Table Of ContentSpringer-Verlag Berlin Heidelberg GmbH
Reiner Bartl . Bertha Frisch
OSTEOPOROSIS
Diagnosis, Prevention,Therapy
A Practical Guide for all Physicians -
from Pediatrics to Geriatrics
With 75 Figures and 25 Tables
i
Springer
ISBN978-3-540-40499-6 ISBN978-3-662-09163-0(eBook)
DOI10.1007/978-3-662-09163-0
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Authors
Reiner Bartl
Professor of Internal Medicine,
Osteology, Hematology and Oncology
Department of Internal Medicine III
Bavarian Center of Osteoporosis
University of Munich
Germany
Bertha Frisch
Professor of Hematology
Departments of Pathology and Hematology
Sourasky Medical Center
University of Tel Aviv
Israel
Christoph Bartl, MD
Department of Trauma-,
Hand- and Reconstructive Surgery
University of Ulm
Germany
With the dawn of the 21St century has come the realisation that bone
and joint diseases are the major cause of pain and physical disability
worldwide. It is undoubtedly this insight that prompted the WHO to
declare the first 10 years of the new century as "The Bone and Joint
Decade 2000-2010". The number of people suffering from these dis
eases - already many millions in every so-called developed as well as
underdeveloped country in the world - is expected to double within
the next 20 years. In many countries the increase will be even greater
due to the longer survival and consequently larger numbers of older
people in the population. It is inevitable that the already astronomical
costs of health care will rise proportionally.
On the positive side there is also no doubt that the enormous
amount of work and research on disorders of bone over the past 10-20
years or so has contributed greatly to our understanding of their
causes, treatment and prevention. Most importantly, perhaps, the
skeleton is now regarded in a new light: as a dynamic organ undergo
ing constant renewal throughout life from start to finish, from the cra
dle to the grave. What is more, it is now abundantly clear that the skele
ton participates in almost every condition that may effect the body!
This applies especially to osteoporosis, which, as emphasised by the
title of this book, is now under control! How did this come about?
~ Because of the elucidation of the factors involved in osseous re
modelling.
~ Because of the development of simple, fast, reliable and non-inva
sive methods for measurement of bone density.
~ Because of the identification of risk factors to which everybody is
exposed, so that appropriate measures can be taken to prevent
development of osteoporosis and/or its progression when fractures
have already occurred.
VIII -Pr-ef-ac-e ------------------------------------------
----------------
~ And because effective medication for prevention and therapy is
now readily available worldwide.
The efficacy of the classes of compounds known as the bisphospho
nates as well as the "selective oestrogen receptor modulators" (SERMs)
and parathyroid hormones has now been unequivocally established
by numerous large multicentre trials involving literally millions of
patients. In addition, simple methods such as a healthy life-style, ade
quate nutrition, sufficient physical activity, vitamin D and calcium
supplements as required can be recommended and adopted on a large
scale. Introduction and acceptance of these methods requires public
awareness and support and the realisation that every individual is the
guardian and caretaker ofhis/her own bones and responsible for their
structural integrity. Still lacking, however, is widespread recognition
of these facts both among the public at large but more importantly
among members of the medical profession. To day, at the start of the
new millennium, when information and knowledge are freely avail
able, such a state of affairs cannot be tolerated. Well-established diag
nostic techniques and effective therapies - both antiresorptive and
osteoanabolic - are now available for prevention, diagnosis and treat
ment of osteoporosis. It should be emphasized that the treatments rec
ommended in this text are all founded on "Evidence based Medicine"
(unless otherwise stated) for which the appropriate references are
given at the end of the text.
The aim of this book is to demonstrate that bone is everybody's
business and especially every doctor's, and to provide guidelines for
the diagnosis, therapy and prevention of osteoporosis - from paedi
atrics to geriatrics. This book will raise awareness and inform physi
cians across disciplines about this preventable and now also treatable
disease.
Our particular goal has been to make this text as "user-friendly" as
possible so that any doctor seeking information on a particular topic
in osteoporosis has uncomplicated and time-saving access to it.
We wish all our readers success in their endeavours to help patients
and to reduce suffering on this strife-ridden, beautiful planet of ours.
God bless you all!
REINER BARTL BERTHA FRISCH
Munich Tel Aviv
1 Osteoporosis: An Epidemic of Overwhelming Proportions! 1
Osteoporosis: A Silent Thief. . . . . . . . . . . . 1
Osteoporosis: The Global Scope of the Problem. 2
2 Bone: A Fascinating Organ . . . . . . . . . . . . . . . . . . . . .. 5
Bone: An Architectural Masterpiece . . . . . . . . 5
Bone: A Permanent Building and Rebuilding Site . 9
Control of Bone Remodelling:
A Network of Complex Mechanisms ................ 16
Leptin: Role of the Central Nervous System
in Regulation of Bone. . . . . . . . . . . 20
Peak Bone Mass: An Investment for a Healthier Life. 22
3 Definition of Osteoporosis . . . . . . . . . . . . . . . . . . . . . . 24
Osteoporosis: How to Define it . . . . . . . 24
Osteoporosis: Which Bones Are Vulnerable 26
Osteoporosis: Also a Question of Quality. 27
How to Define "Fracture"? Not So Simple! . 29
4 Subgroups of Osteoporosis: From Different Points of View . . . . . 33
According to Spread . . . 33
According to Sex and Age 35
According to Extent . . 37
According to Histology. . 38
x
. 40
Risk Factors Which Cannot (Yet) Be Influenced. .40
Risk Factors Which Can Be Influenced. . . . . . . 43
................ 49
Symptoms ................ . 49
Osteoporosis and Teeth, Skin, and Hair. 52
Role of Conventional X-Rays ... 53
Other Useful Imaging Techniques. . . . 55
58
Why Measure Bone Mineral Density? . 58
Which Instruments to Use? 60
Which Bones to Measure? . . . . . . . 66
Indications for BMD . . . . . . . . . . 68
Bone Densitometry in Children: Now Readily Available 71
BMD Measurement: Not a Scary Procedure,
Nothing to Be Afraid of! ....................... 71
73
Which Tests Are Necessary? . . . . . . . . . 73
Significance of Markers of Bone Turnover . 75
When Is a Bone Biopsy Indicated? . . . . . 79
............. 80
Step 1: A Calcium-Rich Diet ......... . 80
Step 2: An Adequate Supply of Vitamins .. . 84
Step 3: Protect the Spine in Everyday Living . 85
Step 4: Regular Physical Activity . . . .... 87
