN FRACTURE INCIDENCE PATTERNS BETWEEN MEN AND WOMEN

OSTEOPOROTIC FRACTURES IN MEN

FRACTURES AT SPECIFIC BONE SITES

BONE DENSITY AND FRACTURE RISK IN MEN

SUMMARY

References

CHAPTER 29 Individualized Prognosis of Fracture in Men

MAGNITUDE OF THE PROBLEM

RISK FACTORS OF FRAGILITY FRACTURE

PROGNOSIS

CONCLUSION

References

CHAPTER 30 Physical Activity, Physical Function and Fall and Fracture Risk in Older Men

INTRODUCTION

PHYSICAL ACTIVITY

PHYSICAL FUNCTION AND PERFORMANCE

References

CHAPTER 31 Economic Impact of Osteoporotic Fractures (versus Women)

BACKGROUND

COST OF ILLNESS STUDIES

GENDER DIFFERENCES IN ECONOMIC IMPACT

METHODOLOGIC APPROACHES TO DEFINING COST OF ILLNESS

ECONOMIC IMPACT OF OSTEOPOROTIC FRACTURES

SUMMARY

References

CHAPTER 32 Adverse Health Outcomes in Men with Osteoporosis

INTRODUCTION

MORBIDITY IN MEN AFTER OSTEOPOROTIC FRACTURES

PSYCHOSOCIAL CONSEQUENCES OF OSTEOPOROTIC FRACTURES IN MEN

MORTALITY IN MEN AFTER OSTEOPOROTIC FRACTURE

CONCLUSIONS

References

SECTION 8 Metabolic Bone Disease in Men

CHAPTER 33 Idiopathic Osteoporosis

INTRODUCTION

DIAGNOSIS

CLINICAL PRESENTATION AND PHENOTYPE

PHYSIOPATHOLOGY AND GENETICS

TREATMENT

AREAS FOR FURTHER RESEARCH

ACKNOWLEDGMENTS

References

CHAPTER 34 Glucocorticoid-induced Osteoporosis

EPIDEMIOLOGY

PATHOPHYSIOLOGY

DIAGNOSIS

THERAPY

CONCLUSIONS

References

CHAPTER 35 Testicular Dysfunction

INTRODUCTION

GONADAL STEROID ACTION

SKELETAL HEALTH IN ANDROGEN DEFICIENCY AT VARIOUS AGES

References

CHAPTER 36 Alcohol Use and Bone Health in Men

INTRODUCTION

ALCOHOL PHYSIOLOGY

EPIDEMIOLOGY

MODERATION; IS LESS MORE?

ALCOHOL IMPACTS ON BONE AND CALCIUM HOMEOSTASIS

BONE MINERAL DENSITY (BMD)

ALCOHOL, FALLS AND FRACTURES IN MEN

ISSUES CONFOUNDING STUDIES OF ALCOHOL USE

CONCLUSION

References

CHAPTER 37 Transplantation Osteoporosis

INTRODUCTION

SKELETAL EFFECTS OF IMMUNOSUPPRESSIVE DRUGS

EFFECT OF TRANSPLANTATION ON BONE AND MINERAL METABOLISM

EVALUATION AND MANAGEMENT OF CANDIDATES FOR TRANSPLANTATION

PREVENTION OF TRANSPLANTATION OSTEOPOROSIS (TABLE 37.3)

