Bone mineral density

Various estimations indicate that nearly twenty million women in America suffer osteoporotic problems. The physiological changes that take place are certainly forms of aging. In one five-year study where ERT compliance was carefully monitored, the bone mineral density increased regardless of the length of treatment or the patient s age when therapy commenced (69). 

Alendronate, etidronate, and risedronate act primarily on the bone by inhibiting normal and abnormal bone resorption. This results in increased bone mineral density, reversing the progression of osteoporosis. 

SOMEKAWA Y, CHiGUCHi M, isHiBASHi T, Aso T (2001) Soy intake related to menopausal symptoms, serum hpids and bone mineral density in postmenopausal Japanese women. Obstet Gynecol. 97 109-15. 

Table 6.1 Cross-sectional, population studies based on dietary intake of soy products and bone mineral density (BMD) or biomarkers of bone turnover...

ANDERSON J J, CHEN X, BOASS A, SYMONS M, KOHLMEIER M, RENNER J B, GARNER S C (2002) Soy isoflavones no effects on bone mineral content and bone mineral density in healthy, menstruating young adult women after one year. J Am Coll Nutr 21, 388-393. 

MEi J, YEUNG s s, RUNG A w (2001) High dietary phytoestrogen intake is associated with higher bone mineral density in postmenopausal but not premenopausal women, J Clin Endocrinol Metabol 86(11), 5217-21. 

TSUCHIDA K, MizusHiMA s, TOBA M, SODA K (1999) Dietary soybeans intake and bone mineral density among 995 middle-aged women in Yokohama. J Epidemiol 9, 14-19. 

It has been shown that in postmenopausal women habitually high intakes of dietary isoflavones are associated with higher bone mineral density (BMD) values at both the spine and hip region (Mei et al, 2001). It is conceivable that an isoflavone-rich diet may help to reverse the state of secondary hyperparathyroidism associated with estrogen withdrawal and hence lower the rate of bone turnover in postmenopausal women, thus reducing the risk of osteoporosis (Valtuena et al, 2003). Phytoestrogens could be used as natural SERMs (Brzezinski and Debi, 1999) and some studies (Setchell, 2001 and refs therein) support such an idea since the molecular targets of... 

HAWORTH C S, SELBY P L, WEBB A K, DODD M E, MUSSON H, MCL NIVEN R, ECONOMOU G, HORROCKS A w, FREEMONT A J, MAWER E B and ADAMS J E (1999) Low bone mineral density in adults with cystic fibrosis. Thorax. 54 (11) 961-7. 

Systemic adverse effects are dose-dependent and are rare at low to medium doses however, high-dose inhaled corticosteroids have been associated with adrenal suppression, decreased bone mineral density, skin thinning, and easy bruising.3,29 Growth suppression in children may occur even with low-dose inhaled corticosteroids however, suppression appears to occur primarily in the first year of treatment and may be due to delayed growth with the potential of future catch-up growth.30... 

CF patients with low bone mineral density and low serum vitamin D levels may improve bone health through supplemental vitamin D analogs beyond those found in standard CF vitamins. The optimal dose and analog have not been determined. For ergocalciferol, a minimum of 400 IU and 800 IU... 

Central bone mineral density testing to evaluate the need for preventive or therapeutic bisphosphonate therapy ... 

One chronic adverse effect that is of concern is osteoporosis.32,33 Carbamazepine, phenytoin, phenobarbital, oxcarbazepine, and valproate have all been shown to decrease bone mineral density, even after only 6 months of treatment. Data on the relationship between other AEDs and osteoporosis are not currently available. Multiple studies have shown the risk of osteoporosis due to chronic AED use to be similar to the risk with chronic use of corticosteroids. Patients taking carbamazepine, phenytoin, phenobarbital, or valproate for longer than 6 months should take supplemental calcium and vitamin D. Additionally routine monitoring for osteoporosis should be performed every 2 years, and patients should be instructed on ways to protect themselves from fractures. 

Monitor for acute and chronic adverse effects of AEDs. Acute adverse effects are best detected by a thorough neurologic examination at clinic visits. Instruct patients to report sedation, ataxia, rash, or other problems immediately. Monitor for chronic adverse effects including a loss of bone mineral density, which should be measured every 2 years in patients taking phenytoin, phenobarbital, carbamazepine, and valproate. 

Reduced bone mineral density associated with an increased risk of fracture. 

Routine monitoring of fasting lipid profile, bone mineral density, and body composition in children is not typically required during GH replacement but should be done before and after discontinuation of therapy.35... 

Consider a bone mineral density test in patients with long-term hypogonadism. Additional Clinical Sequelae... 

The prolonged suppression of estrogen in pre-menopausal women with hyperprolactinemia leads to decreases in bone mineral density and significant risk for the development of osteoporosis. 

BMD, bone mineral density NSAID, non-steroidal anti-inflammatory drug OCs, oral contraceptives PCOS, polycystic ovary syndrome PMDD, premenstrual dysphoric disorder. 

Serious adverse effects Venous thromboembolism Decreased bone mineral density... 

Osteoporosis Oral calcium supplementation (1000-5000 mg/day) Oral vitamin D Calcifediol (1000 lU/day) Calcitriol (0.5 mcg/day) Hormone-replacement therapy Calcitonin or oral bisphosphonates If daily intake less than 1000 mg elemental calcium Documented deficiency If kidney functioning If kidney not functioning Post-menopausal women without contraindications Documented loss in bone mineral density greater than 3% Data lacking for bisphosphonates in patients with Rl... 

O The most important risk factors for fracture are low bone mineral density and a personal history of adult fracture. 

All postmenopausal women with a personal history of osteoporotic fracture and/or low bone mineral density with risk factors for osteoporosis should receive treatment for osteoporosis. 

Many of the risk factors for osteoporosis and osteoporotic fractures are predictors of low bone mineral density, such as age and ethnicity (Table 53-1). The most important risk factors for fracture are low bone mineral density, personal history of adult fracture, age, and family history of osteoporotic fracture. Other important risk factors for osteoporosis and osteoporotic fractures include menopausal status, smoking status, and low body weight. As bone mineral density decreases, the risk of fracture increases. However, the threshold at which individual patients develop a fracture varies, and other factors may play a role in fracture susceptibility. One such factor that can influence the development of fracture is falling. 

Bone mineral density can be measured at various sites throughout the skeletal system and by various methods. The site of measurement can be either central (hip and/or spine) or peripheral (heel, forearm, or hand). Dual-energy x-ray absorptiometry (DXA) can be used to measure central and peripheral sites of bone mineral density. Quantitative ultrasound, peripheral quantitative computed tomography, radiographic absorptiometry, and single-energy x-ray absorptiometry are used to measure peripheral sites. 

Peripheral bone mineral density measurements cannot be used for diagnosis because they do not correlate with central measurements. However, they are useful in identifying patients who are candidates for central DXA and who are at increased risk of fracture.5 It also may be useful in patients who have had multiple fractures or in low-risk patients. Additionally, peripheral measurement of bone mineral density generally is less expensive than central DXA and is easily accessible. Instruments used for peripheral bone densitometry are portable, which allows bone density to be measured in pharmacies and health-fair screening booths. 

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