Osteoporosis: Diagnosis, Prevention, Therapy. A Practical Guide for all Physicians — from Pediatrics to Geriatrics PDF
Preview Osteoporosis: Diagnosis, Prevention, Therapy. A Practical Guide for all Physicians — from Pediatrics to Geriatrics
Springer-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 Cataloging-in-PublicationDataappliedfor Bibliographie information published by Die Deutsche Bibliothek. Die Deutsche BibliothekliststhispublicationintheDeutscheNationalbibliografie;detailedbib liographiedataisavailableintheInternetat<http://dnb.ddb.de>. Thisworkissubjecttocopyright.Allrightsarereserved,whetherthewholeorpart ofthematerialisconcerned,specificallytherightsoftranslation,reprinting,reuse ofillustrations,recitation,broadcasting,reproductiononmicrofilmorinanyother way,andstorageindatabanks.Duplicationofthispublieationor partsthereofis permittedonlyundertheprovisions ofthe GermanCopyrightLawofSeptember 9,1965,initscurrentversion,andpermissionforusemust alwaysbeobtainedfrom Springer-Verlag.ViolationsareliableforprosecutionundertheGermanCopyright Law. springeronline.com ©Springer-VerlagBerlinIIeidelberg2004 OriginallypublishedbySpringer-VerlagBerlinHeidelbergNewYorkin2004. The useofgeneral descriptivenames,registered names,trademarks,etc.in this publicationdoes not imply,evenin the absenceofaspecificstatement,thatsuch namesareexemptfromtherelevantprotectivelawsandregulationsandtherefore freeforgeneraluse. Productliability:Thepublisherscannotguaranteetheaccuracyofanyinformation about dosageandapplicationcontainedinthis book. Ineveryindividual casethe user mustchecksuchinformationbyconsultingtherelevantliterature. Illustrations:R.Henkel,Heidelberg Coverdesign:E.Kirchner,Heidelberg Productmanagementandlayout:B.Wieland,Heidelberg Typesetting:AM-production,Wiesloch 24/3150- 5 4 3 2 1 0 Printedonacid-freepaper 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
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