Osteoporosis (Illustrated)

241 Pages·2006·3.44 MB·English

by  Nigel Arden

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State of the Art
Osteoporosis and its complications should no longer be thought of as an N
ig
inevitable consequence of the aging process. Since the first edition of this e
l
book was published, further strides have been made in detection and A
r
d
treatment, and it has become more and more clear that lifestyle e
n
interventions such as increasing physical activity can have a major impact
on the prognosis of osteoporosis patients.
Despite these advances, as many as 10 million people aged over 50 years in Osteoporosis
the USA today suffer from osteoporosis. With an aging population, increasing
numbers of individuals in developed countries will be at risk from osteoporosis
and its complications – raising awareness among the medical community and
the promotion of prevention strategies are now of vital importance.
Nigel Arden, Editor
This book is a resource for all those involved in the treatment or prevention
of osteoporosis. The new edition has maintained the accessible, highly
illustrated approach of the original, but it has been completely revised and
O
brought up to date, with new images and new sections. The authors, all s
t
experts in their particular aspect of treatment or diagnosis, present a eo
p
readable, concise, and practical guide to osteoporosis in the clinical setting. o
r
o
s
Contents is
• The Epidemiology of Osteoporotic Fractures
• The Pathogenesis of Osteoporosis
• Risk Factors for Fracture
• Strategies for the Prevention and Management of Osteoporosis
• The Radiologic Diagnosis of Osteoporosis
• Biochemical Markers of Bone Turnover
• Treatment of Established Osteoporosis
• Osteoporosis in Men
• Corticosteroid-induced Osteoporosis
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Osteoporosis
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Published by Remedica
Commonwealth House, 1 New Oxford Street, London, WC1A 1NU, UK
Civic Opera Building, 20 North Wacker Drive, Suite 1642, Chicago, IL 60606, USA
[email protected]
www.remedicabooks.com
Tel: [phone]
Fax: [phone]
Publisher: Andrew Ward
In-house editors: Carolyn Dunn, Cath Harris, Lyndsey Parker
Design and artwork: AS&K Skylight Creative Services
© 2006 Remedica
Previously published as ‘Osteoporosis Illustrated’.
While every effort is made by the publisher to see that no inaccurate or misleading data, opinions, or statements appear in
this book, they wish to make it clear that the material contained in the publication represents a summary of the independent
evaluations and opinions of the authors and editor. As a consequence, the authors, editor, publisher, and any sponsoring
company accept no responsibility for the consequences of any inaccurate or misleading data or statements. Neither do they
endorse the content of the publication or the use of any drug or device in a way that lies outside its current licensed
application in any territory.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or
by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher.
Remedica is a member of the AS&K Media Partnership.
ISBN-13: 978 1 850092 05 2
ISBN-10: 1 850092 05 2
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library.
Printed in Malta.
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Osteoporosis
Nigel Arden, Editor
Senior Lecturer in Rheumatology
Medical Research Council Environmental Epidemiology Unit
University of Southampton
Southampton General Hospital
Southampton
UK
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Contents
Chapter 1 The Epidemiology of Osteoporotic Fractures 1
Nicholas Harvey and Cyrus Cooper
Chapter 2 The Pathogenesis of Osteoporosis 27
Juliet Compston
Chapter 3 Risk Factors for Fracture 55
Nigel Arden
Chapter 4 Strategies for the Prevention
and Management of Osteoporosis 75
Pam Brown
Chapter 5 The Radiologic Diagnosis of Osteoporosis 89
Glen Blake and Ignac Fogelman
Chapter 6 Biochemical Markers of Bone Turnover 117
Ramasamyiyer Swaminathan
Chapter 7 Treatment of Established Osteoporosis 143
Judith Bubbear, Ajay Bhatia, and Richard Keen
Chapter 8 Osteoporosis in Men 163
Steve Tuck and Roger Francis
Chapter 9 Corticosteroid-induced Osteoporosis 185
Jackie Clowes and Richard Eastell
Abbreviations 203
Index 207
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Contributors Contributors
Nigel Arden Richard Eastell
Senior Lecturer in Rheumatology Research Dean
Medical Research Council Division of Clinical Sciences (North)
