Osteoporosis - Diagnosis, Prevention, Therapy

Preface

Contents

Epidemiology of Osteoporosis

1.1 Osteoporosis: A Silent Thief!

1.2 Osteoporosis: The Global Scope of the Problem

Biology of Bone

2.1 Bone: An Architectural Masterpiece

2.2 Bone: A Permanent Building and Rebuilding Site

2.3 Remodelling Units

2.4 Some Biological Perspectives on the Mechanisms Involved in the Control and Regulation of Bone Remodelling

2.5 Minimodelling

2.6 Stimuli, Triggers and Mechanisms of Activation of Bone Remodelling

2.7 Control of Bone Remodelling: A Network of Complex Mechanisms

2.8 Osteoimmunology: A Representative of Systems Biology

2.9 The RANK/RANKL/Osteoprotegerin System

2.10 Leptin: Role of the Central Nervous System in Regulation of Bone

2.11 Growth of the Embryo in the Uterus

2.12 Peak Bone Mass: An Investment for a Healthier Life

Pathogenesis of Osteoporosis

3.1 Factors in the Development of Osteoporosis

3.2 Def inition of Osteoporosis

3.3 Osteoporosis – Which Bones are Vulnerable?

3.4 Osteoporosis – Also a Question of Quality!

3.5 Definition of “Fracture&rdquo

3.6 Vertebral ( Spinal) Fractures

3.7 Hip Fractures

3.8 Wrist Fractures

3.9 Other Fractures

Subgroups of Osteoporosis

4.1 According to Spread

4.2 According to Age and Sex

4.3 According to Extent

4.4 According to Histology

Risk Factors for Fractures

5.1 Risk Factors Which Cannot (yet) be Influenced

5.2 Risk Factors Which Can be Influenced

Clinical Evaluation of Osteoporosis

6.1 Indicative Symptoms

6.2 Osteoporosis and Teeth, Skin and Hair – What are the Connections?

6.3 Role of Conventional X- Rays in Osteoporosis

6.4 Other Useful Imaging Techniques

Bone Density in Osteoporosis

7.1 Why Measure Bone Mineral Density?

7.2 Which Instruments to Use?

7.3 Which Bones to Measure?

7.4 Who is Due or Overdue for a BMD Test?

7.5 Bone Densitometry in Children – Now Readily Available!

7.6 BMD Measurement – Not a Scary Procedure, Nothing to be Afraid of!

Laboratory Evaluation of Osteoporosis

8.1 Recommended Tests

8.2 Significance of Markers of Bone Turnover

8.3 Recommendations for Practical Use of Bone Markers

8.4 Potential of Bone Biopsy in Clinical Practice

8.5 When is a Bone Biopsy Indicated?

8.6 Up-to- Date Methods

Prevention of Osteoporosis

9.1 Step 1: First of all a Calcium- Rich Diet!

9.2 Step 2: Ensure an Adequate Supply of Vitamins!

9.3 Step 3: Protect the Spine in Everyday Life!

9.4 Step 4: Regular Physical Activity – for the Preservation of Strong Bones!

9.5 Step 5: No Smoking, Please!

9.6 Step 6: Reduce Nutritional “ Bone Robbers”!

9.7 Step 7: Strive for an Ideal Body Weight!

9.8 Step 8: Identify Drugs that Cause Osteoporosis and Take Appropriate Steps to Counteract Them When Possible and Necessary!

