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Osteoporosis in Men - The Effects of Gender on Skeletal Health
Eric S. Orwoll, John P. Bilezikian, Dirk Vanderschueren
Verlag Elsevier Reference Monographs, 2009
ISBN 9780080923468 , 764 Seiten
2. Auflage
Format PDF, ePUB, OL
Kopierschutz DRM
Front Cover
1
Osteoporosis in Men: The Effects of Gender on Skeletal Health
4
Copyright Page
5
Contents
6
Contributors
10
Foreword
14
Preface
16
SECTION 1 Essentials of Bone Biology
18
CHAPTER 1 The Biochemistry of Bone: Composition and Organization
20
INTRODUCTION
20
BONE ORGANIZATION
20
BONE COMPOSITION: THE BONE COMPOSITE
22
HOW BONES CHANGE WITH AGE
26
ACKNOWLEDGMENTS
27
References
27
CHAPTER 2 Bone Remodeling: Cellular Activities in Bone
32
INTRODUCTION
32
CELLULAR MECHANISM OF BONE REMODELING
32
PHYSIOLOGICAL FUNCTIONS OF BONE REMODELING
37
VARIATION IN BONE REMODELING ACTIVITY THROUGHOUT THE SKELETON
38
References
39
CHAPTER 3 Assessment of Bone Turnover in Men Using Biochemical Markers
42
INTRODUCTION
42
NEW BIOCHEMICAL MARKERS OF BONE METABOLISM AND NEW ASSAYS
42
NEW TECHNOLOGIES FOR DISCOVERY AND ASSAY BONE MARKERS
46
FACTORS INFLUENCING BTM LEVELS IN MEN
46
CLINICAL APPLICATIONS OF BONE TURNOVER MARKERS IN MALE OSTEOPOROSIS
48
EFFECT OF ANTI-OSTEOPOROTIC TREATMENT ON BTM IN MEN
50
CONCLUSION
53
References
53
CHAPTER 4 Fundamentals of Mineral Homeostasis
58
INTRODUCTION
58
TOTAL BODY STORES OF ESSENTIAL MINERALS
58
EXTRACELLULAR MINERAL METABOLISM – CIRCULATING LEVELS
59
INTRACELLULAR MINERAL METABOLISM
64
MINERAL ION BALANCE
65
SUMMARY
66
References
67
CHAPTER 5 The Mechanical Properties of Bone
68
INTRODUCTION
68
THE IDEA OF HIERARCHY IN BONE MECHANICS
68
ANATOMICAL STRUCTURAL EFFECT
69
ULTRASTRUCTURE AND MICROSTRUCTURE AND EFFECTS ON MECHANICAL PROPERTIES
75
ULTRASTRUCTURE AND BONE MECHANICAL PROPERTIES
75
STRAIN RATE, FRACTURE PROPAGATION TOUGHNESS AND FATIGUE
79
THE COMPLETE DEPENDENCE ON DAMAGE REPAIR FOR MECHANICAL FUNCTION
82
References
82
CHAPTER 6 Essentials of Bone Biology: Assessment of Bone Architecture
86
INTRODUCTION
86
DXA AND RADIOGRAPHIC IMAGING
87
COMPUTED TOMOGRAPHY (CT)
88
ASSESSMENT OF BONE MINERAL DENSITY: QUANTITATIVE COMPUTED TOMOGRAPHY (QCT)
89
MEASUREMENT OF STRUCTURE AND BMD USING VOLUMETRIC CT IMAGES OF THE SPINE AND HIP
89
FINDINGS BASED ON VOLUMETRIC QCT ANALYSES
90
3D QCT OF THE VERTEBRAE
91
FINITE ELEMENT MODELING (FEM)
92
MICROCT METHODS
93
CONCLUSION
94
References
95
SECTION 2 Development and Growth of the Male Skeleton
100
CHAPTER 7 Skeletal Growth in Males
102
INTRODUCTION
102
GROWTH IN STATURE
102
GROWTH IN BONE STRUCTURE
103
SKELETAL FRAGILITY HAS ITS ORIGIN EARLY IN LIFE
105
MODELING AND REMODELING – MACHINERY OF TRACKING
106
BONE GROWTH AND GH-IGF-I/SEX HORMONES
106
SUMMARY
107
References
107
CHAPTER 8 Pubertal Growth of the Male Skeleton
112
INTRODUCTION
112
SKELETAL MATURATION
