Osteoporosis discussion

The bisphosphonates are drags used to treat musculoskeletal disorders such as osteoporosis and Fhget s disease. This chapter will discuss the use of these drugs in the treatment of osteoporosis. 

See Chap. 93, Osteoporosis and Other Metabolic Bone Diseases, authored by Mary Beth O Connell and Sheryl F. Vondracek, for a more detailed discussion of this topic. 

Tamoxifen is discussed in Chap. 61, Breast Cancer raloxifene is discussed in Chap. 3, Osteoporosis. Raloxifene decreases bone loss in recently menopausal women without affecting the endometrium and has estrogen-like actions on lipid metabolism. It may exacerbate vasomotor symptoms, and it increases the risk of venous thromboembolism and stroke. 

The benefits of hormonal therapies for osteoporosis prevention are discussed in Chap. 3. Hormone therapy should be considered for osteoporosis prevention only in women at significant risk for osteoporosis who cannot take nonestrogen regimens. 

Polaprezinc has also been shown to be beneficial in treatment of ulcers and other gut lesions (discussed above) and in inhibiting some of the changes surrounding osteoporosis (also discussed above). 

Another much discussed concern is the potential effect on bone, with conditions such as skeletal fluorosis, osteosarcomas, osteoporosis and greater incidence of fractures being considered. 

This paper is written with the aim of providing sufficient background to help understand the mechanism of action of fluoride ion on humans. The main focus is on the effects of fluoride on dental health, in-depth discussion of skeletal fluorosis and use of fluoride for treating osteoporosis being outside the scope of this paper. Current information on the main sources of human exposure to fluoride and current recommendations for adequate intake (Al) of fluoride, as well as methods for assessing exposure, will be reviewed. 

Optimal management of the postmenopausal patient requires careful assessment of her symptoms as well as consideration of her age and the presence of (or risks for) cardiovascular disease, osteoporosis, breast cancer, and endometrial cancer. Bearing in mind the effects of the gonadal hormones on each of these disorders, the goals of therapy can then be defined and the risks of therapy assessed and discussed with the patient. 

Treatments of diseases such as osteoporosis, rickets and osteomalacia, in which there is a disturbance of phosphate levels, is complicated by the interdependence of calcium metabolism. This topic has recently been discussed in relation to clinical medicine21. There is the further difficulty that absorption of phosphate from the bowel can be decreased in the presence of calcium or aluminium salts because of the formation of their insoluble phosphates. Uptake of phosphate by bone is exploited in the treatment of polycythaemia vera by intravenous injection of 32P as sodium phosphate. The resulting irradiation of the neighbouring red bone marrow diminishes the production of red cells. 

Osteolytic bone diseases or bone resorption the most important clinical application of BPs is as inhibitors of osteolytic bone diseases, including osteoporosis, tumor-related bone destruction, and Paget s disease. These are discussed in detail in the next section. 

Discuss the options for the treatment of osteoporosis and decide which you think would be the most suitable for Mrs TY. 

Insufficient intakes of Mn and Cu resulted in significant abnormalities in both serum and bone mineral levels within twelve months. Why a chronic deficiency of trace elements should result in conditions of osteopenia is not at present clear. It has been suggested that osteopenia is associated with an increased rate of bone resorption (33). Others have implicated decreased bone formation or osteoblast activity in some forms of osteoporosis (34). What is obviously at issue is a balance between the rate of bone resorption and that of bone synthesis (35-37). Bow that equilibrium dynamic is affected by trace elements will be discussed below. 

Calcium needs and metabolism have become an important nutrition issue due to the increased prevalence of osteoporosis. Osteoporosis is a disease of fragility of major bones such as the pelvis, femur, and spine caused by an age-related loss of bone minerals. As discussed in Chapter 7, calcium intake and physical activity may favorably affeot the calcium content of bones and delay the onset of osteoporosis. 

The U.S./Canadian report (Institute of Medicine, 1997) discussed requirements only in terms of bone density and maintenance of a plasma concentration of calcitriol above that associated with elevated parathyroid hormone and alkaline phosphatase. Vieth (1999) noted that intakes above 5 /xg per day are required to prevent osteoporosis (Section 3.4.3) and secondary hyperparathyroidism, and suggested that normal sunlight exposure may provide the... 

The relationship between calcium and phosphate metabolism is very complex. The quesbon of the ratio of calcium/phosphate in the diet may be raised when discussing diets needed to support maximal growth or when discussing pathological phenomena, such as hypocalcemia, osteoporosis, kidney stone formation, and the ealcificabtin of soft tissues. A firm grounding in one or two relationships in calcium... 

Although it might seem reasonable to treat osteoporosis with vitamin D, it must be realized that the primary funebon of vitamin D is to maintain plasma calcium levels, not to promote bone formation. An end-effect of vitamin D supplementa-hon is an increase in bone resorpbon and increased excretion of calcium in the urine. Calcium supplements should not be used indiscriminately Two types of persons should not receive calcium supplements persons with hypercalcemia and persons with kidney stones or a family history of kidney stones. These two issues are discussed in the following pages. 

Xenobiotic exposure can adversely affect bones, joints, connective tissue, and muscles. Rheumatoid arthritis, osteoporosis, osteomalacia, systemic sclerosis, scleroderma, systemic lupus erythematosus, and spina bifida are musculoskeletal diseases that have been associated with toxic chemical exposures. Most of these associations, however, have been made to single chemical exposures and not to mixtures. This chapter cites the evidence on which those associations are based and discusses the available examples of mixtures that have been implicated. 

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