Atlas of Osteoporosis PDF
Preview Atlas of Osteoporosis
ATLAS OF OSTEOPOROSIS Second Edition ATLAS OF OSTEOPOROSIS Second Edition Editor Eric S. Orwoll, MD Professor of Medicine Department of Endocrinology Program Director, General Clinical Research Center Oregon Health and Science University Portland, Oregon Series Editor Stanley G. Korenman, MD Professor of Medicine Associate Dean Department of Medicine Division of Endocrinology UCLA School of Medicine UCLA Medical Center Los Angeles, California With 23 contributors CM Springer-Science+Business Media, LLC CURRENT. MEDICINE Current Medicine CM 400 Market Street Suite 700 CURRENT. MEDICINE Philadelphia, PA 19106 Developmental Editors: Teresa M. Giuliana, Gina F Scala Editorial Assistant: Annmarie D'Ortona Cover Design: John McCullough, William C. Whitman, Jr. Design and Layout: Christine Keller-Quirk Illustrators: Wieslawa Langenfeld, Maureen Looney Assistant Production Manager: Margaret La Mare Inde:xing: Holly Lukens Atlas of osteoporosis / editor, Eric Orwoll.-- 2nd ed. p. ;cm. Inc1udes bibliographical references and index. 1. Osteoporosis--Atlases. I. Title: Osteoporosis. 11. Orwoll, Eric S. [DNLM: 1. Osteoporosis--Atlases. WE 17 A8806331 2003] RC931.073.A8562003 616.7'16--dc21 2003046298 ISBN 978-1-4757-4563-4 ISBN 978-1-4757-4561-0 (eBook) DOI 10.1007/978-1-4757-4561-0 Although every effort has been made to ensure that drug doses and other information are presented accurate1y in this publication, the ultimate responsibility rests with the prescribing physician. Neither the publishers nor the author can be held responsible for errors or for any consequences arising from the use of the information contained therein. Any product mentioned in this publication should be used in accordance with the prescribing information prepared by the manufacturers. No claims or endorsements are made for any drug or compound at present under clinical investigation. ©2003, 2002 by Springer Science+Business Media New York Originally published by Current Medicine, Inc. in 2003. Softcover reprint of the hardcover 2nd edition 2003 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any me ans electronic, mechanical, photocopying, recording, or otherwise, without prior written consent of the publisher. 10 9 8 7 6 5 4 3 2 1 For more information please call1 (800) 427-1796 or (215) 574-2266 www.current-science-group.com O steoporosis has long been known to be a major health care prob ed in the First Edition have been more extensively revised to reflect major lem, in both individual and public health terms, but in the last developments. For instance, the renewed realization of the importance of two decades tremendous increases in scientific inquiry have bone biomechanics has led to tremendous research activity in this area. yielded a much greater understanding of the basic biology, clinical char Similarly, the idea that anabolic therapies might allow new bone to be acter, and epidemiology of this condition. These advances have been added has been realized with the recent demonstration of the effective translated into much more sophisticated and effective tools for clinicians ness of parathyroid hormone treatment for osteoporosis. FinaHy, several to use in the prevention and treatment of the disease. These tools, initial chapters have been added to highlight the emergence of new fields ly available only to specialists in endocrinology and rheumatology, are (genetics) or the expansion of others (bone densitometry and the labora now taken advantage ofby a wide range of disciplines, and their applica tory evaluation ofbone disorders). The editor and authors endeavored in tion is being adapted to a large variety of situations. Appropriately, the this latest edition of the Atlas to preserve the considerable strengths of the public is also becoming more educated about these issues, and it is not First Edition and at the same time improve on it through the addition of uncommon for clinicians to have sophisticated discussions with weH-read new information. patients about the diagnosis, prevention, and treatment of osteoporosis. Although osteoporosis has been recognized for miHennia, the knowl In this light, the Second Edition of the Atlas oJOsteoporosis is designed edge regarding this disorder continues to evolve. The sheer volume of to be useful to a broad readership united in their interest in the disorder. available information, as weH as its complexity, poses considerable chal The expert authors have encapsulated not only the weH-established basics lenges to those attempting to summarize it. To whatever extent the Atlas of osteoporosis but also new developments in the field in a format that has succeeded in this endeavor, it is a tribute to the expert authors