Osteoporosis in Men: The Effects of Gender on Skeletal Health

611 Pages·1999·29.85 MB·English

by  Eric S. Orwoll

Osteoporosis in Men
http://avaxho.me/blogs/ChrisRedfield
This Page Intentionally Left Blank
Osteoporosis
in Men
The Effects of Gender
on Skeletal Health
Edited by
Eric S. Orwoll
Oregon Health Sciences University
Portland VA Medical Center
Portland, Oregon
ACADEMIC PRESS
San Diego London Boston New York Sydney Tokyo Toronto
Front cover photograph: Histological section of the vertebral body edge
from an 82-year-old woman. For more details, see Figure 4 (color insert)
in Chapter 16.
This book is printed on acid-free paper. (~)
Copyright ~3 1999 by ACADEMIC PRESS
All Rights Reserved.
No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopy, recording, or any information
storage and retrieval system, without permission in writing from the publisher.
Requests for permission to make copies of any part of the work should be mailed to:
Permissions Department, Harcourt Brace & Company, 6277 Sea Harbor Drive,
Orlando, Florida, 32887-6777.
Academic Press
a division o['Harcourt Brace & Company
525 B Street, Suite 1900, San Diego, California 92101-4495, USA
http://www.apnet.com
Academic Press
24-28 Oval Road, London NWI 7DX, UK
http://www.hbuk.co.uk/ap/
Library of Congress Catalog Card Number: 99-83125
International Standard Book Number: 0-12-528640-6
PRINTED IN THE UNITED STATES OF AMERICA
99 00 01 02 03 04 EB 9 8 7 6 5 4 3 2 1
Contents
Contributors xix
Preface xxiii
Chapter I
Epidemiology of Fractures
L. Joseph Melton 111
I. Introduction 1
11. Effects of Age 2
111. Effects of Gender 3
IV. Effects of Race 4
V. Effects of Geography 6
VI. Secular Trends 7
VII. Public Health Implications 8
References 9
Chapter 2
Economic Impact of Fractures
Anna N. A. Tosteson
I. Introduction 15
11. Economic Evaluation 16
A. Cost of Illness Studies 16
V
vi Contents
B. Cost-EffectivenessAnalysis 16
III. Definition of Costs 17
A. Direct Costs 17
B. Indirect Costs 17
C. Intangible Costs 18
IV. Review of Studies 18
A. Cost of Illness Studies 19
B. Cost-Effectiveness Studies 23
V. Summary of Findings 24
VI. Directions for Future Research 25
References 25
Chapter 3
Hip and Vertebral Fractures
Frazer H. Anderson and Cyrus Cooper
I. Introduction 29
II. Demographic Factors 30
III. Gender-Specific Factors 31
A. Skeletal Growth 32
B. Hormonal Influences in Adult Life 33
C. Trauma 34
IV. Factors Affecting Case Definition 34
A. RadiologicaluMorphometric 34
B. RadiologicaluDensitometric 34
C. Clinical 35
V. Social and Economic Factors 36
A. Occupation 37
B. Diet 38
C. Exercise 39
D. Leisure Activities 39
VI. Falls 39
VII. Consequencs of Osteoporotic Vertebral and Femoral Fracture 41
VIII. Intervention 42
A. Pain Control 42
B. Surgery 43
C. Reduction of Falls Risk 43
D. Reduction of Forces Acting at the Impact Site 44
IX. Future Trends 44
References 45
Contents vii
Chapter 4
Outcomes and the Personal Impact of Osteoporosis
Deborah T. Gold
I. Introduction 51
A. Osteoporosis and Men: What We Know 52
B. Osteoporosis: Its Social/Emotional Impact and Quality
of Life 55
II. Men and Osteoporosis-Where Do We Start to Understand
Outcomes? 58
A. Focus Groups 58
B. Instrumentation 59
III. Commentary 59
IV. Conclusion 60
References 60
Chapter 5