112
BONE MEASUREMENT TECHNIQUES IN CHILDREN
113
SKELETAL CHANGES DURING PUBERTY
115
PEAK BONE MASS
117
CONCLUSION
117
References
118
CHAPTER 9 The Effects of Sex Steroids on Bone Growth
122
INTRODUCTION
122
LONGITUDINAL AND RADIAL BONE GROWTH
122
BONE MASS ACQUISITION DURING CHILDHOOD AND ADOLESCENCE
124
CHANGES IN BONE SIZE BY PERIOSTEAL EXPANSION DURING GROWTH
126
RELEVANT CLINICAL OBSERVATIONS ON THE SEX STEROIDS' EFFECT ON BONE GROWTH
131
CONCLUSIONS
132
References
132
CHAPTER 10 Nutritional Basis of Skeletal Growth
136
INTRODUCTION
136
ASSESSING THE ROLE OF NUTRITION IN SKELETAL ACQUISITION
136
RELATIVE ROLE OF NUTRITION IN SKELETAL REQUISITION
137
MICRONUTRIENTS AND BONE GROWTH
138
DIETARY PATTERNS AND BONE GROWTH
141
DIET AND EXERCISE INTERACTIONS
142
NUTRITION AND PEDIATRIC DISORDERS
142
CONCLUSIONS
143
References
144
CHAPTER 11 Physical Activity and Skeletal Growth
148
INTRODUCTION
148
HOW DOES BONE ADAPT TO PHYSICAL ACTIVITY?
149
HOW TO MEASURE BONE ADAPTATION TO PHYSICAL ACTIVITY
150
WHAT TYPES OF PHYSICAL ACTIVITY PROMOTE BONE STRENGTH?
150
HOW DOES PHYSICAL ACTIVITY INFLUENCE THE NORMAL PATTERN OF BONE ACCRUAL IN BOYS?
150
WHAT HAVE WE LEARNED FROM CROSS-SECTIONAL STUDIES?
151
PROSPECTIVE OBSERVATIONAL STUDIES
152
WHAT HAVE WE LEARNED FROM EXERCISE INTERVENTION STUDIES?
153
DO THE BENEFITS OF PHYSICAL ACTIVITY PERSIST?
159
SUMMARY AND CONCLUSION
160
References
161
SECTION 3 Skeletal Genetics
164
CHAPTER 12 The Genetics of Peak Bone Mass
166
INTRODUCTION
166
LINKAGE STUDIES
168
ASSOCIATION STUDIES
170
ANIMAL STUDIES
175
References
177
SECTION 4 Aging and the Male Skeleton
182
CHAPTER 13 Age-related Changes in Bone Remodeling and Microarchitecture
184
INTRODUCTION
184
THE PROCESS AND PURPOSE OF BONE MODELING AND REMODELING
184
ABNORMALITIES IN BONE REMODELING DURING AGING
186
BONE LOSS DURING YOUNG ADULTHOOD, MENOPAUSE AND ADVANCED AGE
188
REDUCED PERIOSTEAL BONE FORMATION IN ADULTHOOD
190
SEX DIFFERENCES IN TRABECULAR AND CORTICAL BONE LOSS AND FRACTURE RATES
191
SUMMARY AND CONCLUSION
192
References
193
CHAPTER 14 Markers of Bone Remodeling and the Aging Skeleton
196
INTRODUCTION
196
AGE-RELATED CHANGES IN BONE MARKER LEVELS
196
BONE MARKERS, BONE LOSS AND FRACTURE RISK IN AGING MEN
198
THE RESPONSE OF BONE TURNOVER MARKERS TO PHARMACOLOGICAL INTERVENTIONS IN AGING MEN
199
CONCLUSION
199
References
199
CHAPTER 15 Alterations in Mineral Metabolism in the Aging Male
202
INTRODUCTION
202
CELLULAR CHANGES
202
AGE-RELATED HORMONAL CHANGES IN MINERAL METABOLISM
202
SUMMARY
207
References
208
CHAPTER 16 Changes in Bone Size and Geometry with Aging
210
RADIAL BONE GROWTH IN CHILDREN AND ADOLESCENTS
210
RADIAL BONE GROWTH DURING AGING
211
DETERMINANTS OF THE BONE SIZE AND AGE-RELATED CHANGES IN BONE GEOMETRY
212
AGE-RELATED CHANGES IN BONE SHAPE
216
WHY DO BONES GROW IN WIDTH AFTER CESSATION OF THE GROWTH IN LENGTH?