who makes extensive use of graphical displays of important data. devoted time and considerable expertise to the effort. Their contributions Issues that are weH known to be important to skeletal biology and should enable the reader to comprehend the current state of this art, and osteoporosis (eg, nutrition, exercise, and growth) have been updated. That to benefit from it. there is substantive new information in these areas is a testament to the vigor ofthe field and the pace ofits advancement. Some chapters includ- Eric S. Orwoll, MD v LAURA K. BACHRACH, MD ROBERT F. KLEIN, MD Professor, Department of Pediatrics Assistant Professor Stanford University School of Medicine Department of Medicine Stanford Medical Center Oregon Health and Science University Stanford, California Staff Physician Portland Veterans Administration Medical Center PENNY R. BAINBRIDGE, BA, RGN Portland, Oregon Nurse Special ist Metabolie Bone Centre PHILIPP K. LANG, MD, MBA Northern General Hospital Associate Professor Sheffield, United Kingdom Department of Radiology Director MARY L. BOUXSEIN, PHD Division of Musculoskeletal Radiology Assistant Professor Brigham and Women's Hospital Department of Orthopedic Surgery Boston, Massachusetts Harvard Medical School Senior Research Associate ROBERT LlNDSAY, MD Beth Israel Deaconess Medical Center Professor Orthopedic Biomechanics Laboratory Department of Medicine Boston, Massachusetts Columbia-Presbyterian Medical Center New York, New York FELICIA COSMAN, MD Chief of Medicine Associate Professor Helen Hayes Hospital Department of Medicine West Haverstraw, New York Columbia-Presbyterian Medical Center New York, New York ROBERT MARCUS, MD Medical Director Professor Emeritus Clinical Research Center Department of Medicine Helen Hayes Hospital Stanford University School of Medicine West Haverstraw, New York Stanford, California Medical Advisor RICHARD EASTELL, MD, FRCP (UK, EDINBURGH, IRELAND), Eli Ully and Company FRCPATH, FMEDSCI Indianapolis, Indiana Research Dean for the School of Medicine and Biomedical Science Director of the Division of Clinical Sciences (North) MICHAEL R. MCCLUNG, MD University of Sheffield Clinical Sciences Centre Assistant Professor Northern General Hospital Medical Education Sheffield, United Kingdom Providence Portland Medical Center Director LORRAINE A. FITZPATRICK, MD Oregon Osteoporosis Center Professor of Medicine Portland, Oregon Department of Internal Medicine and Endocrinology Mayo Medical School PAUL D. MILLER, MD Consultant Clinical Professor of Medicine Endocrinology and Metabolism University of Colorado Medical Center Mayo Clinic Denver, Colorado Rochester, Minnesota Medical Director Colorado Center for Bone Research KARL j. jEPSEN, PHD Lakewood, Colorado Assistant Professor Department of Orthopedics ERIC S. ORWOLL, MD Mount Sinai School of Medicine Professor of Medicine New York, New York Department of Endocrinology Program Director, General Clinical Research Center B. jENNY KIRATLI, PHD Oregon Health and Science University Research Health Scientist Portland, Oregon Spinal Cord Injury Center Veterans Administration Palo Alto Health Care System Palo Alto, California Vtt SUSAN M. OTT, MD ADRIAN J. SPLITTHOFF, CANDMED Associate Professor Medizinische Fakultät der Albert-Ludwigs-Universität Department of Medicine Freiburg im Breisgau, Germany University ofWashington School of Medicine Research Fellow Seattle, Washington Harvard Medical School Department of Radiology RICHARD l. PRINCE, MD Brigham and Women's Hospital Associate Professor Boston, Massachusetts School of Medicine and Pharmacology University ofWestern Australia JAN E. VANDEVENNE, MD Perth, Australia Radiologist Department of Radiology CLiFFORD J. ROSEN, MD University of Antwerp Medical School Professor of Nutrition Antwerp, Belgium University of Maine Director NELSON B. WATTS, MD Maine Center for Osteoporosis Research Professor St. Joseph's Hospital Department of Medicine Bangor, Maine University of Cincinnati College of Medicine Director lORAN M. SAlAMONE, PHD University of Cincinnati Bone Health and Osteoporosis Center Assistant Professor Cincinnati, Ohio Department of Epidemiology Graduate School of Public Health CARl S.WINAlSKI, MD University of Pittsburgh Assistant Professor Pittsburgh, Pennsylvania Department of Radiology Director of Musculoskeletal MRI Brigham and Women's Hospital Boston, Massachusetts Vttt CHAPTER I The Nature of Osteoporosis Eric S. Orwoll and Robert Marcus Osteoporotie Bone ........................................... ~ .................................... I Bone Mass Measurement ...........................................................................3 Qualitative Abnormalities in Osteoporotie Bone ......................................................... .4 Bone Geometry ..................................................................................6 Role of Remodeling in LifelongAcquisition and Loss of Bone ................................................7 CHAPTER 2 Bone Acquisition and Peak Bone Mass Laura K.Bachrach Bone Mineral Acquisition .......................................................................... 