SUMMARY AND CONCLUSIONS

References

CHAPTER 38 Management of Fractures in Men with Impaired Renal Function

INTRODUCTION

DIAGNOSIS OF OSTEOPOROSIS IN STAGE 1–3 CHRONIC KIDNEY DISEASE

DIAGNOSIS OF OSTEOPOROSIS IN STAGE 5–5D CKD

BIOCHEMICAL MARKERS OF BONE METABOLISM

QUANTITATIVE BONE HISTOMORPHOMETRY

TREATMENT OF OSTEOPOROSIS IN CKD

CONCLUSIONS

References

CHAPTER 39 Primary Hyperparathyroidism in Men

INTRODUCTION

EPIDEMIOLOGY

ETIOLOGY

PATHOLOGY

SIGNS AND SYMPTOMS

CLINICAL PRESENTATION

EVALUATION AND DIAGNOSIS

PARATHYROID IMAGING

NATURAL HISTORY OF MILD PHPT

SURGICAL TREATMENT

CLINICAL COURSE AFTER SURGERY

MEDICAL MANAGEMENT

SUMMARY

References

CHAPTER 40 Hypercalciuria

INTRODUCTION

CLINICAL BONE DISEASE

DEFINITION OF HYPERCALCIURIA

SERUM 1,25D LEVELS

RELATIONSHIP BETWEEN URINE CA AND BONE LOSS

BONE PATHOGENESIS

CALCIUM METABOLISM

DIETARY FACTORS

TREATMENT

References

CHAPTER 41 The Skeletal Phenotype of the Male Athlete

INTRODUCTION

PRINCIPLES OF LOADING

MEASUREMENT OF BONE LOADING AND BONE MASS

HORMONAL DETERMINANTS OF SKELETAL MASS

ENVIRONMENTAL AND NUTRITIONAL DETERMINANTS OF SKELETAL HEALTH IN MALE ATHLETES

COMPARISON OF MALE ATHLETES TO THE FEMALE TRIAD

USE OF ANDROGENIC AND ANABOLIC STEROIDS IN ATHLETICS

BONE MASS AND STRESS FRACTURES IN MALE ATHLETES: A REVIEW OF THE LITERATURE

CONCLUSIONS

References

CHAPTER 42 Inherited and Related Disorders of Bone Matrix Synthesis in Men

INTRODUCTION

INHERITED DEFECTS IN COLLAGEN SYNTHESIS (TABLE 42.2)

MARFAN SYNDROME AND OSTEOPOROSIS

HYPOPHOSPHATASIA IN THE ADULT MALE

FIBROUS DYSPLASIA IN ADULT MALES

OSTEOPOROSIS RELATED TO INHERITED DEFECTS IN COPPER TRANSPORT: MENKES' DISEASE, OCCIPITAL HORN SYNDROME, WILSON DISEASE

HEMOCHROMATOSIS AND OSTEOPOROSIS IN MEN

HOMOCYSTINURIA

INHERITED DEFECTS IN NEUROTROPIC FACTORS RELATED TO BONE

References

SECTION 9 Diagnostic Approach

CHAPTER 43 Dual-Energy X-ray Absorptiometry (DXA) in Men

INTRODUCTION/ BACKGROUND

DUAL-ENERGY X-RAY (DXA) TECHNOLOGY

UNDERSTANDING DXA RESULTS

WHAT SKELETAL SITES TO MEASURE

PITFALLS IN DXA

DXA NORMATIVE DATABASES

CLINICAL USE OF DXA: DIAGNOSIS, MONITORING AND FRACTURE RISK ASSESSMENT

INDICATIONS FOR DXA TESTING IN MEN

VERTEBRAL FRACTURE ASSESSMENT

SUMMARY

References

CHAPTER 44 Quantitative Ultrasound Diagnosis of Osteoporosis in Men

PRINCIPLES OF QUANTITATIVE ULTRASOUND

USE OF QUS TO PREDICT FRACTURE IN MEN

USE OF QUS TO PREDICT WHEN TO OBTAIN DXA IN MEN

MONITORING THERAPY WITH QUS

CONCLUSIONS

References

CHAPTER 45 Advanced Structural Assessment of Bone Using CT and MRI

INTRODUCTION

QCT AND MDCT-BASED STRUCTURAL ANALYSES IN THE DIAGNOSTICS AND MONITORING OF OSTEOPOROSIS PATIENTS

?CT IMAGING AND INDIVIDUAL TRABECULAE SEGMENTATION (ITS)-BASED MORPHOLOGICAL ANALYSIS

HIGH RESOLUTION PERIPHERAL QUANTITATIVE CT (HR-PQCT)

MAGNETIC RESONANCE IMAGING (MRI)

IMAGE-BASED FEA

CONCLUSION

ACKNOWLEDGMENTS

References

CHAPTER 46 Diagnostic Approach: Vertebral Fracture Assessments

INTRODUCTION

PROBLEMS ASSOCIATED WITH IDENTIFICATION OF PREVALENT AND INCIDENT VF

WHY ARE VERTEBRAL FRACTURES RELEVANT IN MEN?