217
METHODOLOGICAL LIMITATIONS OF THE STUDIES ON THE AGE-RELATED CHANGES IN BONE SIZE
219
GENERAL CONCLUSIONS
220
ACKNOWLEDGMENTS
220
References
220
CHAPTER 17 Aging and Bone Loss
224
INTRODUCTION
224
UNDERSTANDING BONE LOSS WITH AGING IN MEN
224
QUANTIFYING BONE LOSS IN MEN
224
BONE LOSS WITH AGING IN MEN
227
FACTORS CONTRIBUTING TO BONE LOSS
230
PRACTICAL SCREENING FOR SIGNIFICANT MALE BONE LOSS AND OSTEOPOROSIS
233
SUMMARY
234
References
234
CHAPTER 18 The Effect of Age on Material Properties
238
INTRODUCTION
238
BIOMECHANICAL MATERIAL PROPERTIES OF THE SKELETON
238
CHANGES TO BIOMECHANICAL MATERIAL PROPERTIES WITH AGE
240
MINERAL EFFECTS IN AGE-RELATED MATERIAL PROPERTY ALTERATIONS
241
COLLAGEN EFFECTS IN AGE-RELATED MATERIAL PROPERTY ALTERATIONS
243
MICRODAMAGE EFFECTS IN AGE-RELATED MATERIAL PROPERTY ALTERATIONS
244
CONCLUSIONS
245
References
246
SECTION 5 Nutritional Issues
250
CHAPTER 19 Calcium, Bone Strength and Fractures
252
INTRODUCTION
252
CALCIUM PHYSIOLOGY
252
CALCIUM REQUIREMENTS
253
CALCIUM AND BONE STRENGTH
254
EVIDENCE OF CALCIUM'S EFFECT ON BMD IN ADULTS
254
CALCIUM AND FRACTURES
255
CHILDREN AND CALCIUM
256
CONCLUSION
257
References
257
CHAPTER 20 Vitamin D and Bone
260
INTRODUCTION
260
ORIGIN, METABOLISM, ACTION AND MODE OF ACTION
260
VITAMIN D AND BONE: BASIC MECHANISMS
261
VITAMIN D AND BONE: CLINICAL ASPECTS
263
SURROGATE ENDPOINTS
263
HARD ENDPOINTS
264
CHOICE OF VITAMIN D PRODUCT AND TREATMENT REGIMEN
266
OPTIMAL VITAMIN D STATUS VERSUS PRESENT WORLD REALITY
266
References
267
CHAPTER 21 Role of Dietary Protein in Bone Growth and Bone Loss
272
INTRODUCTION
272
DIETARY PROTEIN AND BONE GROWTH
272
DAIRY PRODUCTS AND BONE GROWTH
273
DIETARY PROTEIN AND BONE MINERAL MASS
274
DIETARY PROTEIN AND FRACTURE RISK
274
DIETARY PROTEIN AND BONE METABOLISM
275
EFFECTS OF PROTEIN INSUFFICIENCY CORRECTION
277
ACKNOWLEDGMENT
278
References
278
SECTION 6 Sex Steroids and the Skeleton in Men
284
CHAPTER 22 The Molecular Biology of Sex Steroids in Bone: Similarities and Differences among the Sexes
286
INTRODUCTION
286
GENERAL ASPECTS OF THE MECHANISMS OF SEX STEROID ACTION IN BONE CELLS
287
ESTROGEN AND ANDROGENS CONTROL OSTEOBLASTOGENESIS AND OSTEOCLASTOGENESIS
287
ESTROGEN AND ANDROGENS CONTROL BONE CELL SURVIVAL
290
OXIDATIVE STRESS AND THE CONTROL OF BONE MASS
291
ESTROGEN RECEPTOR SIGNALING AND MECHANOTRANSDUCTION
292
EFFECTS ON THE PERIOSTEUM
293
T CELLS AND THE REGULATION OF BONE RESORPTION
293
ER AND AR KNOCKOUT MODELS
294
References
294
CHAPTER 23 Estrogen and the Skeleton – Rodents
300
INTRODUCTION
300
ESTROGENS AND BONE GROWTH IN MALES
300
ESTROGENS AND BONE MAINTENANCE IN MALES
302
References
302
CHAPTER 24 Estrogen and the Skeleton – Humans
306
INTRODUCTION
306
ESTROGEN AND BONE GROWTH IN MEN
306
ESTROGEN AND BONE MAINTENANCE IN MEN