12 Calcium Economies and Bone Health ................................................................. 16 Physieal Activity and Bone Mass ..................................................................... 18 Acquired Bone Fragility ............................................................................2 0 CHAPTER 3 Genetics of Osteoporosis Robert F. Klein Genetic Concepts ................................................................................2 8 Contribution of Genetics to Skeletal Characteristies .....................................................2 9 Methods in Genetic Investigation ....................................................................3 I Genes and Metabolie Bone Disease ..................................................................3 5 CHAPTER 4 Factors That Influence Adult Bone Mass Susan M. Ott Aging and Gender ............................................................................... .42 Clinieal Factors That Affect Bone Mass ................................................................4 3 Nutritional Factors ...............................................................................4 4 Smoking,Alcohol, and Bone ........................................................................ .46 Pregnancy ..................................................................................... .4 7 CHAPTER 5 Epidemiology of Osteoporosis and Associated Fractures Loran M. Salamone Epidemiology of Osteoporosis ......................................................................5 2 Fracture Epidemiology ............................................................................5 6 Risk Factors for Osteoporotic Fractures ..............................................................5 9 Role of Falls ....................................................................................6 2 Impact of Osteoporotie Fractures: Mortality, Morbidity, and Cost ............................................6 3 CHAPTER 6 Radiology of Osteoporotic Fracture Adrian J. Splitthoff,Jan E. Vandevenne, Carl S. Winalski, and Philipp K. Lang Vertebral Compression Fractures ....................................................................6 7 Hip Fractures .................................................................................. .70 Pelvic Insufficiency Fractures ....................................................................... .72 Wrist Fractures .................................................................................7 3 Fractures of the Proximal Humerus ..................................................................7 3 Other Insufficiency Fractures ...................................................................... .74 IX CHAPTER 7 Laboratory Assessment of Skeletal Status Richard Eastell and Penny R. Bainbridge Bone Turnover Markers ............................................................................7 7 Predietion of Bone Loss and Fraetures with Bone Turnover Markers ........................................ .78 Monitoring the Effeet ofTreatment on Bone Turnover Markers ............................................ .79 Bioehemieal Evaluation of Osteoporosis: Seeondary Osteoporosis ...........................................8 0 CHAPTER 8 Bone Densitometry in Osteoporosis Care Michael R. McC/ung Teehnology .....................................................................................8 4 Predicting Fraeture Risk ...........................................................................8 5 Diagnosing Osteoporosis ..........................................................................8 7 Monitoring Change ...............................................................................8 9 Indieations ......................................................................................9 1 Case Examples ..................................................................................9 3 CHAPTER 9 Estrogen-dependent Bone Loss and Osteoporosis Robert Lindsay and Felicia Cosman Biology of Estrogen Deficieney ......................................................................9 6 Effeets of Estrogen on Intermediate Markers (Bone Mass and Turnover) .......................................9 7 Effeets of Estrogen Intervention on Fraeture Oeeurrenee ..................................................9 9 Importanee of Estrogen in Men ..................................................................... 