Osteoporosis (Illustrated) PDF
Preview Osteoporosis (Illustrated)
R545_Osteo_Cover_09.qxd 10/1/06 14:36 Page 1 State of the Art Osteoporosis and its complications should no longer be thought of as an N ig inevitable consequence of the aging process. Since the first edition of this e l book was published, further strides have been made in detection and A r d treatment, and it has become more and more clear that lifestyle e n interventions such as increasing physical activity can have a major impact on the prognosis of osteoporosis patients. Despite these advances, as many as 10 million people aged over 50 years in Osteoporosis the USA today suffer from osteoporosis. With an aging population, increasing numbers of individuals in developed countries will be at risk from osteoporosis and its complications – raising awareness among the medical community and the promotion of prevention strategies are now of vital importance. Nigel Arden, Editor This book is a resource for all those involved in the treatment or prevention of osteoporosis. The new edition has maintained the accessible, highly illustrated approach of the original, but it has been completely revised and O brought up to date, with new images and new sections. The authors, all s t experts in their particular aspect of treatment or diagnosis, present a eo p readable, concise, and practical guide to osteoporosis in the clinical setting. o r o s Contents is • The Epidemiology of Osteoporotic Fractures • The Pathogenesis of Osteoporosis • Risk Factors for Fracture • Strategies for the Prevention and Management of Osteoporosis • The Radiologic Diagnosis of Osteoporosis • Biochemical Markers of Bone Turnover • Treatment of Established Osteoporosis • Osteoporosis in Men • Corticosteroid-induced Osteoporosis R545_Osteo_17.qxd 10/1/06 14:31 Page i Osteoporosis R545_Osteo_17.qxd 10/1/06 14:31 Page ii Published by Remedica Commonwealth House, 1 New Oxford Street, London, WC1A 1NU, UK Civic Opera Building, 20 North Wacker Drive, Suite 1642, Chicago, IL 60606, USA [email protected] www.remedicabooks.com Tel: +44 20 7759 2900 Fax: +44 20 7759 2951 Publisher: Andrew Ward In-house editors: Carolyn Dunn, Cath Harris, Lyndsey Parker Design and artwork: AS&K Skylight Creative Services © 2006 Remedica Previously published as ‘Osteoporosis Illustrated’. While every effort is made by the publisher to see that no inaccurate or misleading data, opinions, or statements appear in this book, they wish to make it clear that the material contained in the publication represents a summary of the independent evaluations and opinions of the authors and editor. As a consequence, the authors, editor, publisher, and any sponsoring company accept no responsibility for the consequences of any inaccurate or misleading data or statements. Neither do they endorse the content of the publication or the use of any drug or device in a way that lies outside its current licensed application in any territory. 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 publisher. Remedica is a member of the AS&K Media Partnership. ISBN-13: 978 1 850092 05 2 ISBN-10: 1 850092 05 2 British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. Printed in Malta. R545_Osteo_17.qxd 10/1/06 14:31 Page iii Osteoporosis Nigel Arden, Editor Senior Lecturer in Rheumatology Medical Research Council Environmental Epidemiology Unit University of Southampton Southampton General Hospital Southampton UK R545_Osteo_17.qxd 10/1/06 14:31 Page iv R545_Osteo_17.qxd 10/1/06 14:31 Page v Contents Chapter 1 The Epidemiology of Osteoporotic Fractures 1 Nicholas Harvey and Cyrus Cooper Chapter 2 The Pathogenesis of Osteoporosis 27 Juliet Compston Chapter 3 Risk Factors for Fracture 55 Nigel Arden Chapter 4 Strategies for the Prevention and Management of Osteoporosis 75 Pam Brown Chapter 5 The Radiologic Diagnosis of Osteoporosis 89 Glen Blake and Ignac Fogelman Chapter 6 Biochemical Markers of Bone Turnover 117 Ramasamyiyer Swaminathan Chapter 7 Treatment of Established Osteoporosis 143 Judith Bubbear, Ajay Bhatia, and Richard Keen Chapter 8 Osteoporosis in Men 163 Steve Tuck and Roger Francis Chapter 9 Corticosteroid-induced Osteoporosis 185 Jackie Clowes and Richard Eastell Abbreviations 203 Index 207 R545_Osteo_17.qxd 10/1/06 14:31 Page vi Contributors Contributors Nigel Arden Richard Eastell Senior Lecturer in Rheumatology Research Dean Medical Research Council Division of Clinical Sciences (North) Environmental Epidemiology