307
ESTROGEN AND FRACTURES IN MEN
308
References
309
CHAPTER 25 Androgens and Bone: Basic Aspects
312
INTRODUCTION
312
ANDROGENS AND THE ROLE OF ANDROGEN METABOLISM IN BONE
312
DHT
312
MECHANISMS OF ANDROGEN ACTION IN BONE: THE ANDROGEN RECEPTOR
315
MOLECULAR MECHANISMS OF ANDROGEN ACTION IN BONE CELLS: THE AR
315
LOCALIZATION OF AR EXPRESSION IN OSTEOBLASTIC POPULATIONS
316
REGULATION OF AR EXPRESSION
318
EFFECTS OF ANDROGENS ON THE PROLIFERATION AND DIFFERENTIATION OF OSTEOBLASTIC CELLS
320
ANDROGEN EFFECTS ON OSTEOCLASTS AND OTHER CELLS
322
ANDROGEN EFFECTS ON BONE: ANIMAL STUDIES
323
EFFECTS ON BONE GROWTH DURING SKELETAL DEVELOPMENT
323
EFFECTS ON EPIPHYSEAL FUNCTION DURING DEVELOPMENT
323
EFFECTS ON BONE MASS IN GROWING MALE ANIMALS: ANIMAL MODELS OF ALTERED ANDROGEN RESPONSIVENESS
324
EFFECTS ON THE PERIOSTEUM: THE ROLE OF AR VERSUS AROMATIZATION OF TESTOSTERONE
326
EFFECTS ON BONE MASS IN ADULTS: EFFECTS OF CASTRATION IN YOUNG AND ADULT ANIMALS
326
ANDROGENS IN THE FEMALE ANIMAL
328
EFFECTS OF REPLACEMENT SEX STEROIDS AFTER CASTRATION
328
SUMMARY
329
References
329
CHAPTER 26 Androgens and the Skeleton – Humans
336
INTRODUCTION
336
ANDROGENS AND BONE METABOLISM IN NORMAL MEN
336
BONE MINERAL DENSITY IN MEN WITH HYPOGONADISM OR OTHER DISORDERS OF ANDROGEN ACTION
341
EFFECTS OF ANDROGEN THERAPY ON SKELETAL INTEGRITY IN MEN
344
SUMMARY AND FUTURE DIRECTIONS
347
References
347
CHAPTER 27 Androgen Effects on the Skeletal Muscle
352
INTRODUCTION
352
EPIDEMIOLOGICAL STUDIES DEMONSTRATING THE RELATIONSHIP OF SERUM TESTOSTERONE CONCENTRATIONS AND MUSCLE MASS AND PHYSICAL FUNCTION
352
THE EFFECTS OF EXPERIMENTAL LOWERING OF ENDOGENOUS TESTOSTERONE CONCENTRATIONS ON BODY COMPOSITION
353
THE EFFECTS OF PHYSIOLOGIC TESTOSTERONE REPLACEMENT IN MODELS OF ANDROGEN DEFICIENCY
353
TESTOSTERONE DOSE-RESPONSE RELATIONSHIPS IN YOUNG AND OLDER MEN
353
INTERACTIVE EFFECTS OF TESTOSTERONE AND RESISTANCE EXERCISE TRAINING
354
RANDOMIZED CLINICAL TRIALS OF TESTOSTERONE IN OLDER MEN WITH LOW OR LOW NORMAL TESTOSTERONE LEVELS
354
EFFECTS OF ANDROGEN REPLACEMENT ON BODY COMPOSITION AND MUSCLE PERFORMANCE IN MEN WITH CHRONIC ILLNESS
355
TESTOSTERONE EFFECTS ON FATIGUE/ENERGY, SENSE OF WELL-BEING AND QUALITY OF LIFE
357
REACTION TIME
357
MECHANISMS OF TESTOSTERONE EFFECTS ON SKELETAL MUSCLE
357
HOW TESTOSTERONE EFFECTS ON THE SKELETAL MUSCLE–BONE UNIT MAY AFFECT FRACTURE RISK
359
ACHIEVING TISSUE SELECTIVITY OF TESTOSTERONE EFFECTS
359
CONCLUSION
360
References
360
SECTION 7 Fractures in Men
366
CHAPTER 28 Epidemiology of Fractures
368
INTRODUCTION
368
OVERALL FRACTURE INCIDENCE IN MEN
368
DIFFERENCES IN FRACTURE INCIDENCE PATTERNS BETWEEN MEN AND WOMEN
368
OSTEOPOROTIC FRACTURES IN MEN
369
FRACTURES AT SPECIFIC BONE SITES
370
