Table Of ContentShared Care f or
O s t e o p o r o s is
Shared Care f or
Osteoporosis
Roger Smith MA MD pho FRCP
Consultant Physician, Nuffield Orthopaedic Centre,
Headington, Oxford, UK
John Harrison MBBS MRCP MRCGP DRCOG DFFP
General Practitioner, Washington House Surgery,
Brackley, Northamptonshire, UK
Cyrus Cooper MA DM FRCP
MRC Clinical Scientist, Professor of Rheumatology and
Consultant Rheumatologist,
MRC Environmental Epidemiology Unit,
University of Southampton,
Southampton General Hospital,
Southampton, UK
I S IS
MEDICAL
M E D IA
Oxford
© 1998 Isis Medical Media Ltd
59 St Aldates
Oxford OX1 1ST, UK
First published 1998
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
copyright owner.
The Authors have asserted their right under the Copyright, Designs and Patents Act,
1988, to be identified as the Authors of this work.
British Library Cataloguing in Publication Data
A catalogue record for this title is available from the British Library
ISBN 1 899066 26 8
Smith, R. (Roger)
Shared Care for Osteoporosis
Roger Smith, John Hanison and Cyrus Cooper
Always refer to the manufacturer's Prescribing Information before prescribing
drugs cited in this book.
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Contents
Acknowledgements vi
Preface vii
Chapter 1 Introduction 1
Chapter 2 Life cycle of the skeleton 7
Chapter 3 Nature and extent of the problem 31
Chapter 4 Clinical recognition and diagnosis of 53
osteoporosis
Chapter 5 Prevention of osteoporosis 81
Chapter 6 Treatment of osteoporosis 101
Chapter 7 Current problems 119
Chapter 8 Implications for shared care 129
Index 135
í
Acknowledgements
We are indebted to our families for their patience, to our secretaries
for their tolerance and to Julian Grover for his considerable efforts.
vi
Preface
The main aim of this book is to improve the management of patients
with, or likely to develop, osteoporosis. It is intended as a practical
guide for all health professionals involved in shared patient care.
The introductory sections explain the ways in which osteoporosis
develops and describe the nature and extent of the problem.
Subsequent chapters discuss diagnosis, methods of prevention and
treatment. Current problems are then dealt with as well as the optimal
structure for shared care.
Although we have attempted to keep repetition to a minimum,
some topics, particularly densitometry and hormone replacement
therapy, are of primary importance and are covered in several
chapters in the text. Several comprehensive reviews have been
published recently and the authors have referred the interested reader
to these, where appropriate, thus avoiding long reference lists at the
end of each chapter.
Each contributing author is a specialist concerned with a different
aspect of osteoporosis and we hope that our personal experience and
insight into the field has been an advantage when writing about a
disease which involves a wide range of clinical specialities.
R. Smith, J. Harrison, C. Cooper
vii
Chapter 1
Introduction
Introduction
Osteoporosis is a condition that has recently assumed great
importance. A number of factors have contributed to this; they are
summarized in this chapter and subsequently in more detail in
Chapter 3. Osteoporosis is not a new disease but it is largely related
to age, and increased life expectancy is the main reason why it is
now more common than in previous centuries.
Current interest in osteoporosis arises from the recognition that it
contributes significantly to bony fragility and fracture, that the
likelihood of fracture may now be predicted, and that the prevention
and treatment of osteoporosis should significantly reduce fracture rate.
Such a reduction would have enormous potential benefits both to
affected persons and to the health service. The development of drugs
effective in the prevention of bone loss also holds the promise of
large financial rewards for the pharmaceutical industry and drives
much current research. The problems of osteoporosis are by no
means solved (Chapter 7) and new knowledge continues to appear.
Shared care
For the full advantages of current work on osteoporosis to be made
available to patients, it is important that this knowledge should be
widely disseminated to those who have the responsibilit y for their
care. The main aim of this book is to provide such a review of
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