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OSTEOPOROSIS
A Guide for Clinicians
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OSTEOPOROSIS
A Guide for Clinicians
Pauline M. Camacho, MD, FACE
Associate Professor of Medicine
Division of Endocrinology and Metabolism
Loyola University Chicago Stritch School of Medicine
Director, Loyola University Osteoporosis and Metabolic
Bone Disease Center
Maywood, Illinois
Paul D. Miller, MD
Distinguished Clinical Professor of Medicine
University of Colorado Health Sciences Center
Medical Director
Colorado Center for Bone Research
Lakewood, Colorado
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Executive Editor:Charles Mitchell
Managing Editor:Sirkka Bertling
Developmental Editor:Grace R. Caputo, Dovetail Content Solutions
Project Manager:Fran Gunning
Senior Manufacturing Manager:Benjamin Rivera
Marketing Manager:Angela Panetta
Design Coordinator:Stephen Druding
Production Services:Nesbitt Graphics, Inc.
Printer:R. R. Donnelley, Crawfordsville
© 2007 by LIPPINCOTT WILLIAMS & WILKINS, a Wolters Kluwer business
530 Walnut Street
Philadelphia, PA19106 USA
LWW.com
All rights reserved. This book is protected by copyright. No part of this book may be reproduced in
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trieval system without written permission from the copyright owner, except for brief quotations
embodied in critical articles and reviews. Materials appearing in this book prepared by individu-
als as part of their official duties as U.S. government employees are not covered by the above-
mentioned copyright.
Printed in the USA
Library of Congress Cataloging-in-Publication Data
Camacho, Pauline M.
Osteoporosis : a guide for clinicians / Pauline M. Camacho, Paul D. Miller.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7817-8619-5 (alk. paper)
ISBN-10: 0-7817-8619-3 (alk. paper)
1. Osteoporosis. 2. Osteoporosis—Treatment. I. Miller, Paul, 1943- II.
Title.
[DNLM: 1. Osteoporosis. WE 250 C172o 2007]
RC931.O73C37 2007
616.7(cid:1)16—dc22
2007000190
Care has been taken to confirm the accuracy of the information presented and to describe
generally accepted practices. However, the authors, editors, and publisher are not responsible for
errors or omissions or for any consequences from application of the information in this book and
make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy
of the contents of the publication. Application of this information in a particular situation
remains the professional responsibility of the practitioner.
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dosage set forth in this text are in accordance with current recommendations and practice at the
time of publication. However, in view of ongoing research, changes in government regulations,
and the constant flow of information relating to drug therapy and drug reactions, the reader is
urged to check the package insert for each drug for any change in indications and dosage and for
added warnings and precautions. This is particularly important when the recommended agent is
a new or infrequently employed drug.
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tration (FDA) clearance for limited use in restricted settings. It is the responsibility of the health
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This book is dedicated to our families.
You are our constant inspiration.
Thank you for being there for us.
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Preface
As the population ages, the prevalence of osteoporosis is increasing world-
wide. Care of osteoporotic patients is in the hands of endocrinologists,
rheumatologists, geriatricians, primary care physicians, and even physician
assistants and nurse practitioners. The field of osteoporosis is evolving rap-
idly, with new agents, diagnostic methods, and management options being
added every day. New data are being published monthly, and for clinicians
busy in their practices it is challenging to find the luxury of time to learn
these new developments.
Osteoporosis AGuide for Clinicianspresents the disease in a comprehen-
sive yet palatable and easily digestible form for busy clinicians, fellows,
residents, and students. It delves into all aspects of the disease, from patho-
physiology to diagnosis and management. Separate chapters have been de-
voted to vitamin D deficiency and workup and recognition of secondary
causes of bone loss, because these are very important aspects in treating pa-
tients successfully. Two chapters focus on future agents on the horizon for
osteoporosis and tailoring therapy to specific patient populations. We have
also included real patient cases from our clinics and emphasized teaching
points for each of the cases.
As an added bonus, we have annotated most of the references so that any-
one interested in learning more about the studies mentioned in the text will
have easy access to the research methodology, results, and conclusions. To
our knowledge, this is the first osteoporosis book that has done this.
After reading Osteoporosis, the clinician should have a good understand-
ing of the disorder and should feel comfortable treating it and implementing
the appropriate workup and follow-up. We hope that this book will be a
valuable tool in providing excellent osteoporosis care in clinics and will help
individuals in teaching institutions in disseminating knowledge about the
disease to their colleagues and trainees.
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Acknowledgments
We would like to thank all of those who have helped make this book a real-
ity: Charley Mitchell, the acquisitions editor at Lippincott Williams &
Wilkins; Grace Caputo of Dovetail Content Solutions for her perseverance
in keeping us on schedule; Alexandra Reiher, Elizabeth Dillard, Amanda
Venti, Leslie Dalaza, and Monica Agarwal for annotating the references;
Amit Dayal for his original illustrations; our secretaries, Charmaine Zaw-
itaj, Colette Swain, and Abby Erickson; and most of all our families, who
have inspired us and have always supported us in our academic pursuits.
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