BONE DENSITY AND FRACTURE RISK IN MEN
373
SUMMARY
374
References
374
CHAPTER 29 Individualized Prognosis of Fracture in Men
378
MAGNITUDE OF THE PROBLEM
378
RISK FACTORS OF FRAGILITY FRACTURE
380
PROGNOSIS
382
CONCLUSION
386
References
386
CHAPTER 30 Physical Activity, Physical Function and Fall and Fracture Risk in Older Men
392
INTRODUCTION
392
PHYSICAL ACTIVITY
392
PHYSICAL FUNCTION AND PERFORMANCE
395
References
399
CHAPTER 31 Economic Impact of Osteoporotic Fractures (versus Women)
402
BACKGROUND
402
COST OF ILLNESS STUDIES
403
GENDER DIFFERENCES IN ECONOMIC IMPACT
403
METHODOLOGIC APPROACHES TO DEFINING COST OF ILLNESS
403
ECONOMIC IMPACT OF OSTEOPOROTIC FRACTURES
405
SUMMARY
409
References
409
CHAPTER 32 Adverse Health Outcomes in Men with Osteoporosis
412
INTRODUCTION
412
MORBIDITY IN MEN AFTER OSTEOPOROTIC FRACTURES
412
PSYCHOSOCIAL CONSEQUENCES OF OSTEOPOROTIC FRACTURES IN MEN
414
MORTALITY IN MEN AFTER OSTEOPOROTIC FRACTURE
415
CONCLUSIONS
416
References
416
SECTION 8 Metabolic Bone Disease in Men
420
CHAPTER 33 Idiopathic Osteoporosis
422
INTRODUCTION
422
DIAGNOSIS
422
CLINICAL PRESENTATION AND PHENOTYPE
425
PHYSIOPATHOLOGY AND GENETICS
426
TREATMENT
427
AREAS FOR FURTHER RESEARCH
428
ACKNOWLEDGMENTS
428
References
428
CHAPTER 34 Glucocorticoid-induced Osteoporosis
432
EPIDEMIOLOGY
432
PATHOPHYSIOLOGY
432
DIAGNOSIS
434
THERAPY
435
CONCLUSIONS
436
References
436
CHAPTER 35 Testicular Dysfunction
440
INTRODUCTION
440
GONADAL STEROID ACTION
440
SKELETAL HEALTH IN ANDROGEN DEFICIENCY AT VARIOUS AGES
442
References
447
CHAPTER 36 Alcohol Use and Bone Health in Men
452
INTRODUCTION
452
ALCOHOL PHYSIOLOGY
452
EPIDEMIOLOGY
452
MODERATION; IS LESS MORE?
453
ALCOHOL IMPACTS ON BONE AND CALCIUM HOMEOSTASIS
453
BONE MINERAL DENSITY (BMD)
454
ALCOHOL, FALLS AND FRACTURES IN MEN
455
ISSUES CONFOUNDING STUDIES OF ALCOHOL USE
456
CONCLUSION
457
References
457
CHAPTER 37 Transplantation Osteoporosis
460
INTRODUCTION
460
SKELETAL EFFECTS OF IMMUNOSUPPRESSIVE DRUGS
460
EFFECT OF TRANSPLANTATION ON BONE AND MINERAL METABOLISM
461
EVALUATION AND MANAGEMENT OF CANDIDATES FOR TRANSPLANTATION
464
PREVENTION OF TRANSPLANTATION OSTEOPOROSIS (TABLE 37.3)
465
SUMMARY AND CONCLUSIONS
466
References
467
CHAPTER 38 Management of Fractures in Men with Impaired Renal Function
470
INTRODUCTION
470
DIAGNOSIS OF OSTEOPOROSIS IN STAGE 1–3 CHRONIC KIDNEY DISEASE
470
DIAGNOSIS OF OSTEOPOROSIS IN STAGE 5–5D CKD
472
BIOCHEMICAL MARKERS OF BONE METABOLISM
472
QUANTITATIVE BONE HISTOMORPHOMETRY
473
TREATMENT OF OSTEOPOROSIS IN CKD
474
CONCLUSIONS
478
References
478
CHAPTER 39 Primary Hyperparathyroidism in Men
482
INTRODUCTION
482
EPIDEMIOLOGY
482
ETIOLOGY
484
PATHOLOGY
484
SIGNS AND SYMPTOMS
484
CLINICAL PRESENTATION
486
EVALUATION AND DIAGNOSIS
486
PARATHYROID IMAGING
487