9.9 Step 9: Recognize Diseases Which Damage Bones!

9.10 Step 10: Management of Patients Who Have Already Sustained a Fracture

Physical Activity and Exercise Programs

10.1 Strong Muscles Make and Maintain Strong Bones!

10.2 The Muscle– Bone Unit and Sarcopenia

10.3 Exercise Programs – Preventive and Restorative

10.4 Implementation of a Training Program

Treatment Strategies in Osteoporosis

11.1 Evidence- Based Strategies for the Therapy of Osteoporosis

11.2 Comprehensive Approach to the Therapy of Osteoporosis

11.3 Indication for Treatment – Combining BMD with Clinical Factors

Management of Pain in Osteoporosis

12.1 Start with the Patient, not the Disease!

12.2 Acute Phase

12.3 Chronic Phase – Short Term

12.4 Chronic Phase – Long Term

12.5 Electric Potentials in Bone

Calcium and Vitamin D

13.1 Calcium: A Lifelong Companion

13.2 The Concept of Vitamin D in the 21st Century

13.3 Vitamin D: Don’t Rely on Sunshine, Take Supplements

13.4 Rickets

13.5 Other Vitamins Involved in Skeletal Health

Hormones for Replacement Therapy

14.1 Hormone Replacement Therapy for Women – Now Recommended for Symptoms Only!

14.2 Which Oestrogens and Progestins, and How to Take Them?

14.3 Which Women to Treat?

14.4 How Long to Treat?

14.5 How to Monitor HRT?

14.6 What are the Risks and Adverse Events of HRT?

14.7 What are the Main Contraindications?

14.8 Natural Oestrogens – How Effective are They?

14.9 Dehydroepiandrosterone (DHEA) – Is it Useful for the Prevention of Bone Loss?

14.10 Testosterone – Good for Bones and Well- Being in Men!

14.11 Anabolic Steroids – Strong Muscles for Healthy Bones!

Bisphosphonates

15.1 A Brief Survey of Bisphosphonates

15.2 Pharmacokinetics

15.3 Toxicity and Contraindications

15.4 Osteomyelitis/Osteonecrosis of the Jaw ( ONJ)

15.5 Contraindications

15.6 Oral Bisphosphonates Currently Used in Osteoporosis

15.7 Alendronate

15.8 Risedronate

15.9 Etidronate

15.10 Ibandronate

15.11 Intravenous Bisphosphonates for the Treatment of Osteoporosis

15.12 Ibandronate

15.13 Zoledronate

15.14 Clodronate and Pamidronate

15.15 Recommendations for Intravenous Therapy

15.16 Duration of Therapy with Bisphosphonates and Long- Term Studies

15.17 A Summary of Results Achieved to Date

15.18 Meta-analyses of Antiresorptive Substances

Selective Oestrogen- Receptor Modulators

16.1 A Brief Overview of SERMs – New Selective Antiresorptive Agents

16.2 Raloxifene – Utilization of Physiological Eff ects on Bone

Peptides of the Parathyroid Hormone Family

17.1 Osteoanabolic Action of PTH – Paradoxical Eff ects Depend on Type of Administration

Strontium Ranelate

Calcitonin and Fluoride

Combination and Sequential Therapies

Future Directions

22.1 Adherence to Treatment

22.2 Monitoring Treatment

Adherence and Monitoring of Osteoporosis Therapy

22.3 Monitoring Antiresorptive Therapy

22.4 Monitoring Osteo-anabolic Therapy

Osteoporotic Fractures

23.1 Fragility Fractures

23.2 Fractures and the Healing Process

23.3 Effects of Drugs and Lifestyle on Fracture Healing

23.4 Risk Factors for Osteoporotic Fractures

23.5 Management of Osteoporotic Fractures

23.6 Prevention of Further Fragility Fractures with Specific Drugs

23.7 Fracture Sites and Their Clinical Significance

Pregnancy and Lactation

Osteoporosis in Men

25.1 Clinical Evaluation of Osteoporosis in Men

25.2 Special Features in Men

25.3 Prevention and Treatment in Men

25.4 Therapy of Osteoporosis in Men

Osteoporosis in Children

26.1 First Clarification – Hereditary or Acquired?

26.2 Idiopathic Juvenile Osteoporosis, Idiopathic Juvenile Arthritis, and Other Conditions

26.3 Osteogenesis Imperfecta Must Not Be Overlooked!

26.4 Turner Syndrome and Charge Syndrome