Unit University of Sheffield University of Southampton Northern General Hospital Southampton General Hospital Sheffield, UK Southampton, UK Ignac Fogelman Ajay Bhatia Professor of Nuclear Medicine Specialist Registrar Department of Nuclear Medicine Metabolic Bone Unit Guy’s, King’s and St Thomas’ School of Medicine The Royal National Orthopaedic Hospital London, UK Stanmore, UK Roger Francis Glen Blake Reader in Medicine (Geriatrics) Senior Lecturer Musculoskeletal Unit Department of Nuclear Medicine Freeman Hospital Guy’s, King’s and St Thomas’ School of Medicine Newcastle upon Tyne, UK London, UK Nicholas Harvey Pam Brown Specialist Registrar General Practitioner Medical Research Council Swansea, UK Environmental Epidemiology Unit University of Southampton Judith Bubbear Southampton General Hospital Clinical Research Fellow Southampton, UK Metabolic Bone Unit The Royal National Orthopaedic Hospital Richard Keen Stanmore, UK Consultant Rheumatologist University College London Jackie Clowes Centre for Rheumatology ARC Clinical Scientist London, UK Mayo Clinic and Foundation Endocrine Research Unit Ramasamyiyer Swaminathan St Mary’s Hospital Professor of Clinical Chemistry Rochester, MN, USA Department of Clinical Chemistry Guy’s, King's and St Thomas’ School of Medicine Juliet Compston London, UK Reader and Honorary Consultant Physician Department of Medicine Steve Tuck Addenbrooke’s Hospital Consultant Rheumatologist Cambridge, UK James Cook University Hospital Middlesbrough, UK Cyrus Cooper Professor of Rheumatology Medical Research Council Environmental Epidemiology Unit University of Southampton Southampton General Hospital Southampton, UK R545_Osteo_17.qxd 10/1/06 14:31 Page vii Introduction Since the first edition of Osteoporosis Illustrated was published in 1997, knowledge about the causes and treatment of osteoporosis has continued to expand at a dramatic rate. There have been major advances in cellular biology, which have allowed further insights to be obtained into the pathogenesis of osteoporosis, and potentially two new therapeutic agents. There is now an ever-increasing array of techniques to measure bone density and size, which have helped to provide a greater understanding of the forces which affect bone fragility, including bone architecture and micro-architecture, as well as bone mineral density. Finally, there have been a number of new therapeutic agents on the market since the first edition, which have allowed more effective management of patients at high risk for osteoporotic fractures. This explosion of research has exponentially increased the amount of information available to clinicians via increasing numbers of dedicated osteoporosis journals and conferences in every country. Most large text books are rapidly out of date in this fast moving field, and it is now difficult for even the most dedicated specialist to remain abreast of scientific and therapeutic advances. In this book, experts in their field have each provided a current ‘state of the art’ overview of the important areas in osteoporosis today. The style of the chapters, with figures and illustrations, is designed to facilitate understanding of the concepts and processes involved, in addition to providing an enjoyable read. Osteoporosis is now a treatable disease, let us hope we can all keep up with the advances going forward. Nigel Arden Editor R545_Osteo_17.qxd 10/1/06 14:31 Page viii R545_Osteo_17.qxd 10/1/06 14:31 Page 1 11 The Epidemiology of Osteoporotic Fractures Nicholas Harvey and Cyrus Cooper Definition of osteoporosis Osteoporosis is a skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture [1]. It is a major public health issue, affecting a large proportion of the population >50 years of age. It leads to a huge burden through the increased morbidity and mortality associated with fragility fractures. The term ‘osteoporosis’ was first introduced in France and Germany in the 19th century. It means ‘porous bone’ and initially implied a histologic diagnosis, but was later refined to mean bone that was normally mineralized, but reduced in quantity (Figure 1.1). The definition of osteoporosis has, historically, been difficult. A definition based on bone mineral density (BMD) might not encompass all of the risk factors for fracture, whereas a fracture-based definition will not enable the identification of (a) (b) Figure 1.1 (a) Normal and(b) osteoporotic bone. 1
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