NATURAL HISTORY OF MILD PHPT
488
SURGICAL TREATMENT
488
CLINICAL COURSE AFTER SURGERY
490
MEDICAL MANAGEMENT
491
SUMMARY
493
References
493
CHAPTER 40 Hypercalciuria
496
INTRODUCTION
496
CLINICAL BONE DISEASE
496
DEFINITION OF HYPERCALCIURIA
497
SERUM 1,25D LEVELS
497
RELATIONSHIP BETWEEN URINE CA AND BONE LOSS
498
BONE PATHOGENESIS
499
CALCIUM METABOLISM
500
DIETARY FACTORS
501
TREATMENT
502
References
504
CHAPTER 41 The Skeletal Phenotype of the Male Athlete
508
INTRODUCTION
508
PRINCIPLES OF LOADING
508
MEASUREMENT OF BONE LOADING AND BONE MASS
508
HORMONAL DETERMINANTS OF SKELETAL MASS
509
ENVIRONMENTAL AND NUTRITIONAL DETERMINANTS OF SKELETAL HEALTH IN MALE ATHLETES
511
COMPARISON OF MALE ATHLETES TO THE FEMALE TRIAD
513
USE OF ANDROGENIC AND ANABOLIC STEROIDS IN ATHLETICS
514
BONE MASS AND STRESS FRACTURES IN MALE ATHLETES: A REVIEW OF THE LITERATURE
514
CONCLUSIONS
518
References
518
CHAPTER 42 Inherited and Related Disorders of Bone Matrix Synthesis in Men
522
INTRODUCTION
522
INHERITED DEFECTS IN COLLAGEN SYNTHESIS (TABLE 42.2)
523
MARFAN SYNDROME AND OSTEOPOROSIS
529
HYPOPHOSPHATASIA IN THE ADULT MALE
531
FIBROUS DYSPLASIA IN ADULT MALES
532
OSTEOPOROSIS RELATED TO INHERITED DEFECTS IN COPPER TRANSPORT: MENKES' DISEASE, OCCIPITAL HORN SYNDROME, WILSON DISEASE
533
HEMOCHROMATOSIS AND OSTEOPOROSIS IN MEN
534
HOMOCYSTINURIA
535
INHERITED DEFECTS IN NEUROTROPIC FACTORS RELATED TO BONE
535
References
536
SECTION 9 Diagnostic Approach
540
CHAPTER 43 Dual-Energy X-ray Absorptiometry (DXA) in Men
542
INTRODUCTION/ BACKGROUND
542
DUAL-ENERGY X-RAY (DXA) TECHNOLOGY
542
UNDERSTANDING DXA RESULTS
543
WHAT SKELETAL SITES TO MEASURE
544
PITFALLS IN DXA
544
DXA NORMATIVE DATABASES
546
CLINICAL USE OF DXA: DIAGNOSIS, MONITORING AND FRACTURE RISK ASSESSMENT
548
INDICATIONS FOR DXA TESTING IN MEN
552
VERTEBRAL FRACTURE ASSESSMENT
553
SUMMARY
554
References
555
CHAPTER 44 Quantitative Ultrasound Diagnosis of Osteoporosis in Men
558
PRINCIPLES OF QUANTITATIVE ULTRASOUND
558
USE OF QUS TO PREDICT FRACTURE IN MEN
558
USE OF QUS TO PREDICT WHEN TO OBTAIN DXA IN MEN
559
MONITORING THERAPY WITH QUS
560
CONCLUSIONS
560
References
561
CHAPTER 45 Advanced Structural Assessment of Bone Using CT and MRI
564
INTRODUCTION
564
QCT AND MDCT-BASED STRUCTURAL ANALYSES IN THE DIAGNOSTICS AND MONITORING OF OSTEOPOROSIS PATIENTS
565
?CT IMAGING AND INDIVIDUAL TRABECULAE SEGMENTATION (ITS)-BASED MORPHOLOGICAL ANALYSIS
568
HIGH RESOLUTION PERIPHERAL QUANTITATIVE CT (HR-PQCT)
571
MAGNETIC RESONANCE IMAGING (MRI)
572
IMAGE-BASED FEA
575
CONCLUSION
577
ACKNOWLEDGMENTS
577
References
578
CHAPTER 46 Diagnostic Approach: Vertebral Fracture Assessments
582
INTRODUCTION
582
PROBLEMS ASSOCIATED WITH IDENTIFICATION OF PREVALENT AND INCIDENT VF
582
WHY ARE VERTEBRAL FRACTURES RELEVANT IN MEN?