ESTABLISH THE PRESENCE OF VF: WHEN IS A DEFORMITY A TRUE OSTEOPOROTIC FRACTURE?

IMAGING APPROACHES FOR THE IDENTIFICATION OF VF

ADDITIONAL AREAS FOR RESEARCH

CONCLUSIONS

References

CHAPTER 47 The Use of Bone Biopsies in the Diagnosis of Male Osteoporosis

INTRODUCTION

AGE-DEPENDENT CHANGES IN BONE PROPERTIES IN FEMALES

CHANGES IN BONE REMODELING WITH AGE IN MALES

CHANGES IN BONE STRUCTURE WITH AGING IN MALES AND FEMALES

HISTOMORPHOMETRY IN MALE OSTEOPOROSIS

SECONDARY OSTEOPOROSIS

INDICATIONS FOR BONE BIOPSIES IN MALE OSTEOPOROSIS

FUTURE ASPECTS

CONCLUSION

References

CHAPTER 48 Overall Approach to the Evaluation and Treatment of Osteoporosis in Men

DIAGNOSTIC CONSIDERATIONS

TREATMENT CONSIDERATIONS

References

SECTION 10 Therapy

CHAPTER 49 Diagnostic Thresholds for Osteoporosis in Men

INTRODUCTION

DIAGNOSIS OF OSTEOPOROSIS

DIAGNOSTIC CRITERIA FOR MEN

NORMATIVE REFERENCE RANGES

LIMITATIONS

References

CHAPTER 50 Cost-Effectiveness of Interventions to Reduce Osteoporosis-Related Fractures in Men: Current Data, Controversies, and Challenges