26.5 X- Linked Hypophosphatemic Rickets

26.6 Gaucher’s Disease

Immobilization Osteoporosis

27.1 Examples of Bone Loss

27.2 Space Travel and the Force of Gravity

27.3 Therapy of Immobilization Osteoporosis

Osteoporosis in Medical Disciplines

28.1 Assessment of Secondary Osteoporoses

28.2 Cardiology

28.3 Dermatology

28.4 Endocrinology

28.5 Gastroenterology

28.6 Genetics

28.7 Haematology and Storage Disorders

28.8 Infectious Disorders

28.9 Nephrology

28.10 Neurology and Psychiatry

28.11 Oncology

28.12 Pulmonology

28.13 Rheumatology and Immunology

Osteoporosis and Drugs

29.1 Corticosteroid- Induced Osteoporosis

29.2 Transplantation Osteoporosis

29.3 Tumour Therapy- Induced Osteoporosis

29.4 Drug- Induced Osteoporomalacia

29.5 Antiepileptic Drug- Related Osteopathy, a Pressing Need for Better Understanding

AIDS Osteopathy

30.1 Manifestations of AIDS Osteopathy

30.2 Diagnosis

30.3 Treatment Strategies

Renal Osteopathy

31.1 Definition

31.2 Pathophysiology

31.3 Symptoms

31.4 Biochemical Investigation

31.5 Radiological Investigation

31.6 Treatment Strategies

Localized Osteopathies

32.1 Complex Regional Pain Syndrome ( CRPS)

32.2 Transient Osteoporosis and the Bone Marrow Oedema Syndrome ( BMOS)

32.3 Vanishing Bone Disease ( Gorham- Stout Syndrome)

32.4 Fibrous Dysplasia

32.5 Paget’s Disease of Bone

Periprosthetic Osteoporosis and Aseptic Loosening of Prostheses

33.1 Pathogenesis

33.2 Diagnosis

33.3 Treatment Strategies

33.4 Bisphosphonates

Oral Bone Loss, Periodontitis and Osteoporosis

34.1 Oral Bone Loss and Systemic Osteoporosis

34.2 Pathogenesis of Periodontitis

34.3 Clinical Findings

34.4 Treatment Strategies

34.5 Bisphosphonates

Disorders of Bone Due to Tumours

35.1 Links Between Osteoporosis and Cancer

35.2 Tumour-Induced Hypercalcaemia (TIH)

35.3 Tumour- Induced Bone Pain (TIBP)

35.4 Skeletal Manifestations in Multiple Myeloma ( MM)

35.5 Skeletal Metastases – The Fundamental Problem in Clinical Oncology

35.6 Skeletal Metastases of Breast and Prostate Cancer

The Metabolic Syndrome – A Major Cause of Osteoporosis in the World Today

Bibliography

Introduction

Books on Osteoporosis

Selected Articles in Journals

Chapter 1 Epidemiology of Osteoporosis

Chapter 2 Biology of Bone

Chapter 3 Pathogenesis of Osteoporosis

Chapter 4 Subgroups of Osteoporosis

Chapter 5 Risk Factors for Fractures

Chapter 6 Clinical Evaluation of Osteoporosis

Chapter 7 Bone Density in Osteoporosis

Chapter 8 Laboratory Evaluation of Osteoporosis

Chapter 9 Prevention of Osteoporosis

Chapter 10 Physical Activity and Exercise Programs

Chapter 11 Treatment Strategies in Osteoporosis

Chapter 12 Management of Pain in Osteoporosis

Chapter 13 Calcium and Vitamin D

Chapter 14 Hormones for Replacement Therapy

Chapter 15 Bisphosphonates

Chapter 16 Selective Oestrogen- Receptor Modulators

Chapter 17 Peptides of the Parathyroid Hormone Family

Chapter 18 Strontium Ranelate

Chapter 19 Calcitonin and Fluoride

Chapter 20 Combination and Sequential Therapies

Chapter 21 Future Directions

Chapter 22 Adherence and Monitoring of Osteoporosis Therapy

Chapter 23 Osteoporotic Fractures

Chapter 24 Pregnancy and Lactation

Chapter 25 Osteoporosis in Men

Chapter 26 Osteoporosis in Children

Chapter 27 Immobilization Osteoporosis

Chapter 28 Osteoporosis in Medical Disciplines

Chapter 29 Osteoporosis and Drugs

Chapter 30 AIDS Osteopathy

Chapter 31 Renal Osteopathy

Chapter 32 Localized Osteopathies

Chapter 33 Periprosthetic Osteoporosis and Aseptic Loosening of Prostheses

Chapter 34 Oral Bone Loss, Periodontitis and Osteoporosis

Chapter 35 Disorders of Bone due to Tumours

Chapter 36 The Metabolic Syndrome – A Major Cause of Osteoporosis in the World Today

Subject Index