583
ESTABLISH THE PRESENCE OF VF: WHEN IS A DEFORMITY A TRUE OSTEOPOROTIC FRACTURE?
584
IMAGING APPROACHES FOR THE IDENTIFICATION OF VF
584
ADDITIONAL AREAS FOR RESEARCH
590
CONCLUSIONS
590
References
590
CHAPTER 47 The Use of Bone Biopsies in the Diagnosis of Male Osteoporosis
594
INTRODUCTION
594
AGE-DEPENDENT CHANGES IN BONE PROPERTIES IN FEMALES
594
CHANGES IN BONE REMODELING WITH AGE IN MALES
595
CHANGES IN BONE STRUCTURE WITH AGING IN MALES AND FEMALES
595
HISTOMORPHOMETRY IN MALE OSTEOPOROSIS
595
SECONDARY OSTEOPOROSIS
597
INDICATIONS FOR BONE BIOPSIES IN MALE OSTEOPOROSIS
601
FUTURE ASPECTS
601
CONCLUSION
601
References
602
CHAPTER 48 Overall Approach to the Evaluation and Treatment of Osteoporosis in Men
606
DIAGNOSTIC CONSIDERATIONS
606
TREATMENT CONSIDERATIONS
611
References
615
SECTION 10 Therapy
620
CHAPTER 49 Diagnostic Thresholds for Osteoporosis in Men
622
INTRODUCTION
622
DIAGNOSIS OF OSTEOPOROSIS
622
DIAGNOSTIC CRITERIA FOR MEN
623
NORMATIVE REFERENCE RANGES
624
LIMITATIONS
627
References
627
CHAPTER 50 Cost-Effectiveness of Interventions to Reduce Osteoporosis-Related Fractures in Men: Current Data, Controversies, and Challenges
630
INTRODUCTION
630
CHARACTERISTICS OF GOOD HEALTH ECONOMIC MODELING STUDIES
631
REVIEW OF COST-EFFECTIVENESS STUDIES IN MEN
632
CONTROVERSIES AND CHALLENGES IN HEALTH ECONOMIC MODELING OF FRACTURE PREVENTION STRATEGIES
640
CONCLUSIONS
642
References
642
CHAPTER 51 Nutritional Therapy for Skeletal Health in Men
646
INTRODUCTION
646
MACRONUTRIENTS
646
CALCIUM AND VITAMIN D
647
OTHER NUTRIENTS
649
CONCLUSION
649
References
649
CHAPTER 52 Exercise Programs for Patients with Osteoporosis
652
GOALS OF EXERCISE IN PATIENTS WITH OSTEOPOROSIS
652
PITFALLS IN ASSESSING EXERCISE INTERVENTIONS
653
THE ROLE OF PHYSICS, ANATOMY AND PHYSIOLOGY FOR DESIGNING AND ASSESSING EXERCISE INTERVENTIONS
653
BONE STRENGTH AND FALL RISK: TWO DIFFERENT GOALS, TWO DIFFERENT RELATIONSHIPS TO MUSCLE
655
BIPEDAL LOCOMOTION AND ONE-LEG-STANDING
656
THE SKELETON AS TENSEGRITY STRUCTURE
656
DXA–BMD AS OUTCOME PARAMETER OF EXERCISE INTERVENTIONS
657
RELATIONSHIPS BETWEEN MUSCLE AND BONE: THE MUSCLE–BONE UNIT
657
CORRELATIONS OF PHYSICAL ACTIVITY AND LOCOMOTOR PERFORMANCES WITH FRACTURES, FALLS AND ONSET OF DISABILITY
658
SARCOPENIA AND AGE-ASSOCIATED FUNCTIONAL DECLINE
659
OSTEOPOROSIS-RELATED FRACTURES AND FALLS
660
EXERCISE INTERVENTIONS AND BONE STRENGTH
661
EFFECT OF EXERCISE INTERVENTION ON MUSCLE STRUCTURE AND MUSCLE FUNCTION
662
EFFECT OF EXERCISE INTERVENTIONS ON RISK FACTORS FOR FALLS, FRACTURES AND ONSET OF DISABILITY
662
EXERCISE INTERVENTIONS AND FALL PREVENTION