102 CHAPTER 10 Osteoporosis in Men Eric S. Orwoll and Robert F. Klein Incidenee and Risk .............................................................................. 10 6 Bone Mass Density and Strueture ................................................................... 109 Causes ....................................................................................... 110 Diagnosis and Evaluation .......................................................................... 1 14 Therapy ....................................................................................... I I 6 CHAPTER 11 Osteoporosis Associated with Systemic IIIness and Medications Paul D. Miller Osteoporosis Related to Gastrointestinal Diseases ...................................................... 120 Osteoporosis Related to Liver, Kidney, or Panereatie Diseases ............................................. 121 Osteoporosis Related to Medieation Administration ..................................................... 125 Osteoporosis Related to Bone Marrow Disorders ...................................................... 125 Osteoporosis Related to Endoerine Disorders ......................................................... 127 Osteoporosis Related to Pregnaney ................................................................. 132 Osteoporosis Related to Nutritional Deficieney ........................................................ 132 Low Bone Mass Related to Osteomalacia and Osteogenesis Imperfeeta ...................................... 132 Diseases That Might Be Deteeted in the Clinical Assessment of Patients with Metabolie Bone Disease .............. 135 x CHAPTER 12 GI ucocortieoid-i nd uced Osteoporosis Lorraine A. Fitzpatrick Epidemiology and Risk Factors ..................................................................... 138 Pathophysiology ................................................................................ 139 Bone Histomorphometry ......................................................................... 139 Physieal Findings ................................................................................ 140 Radiographie Diagnosis ........................................................................... 140 Bone Scans .................................................................................... 143 CHAPTER 13 Immobilization Osteoporosis B. Jenny Kiratli Bone Biomechanics .............................................................................. 150 Clinical Evidence ................................................................................ 152 Long Bone Fractures After Spinal Cord Injury .......................................................... 156 Theoretieal Framework for Fracture Risk Prediction .................................................... 162 CHAPTER 14 Etiology and Biomechanies of Hip and Vertebral Fractures Mary L Bouxsein and Karl J. Jepsen Basie Bone Biomechanics ......................................................................... 166 Age-related Changes in Bone ...................................................................... 167 Determinants of Fracture Risk and Introduction ofthe Factor of Risk ....................................... 169 Biomechanies of Hip Fractures ..................................................................... 170 Biomechanies ofVertebral Fractures ................................................................. 171 Fracture Prevention ............................................................................. 172 CHAPTER 15 Role of Nonpharmacologie Approach to Fracture and Osteoporosis Richard L Prince Overview of Bone Acquisition and Maintenance ........................................................ 175 Dietary Intervention for Bone Maintenance ........................................................... 178 Role of Activity and Exercise ....................................................................... 185 CHAPTER 16 Bisphosphonate Therapy for Osteoporosis Nelson B. Watts CHAPTER 17 Bone Anabolie Agents Clifford J. Rosen Insulin-like Growth Factor ........................................................................ 196 Human Growth Hormone ........................................................................2 0 I Parathyroid Hormone ............................................................................2 02 Sodium Fluoride ................................................................................2 04 Index ....................................................................................... . 209 Color Plates ................................................................................ 217 Xl
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