Accumulation of Bone Mass during Childhood
and Adolescence
Vicente Gilsanz
I. Introduction 65
II. Techniques for Bone Measurements in Children 66
Ill. Peak Bone Mass 67
IV. Age-Related Changes in the Axial and Appendicular Skeletons 68
V. Nutrition 70
VI. Physical Activity 71
VII. Genetics 73
VIII. Gender 74
IX. Race 77
X. Conclusion 79
References 80
Chapter 6
Bone Size, Mass, and Volumetric Density: The Importance
of Structure in Skeletal Health
Ego Seeman
I. Introduction 87
II. Comparing Men and Women of Different Races 88
viii Contents
A. Growth in Size, Mass, and Volumetric Density of the Axial
Skeleton 88
B. Growth in Size, Mass, and Volumetric Density of the
Appendicular Skeleton 91
C. Delayed Puberty 93
III. Changes in Bone Size, Mass, and Volumetric Density during
Aging 94
A. Trabecular and Cortical Bone Loss 94
B. Relative Contributions of Peak Bone Mass and Bone Loss to Bone
Mass in Old Age 98
C. Hip Axis Length 99
IV. Comparing Men with and without Fractures 100
A. Reduced Bone Size 100
B. Less Bone in the Bone~Reduced Accrual and Excessive Bone
Loss 101
C. Histomorphometry and Reduced Bone Formation 102
D. Cellular Evidence of Reduced Bone Formation 103
V. Summary 105
VI. Questions 106
References 107
Chapter 7
Aging and Changes in Cortical Mass and Structure
R. Bruce Martin
I. Introduction 111
II. Basic Mechanical Considerations in Diaphyseal Modeling 112
III. The Mechanical Role of Remodeling 114
IV. Gender Differences in Modeling during Puberty 114
V. Animal Studies of the Effects of Sex Hormones on Modeling 116
VI. Male Hypogonadism 118
VII. Remodeling, Fatigue Damage, and Mechanical Properties in the
Aging Skeleton 119
VIII. Compensatory Modeling in the Aging Skeleton 121
IX. The Neck of the Femur 123
X. Summary and Research Directions 125
References 126
Contents ix
Chapter 8
Skeletal Effects of Exercise in Men
Belinda Beck and Robert Marcus
I. Introduction 129
II. Definitions 130
III. The Male Skeleton~Why Care about It? 130
A. Bone Density: Gender Comparison 130
B. Fracture Risk 130
C. Acquisition and Loss of Bone 131
IV. The Response of Bone to Loading~Fundamental Aspects 132
A. Characteristics of Effective Mechanical Loading 132
B. The Curvilinear Nature of Skeletal Response 133
C. The Role of Bone Geometry 134
V. Translating Theory into Practice~Exercise and Bone 135
A. Limitations of the Literature 135
B. Relationship of Body Mass to BMD 136
C. Relationship of Muscle Strength to BMD 137
D. Exercise Effects~Cross-Sectional Study Findings 137
E. Exercise Effects~InterventionTrial Findings 143
VI. Unloading Bone~In Brief 145
VII. Hormonal Factors 146
A. Acute Exercise Response 146
B. Chronic Exercise Response 146
VIII. Sex Comparison of Exercise Effect on Bone 147
IX. Maintaining Bone Mass--Exercise Prescription 148
X. Conclusions 149
References 150
Chapter 9
Insulin-like Growth Factors and Bone: Implications for the
Pathogenesis and Treatment of Osteoporosis
Clifford J. Rosen
I. Introduction 157
II. Physiology of the IGFs 158
A. IGF-I and IGF-II Structure and Function 158
B. The Skeletal IGF Regulatory System 160
C. Regulation of Serum and Skeletal IGFs 162
III. IGFs and Their Role in Acquisition and Maintenance of Adult
Bone Mass 167
A. Acquisition of Peak Bone MassmRole of the IGFs 167