663
WHOLE BODY VIBRATION
663
RISK OF EXERCISES
663
RECOMMENDATIONS FOR DESIGNING AND PRESCRIBING EXERCISE PROGRAMS FOR PATIENTS WITH OSTEOPOROSIS
663
FUTURE DEVELOPMENTS AND DEMANDS
664
References
665
CHAPTER 53 Calcitonin: History, Physiology, Pathophysiology and Therapeutic Applications
670
INTRODUCTION
670
SYNTHESIS AND LOCALIZATION
670
STRUCTURE OF CALCITONIN AND ITS MEASUREMENTS
670
PHYSIOLOGICAL ROLE OF CALCITONIN
671
BIOLOGICAL EFFECTS OF CALCITONIN
673
CLINICAL PHARMACOLOGY
673
COMMERCIALLY AVAILABLE CALCITONIN PREPARATIONS
674
THERAPEUTIC USES
676
References
680
CHAPTER 54 Treatment of Male Osteoporosis with Bisphosphonates
684
INTRODUCTION
684
PHARMACOLOGY OF BISPHOSPHONATES
684
DO MEN RESPOND DIFFERENTLY TO BISPHOSPHONATES?
685
BISPHOSPHONATES IN MEN WITH PRIMARY OSTEOPOROSIS
687
BISPHOSPHONATES IN MEN WITH SECONDARY OSTEOPOROSIS
692
SPECIAL ISSUES RELATED TO TREATMENT OF MALE OSTEOPOROSIS WITH BPS
693
CONCLUSIONS
694
References
694
CHAPTER 55 Treatment of Male Osteoporosis with Parathyroid Hormone
698
INTRODUCTION
698
ANABOLIC ACTIONS OF PARATHYROID HORMONE
698
INDICATIONS FOR TERIPARATIDE USE
699
TERIPARATIDE IN MALE OSTEOPOROSIS
700
COMBINATION OR SEQUENTIAL THERAPY WITH PTH AND AN ANTI-RESORPTIVE AGENT
701
ANTI-RESORPTIVE USE PRIOR TO PTH THERAPY
702
CONSEQUENCES OF DISCONTINUING PTH THERAPY
702
SAFETY OF PTH
703
FUTURE CONSIDERATIONS
703
CONCLUSIONS
703
References
704
CHAPTER 56 Testosterone Therapy for Osteoporosis in Men
708
INTRODUCTION
708
THE MAGNITUDE OF THE PROBLEM
708
MARKERS OF FRACTURE RISK
708
MECHANISMS BY WHICH TESTOSTERONE INFLUENCES MUSCLE AND BONE
709
STUDIES ON THE ASSOCIATION BETWEEN TESTOSTERONE AND MUSCLE AND BONE IN MEN
709
DIAGNOSIS OF HYPOGONADISM/ANDROGEN DEFICIENCY
716
EPIDEMIOLOGY OF ANDROGEN DEFICIENCY AND CO-PREVALENCE WITH OSTEOPOROSIS
718
TESTOSTERONE PREPARATIONS
718
STRATEGIES TO MINIMIZE RISK OF ADVERSE EFFECTS
720
TESTOSTERONE ADMINISTRATION AND MONITORING
721
BMD
721
USE OF TESTOSTERONE THERAPY IN MEN AT RISK FOR OSTEOPOROSIS AND FRACTURE
722
SELECTIVE ANDROGEN RECEPTOR MODULATORS (SARMS)
723
ACKNOWLEDGMENTS
723
References
723
CHAPTER 57 Future Therapies: Strontium, SERMs, SARMs and New Therapies on the Horizon
730
INTRODUCTION
730
STRONTIUM
730
SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS)
733
SELECTIVE ANDROGEN RECEPTOR MODULATORS (SARMS)
736
NEW THERAPIES ON THE HORIZON
739
CONCLUSION
745
ACKNOWLEDGMENTS
745
Glossary of abbreviations
746
References
746
Index
750
A
750
B
751
C
751
D
752
E
752
F
752
G
753
H
753
I
754
K
754
L
754
M
754
N
754
O
755
P
755
Q
756
R
756
S
756
T
757
U
757
V
757
W
758
Y
758
Color Plates
760