Environmental Epidemiology Unit University of Sheffield
University of Southampton Northern General Hospital
Southampton General Hospital Sheffield, UK
Southampton, UK
Ignac Fogelman
Ajay Bhatia Professor of Nuclear Medicine
Specialist Registrar Department of Nuclear Medicine
Metabolic Bone Unit Guy’s, King’s and St Thomas’ School of Medicine
The Royal National Orthopaedic Hospital London, UK
Stanmore, UK
Roger Francis
Glen Blake Reader in Medicine (Geriatrics)
Senior Lecturer Musculoskeletal Unit
Department of Nuclear Medicine Freeman Hospital
Guy’s, King’s and St Thomas’ School of Medicine Newcastle upon Tyne, UK
London, UK
Nicholas Harvey
Pam Brown Specialist Registrar
General Practitioner Medical Research Council
Swansea, UK Environmental Epidemiology Unit
University of Southampton
Judith Bubbear
Southampton General Hospital
Clinical Research Fellow
Southampton, UK
Metabolic Bone Unit
The Royal National Orthopaedic Hospital Richard Keen
Stanmore, UK Consultant Rheumatologist
University College London
Jackie Clowes
Centre for Rheumatology
ARC Clinical Scientist
London, UK
Mayo Clinic and Foundation
Endocrine Research Unit Ramasamyiyer Swaminathan
St Mary’s Hospital Professor of Clinical Chemistry
Rochester, MN, USA Department of Clinical Chemistry
Guy’s, King's and St Thomas’ School of Medicine
Juliet Compston
London, UK
Reader and Honorary Consultant Physician
Department of Medicine Steve Tuck
Addenbrooke’s Hospital Consultant Rheumatologist
Cambridge, UK James Cook University Hospital
Middlesbrough, UK
Cyrus Cooper
Professor of Rheumatology
Medical Research Council
Environmental Epidemiology Unit
University of Southampton
Southampton General Hospital
Southampton, UK
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Introduction
Since the first edition of Osteoporosis Illustrated was published in 1997,
knowledge about the causes and treatment of osteoporosis has continued to expand
at a dramatic rate. There have been major advances in cellular biology, which
have allowed further insights to be obtained into the pathogenesis of osteoporosis,
and potentially two new therapeutic agents. There is now an ever-increasing array
of techniques to measure bone density and size, which have helped to provide
a greater understanding of the forces which affect bone fragility, including bone
architecture and micro-architecture, as well as bone mineral density. Finally, there
have been a number of new therapeutic agents on the market since the first edition,
which have allowed more effective management of patients at high risk for
osteoporotic fractures. This explosion of research has exponentially increased the
amount of information available to clinicians via increasing numbers of dedicated
osteoporosis journals and conferences in every country.
Most large text books are rapidly out of date in this fast moving field, and it is
now difficult for even the most dedicated specialist to remain abreast of scientific
and therapeutic advances. In this book, experts in their field have each provided
a current ‘state of the art’ overview of the important areas in osteoporosis today.
The style of the chapters, with figures and illustrations, is designed to facilitate
understanding of the concepts and processes involved, in addition to providing an
enjoyable read. Osteoporosis is now a treatable disease, let us hope we can all keep
up with the advances going forward.
Nigel Arden
Editor
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11
The Epidemiology of
Osteoporotic Fractures
Nicholas Harvey and Cyrus Cooper
Definition of osteoporosis
Osteoporosis is a skeletal disease characterized by low bone mass and
microarchitectural deterioration of bone tissue, with a consequent increase in
bone fragility and susceptibility to fracture [1]. It is a major public health issue,
affecting a large proportion of the population >50 years of age. It leads to
a huge burden through the increased morbidity and mortality associated with
fragility fractures.
The term ‘osteoporosis’ was first introduced in France and Germany in the
19th century. It means ‘porous bone’ and initially implied a histologic diagnosis,
but was later refined to mean bone that was normally mineralized, but reduced
in quantity (Figure 1.1).
The definition of osteoporosis has, historically, been difficult. A definition based
on bone mineral density (BMD) might not encompass all of the risk factors for
fracture, whereas a fracture-based definition will not enable the identification of
(a) (b)
Figure 1.1 (a) Normal and(b) osteoporotic bone.
1