INTRODUCTION

CHARACTERISTICS OF GOOD HEALTH ECONOMIC MODELING STUDIES

REVIEW OF COST-EFFECTIVENESS STUDIES IN MEN

CONTROVERSIES AND CHALLENGES IN HEALTH ECONOMIC MODELING OF FRACTURE PREVENTION STRATEGIES

CONCLUSIONS

References

CHAPTER 51 Nutritional Therapy for Skeletal Health in Men

INTRODUCTION

MACRONUTRIENTS

CALCIUM AND VITAMIN D

OTHER NUTRIENTS

CONCLUSION

References

CHAPTER 52 Exercise Programs for Patients with Osteoporosis

GOALS OF EXERCISE IN PATIENTS WITH OSTEOPOROSIS

PITFALLS IN ASSESSING EXERCISE INTERVENTIONS

THE ROLE OF PHYSICS, ANATOMY AND PHYSIOLOGY FOR DESIGNING AND ASSESSING EXERCISE INTERVENTIONS

BONE STRENGTH AND FALL RISK: TWO DIFFERENT GOALS, TWO DIFFERENT RELATIONSHIPS TO MUSCLE

BIPEDAL LOCOMOTION AND ONE-LEG-STANDING

THE SKELETON AS TENSEGRITY STRUCTURE

DXA–BMD AS OUTCOME PARAMETER OF EXERCISE INTERVENTIONS

RELATIONSHIPS BETWEEN MUSCLE AND BONE: THE MUSCLE–BONE UNIT

CORRELATIONS OF PHYSICAL ACTIVITY AND LOCOMOTOR PERFORMANCES WITH FRACTURES, FALLS AND ONSET OF DISABILITY

SARCOPENIA AND AGE-ASSOCIATED FUNCTIONAL DECLINE

OSTEOPOROSIS-RELATED FRACTURES AND FALLS

EXERCISE INTERVENTIONS AND BONE STRENGTH

EFFECT OF EXERCISE INTERVENTION ON MUSCLE STRUCTURE AND MUSCLE FUNCTION

EFFECT OF EXERCISE INTERVENTIONS ON RISK FACTORS FOR FALLS, FRACTURES AND ONSET OF DISABILITY

EXERCISE INTERVENTIONS AND FALL PREVENTION

WHOLE BODY VIBRATION

RISK OF EXERCISES

RECOMMENDATIONS FOR DESIGNING AND PRESCRIBING EXERCISE PROGRAMS FOR PATIENTS WITH OSTEOPOROSIS

FUTURE DEVELOPMENTS AND DEMANDS

References

CHAPTER 53 Calcitonin: History, Physiology, Pathophysiology and Therapeutic Applications

INTRODUCTION

SYNTHESIS AND LOCALIZATION

STRUCTURE OF CALCITONIN AND ITS MEASUREMENTS

PHYSIOLOGICAL ROLE OF CALCITONIN

BIOLOGICAL EFFECTS OF CALCITONIN

CLINICAL PHARMACOLOGY

COMMERCIALLY AVAILABLE CALCITONIN PREPARATIONS

THERAPEUTIC USES

References

CHAPTER 54 Treatment of Male Osteoporosis with Bisphosphonates

INTRODUCTION

PHARMACOLOGY OF BISPHOSPHONATES

DO MEN RESPOND DIFFERENTLY TO BISPHOSPHONATES?

BISPHOSPHONATES IN MEN WITH PRIMARY OSTEOPOROSIS

BISPHOSPHONATES IN MEN WITH SECONDARY OSTEOPOROSIS

SPECIAL ISSUES RELATED TO TREATMENT OF MALE OSTEOPOROSIS WITH BPS

CONCLUSIONS

References

CHAPTER 55 Treatment of Male Osteoporosis with Parathyroid Hormone

INTRODUCTION

ANABOLIC ACTIONS OF PARATHYROID HORMONE

INDICATIONS FOR TERIPARATIDE USE

TERIPARATIDE IN MALE OSTEOPOROSIS

COMBINATION OR SEQUENTIAL THERAPY WITH PTH AND AN ANTI-RESORPTIVE AGENT

ANTI-RESORPTIVE USE PRIOR TO PTH THERAPY

CONSEQUENCES OF DISCONTINUING PTH THERAPY

SAFETY OF PTH

FUTURE CONSIDERATIONS

CONCLUSIONS

References

CHAPTER 56 Testosterone Therapy for Osteoporosis in Men

INTRODUCTION

THE MAGNITUDE OF THE PROBLEM

MARKERS OF FRACTURE RISK

MECHANISMS BY WHICH TESTOSTERONE INFLUENCES MUSCLE AND BONE

STUDIES ON THE ASSOCIATION BETWEEN TESTOSTERONE AND MUSCLE AND BONE IN MEN

DIAGNOSIS OF HYPOGONADISM/ANDROGEN DEFICIENCY

EPIDEMIOLOGY OF ANDROGEN DEFICIENCY AND CO-PREVALENCE WITH OSTEOPOROSIS

TESTOSTERONE PREPARATIONS

STRATEGIES TO MINIMIZE RISK OF ADVERSE EFFECTS

TESTOSTERONE ADMINISTRATION AND MONITORING

BMD

USE OF TESTOSTERONE THERAPY IN MEN AT RISK FOR OSTEOPOROSIS AND FRACTURE

SELECTIVE ANDROGEN RECEPTOR MODULATORS (SARMS)

ACKNOWLEDGMENTS

References

CHAPTER 57 Future Therapies: Strontium, SERMs, SARMs and New Therapies on the Horizon

INTRODUCTION

STRONTIUM

SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS)

SELECTIVE ANDROGEN RECEPTOR MODULATORS (SARMS)

NEW THERAPIES ON THE HORIZON

CONCLUSION

ACKNOWLEDGMENTS

Glossary of abbreviations

References

Index

A

B

C

D

E

F

G

H

I

K

L

M

N

O

P

Q

R

S

T

U

V

W

Y

Color Plates