Osteoporosis fractures

L.L. Demos, H. Kazda, F.M. Cicuttini, M.l. Sinclair, C.K. Fairley, Water fluoridation, osteoporosis, fractures—Recent developments, Aust. Dent. J. 46 (2001) 80-87. 

The second patent defines drugs for the prevention and treatment of osteoporosis, fracture, lumbago, and rheumatic arthritis. These drugs contain compounds such as ceramides, sphingomyelins, sphingoglycolipids and... 

Decrease mast cell numbers Osteoporosis, fractures and aseptic necrosis of hip... 

The anemia is characterized as hypochromic and normocytic with a reduced reticulocyte count, hypo-ferremia, and thrombocytopenia. Bone marrow aspirate reveals megaloblastic changes and vacuolization of both erythroid and myeloid progenitor lineages. It is believed that a profound copper deficiency results in a multicopper oxidase deficient state and as such bone marrow demands are unmet by the lack of ferroxidase activity. Bone abnormalities are common and manifest as osteoporosis, fractures, and epiphyseal separation. Other manifestations of copper deficiency include hypopigmentation, hypotonia, growth arrest, abnormal cholesterol and glucose metabolism, and increased rate of infections. 

Oral calcium has long been used for the treatment of osteoporosis, both in the form of dietary and pharmacological supplements. In patients with calcium deficiency, oral calcium at doses of 1000-1500 mg/day corrects a negative calcium balance and suppresses PTH secretion. Sufficient calcium intake is most important for the acciual of peak bone mass in the young, but is also considered the basis of most anti-osteoporotic regimens. In the elderly, supplementation with oral calcium and vitamin D reduces the risk of hip fracture by about 30 4-0%. 

A peptide hormone rapidly inhibiting osteoclast activity. The relevance of calcitonin in human calcium homeostasis is not well understood. Calcitonin has been used for the treatment of osteoporosis, although due to the availability of more potent drugs with less side effects, and the lack of clear data on the anti-fracture efficacy of calcitonin, its clinical use has been steadily declining. 

Fluoride stimulates bone formation by protein kinase activation mediated effects on osteoblasts. Fluorides have been used in the treatment of osteoporosis, but their anti-fracture effect is not undisputed. 

Osteoporosis is a common condition, in which bone density is decreased as a consequence of an imbalance between bone formation (osteoblast) and bone loss (osteoclast). This leads to fragile bones, which are at an increased risk for fractures. The term porosis means spongy, which describes the large holes seen in these bones. 

A major regulator of bone metabolism and calcium homeostasis, parathyroid hormone (PTH) is stimulated through a decrease in plasma ionised calcium and increases plasma calcium by activating osteoclasts. PTH also increases renal tubular calcium re-absorption as well as intestinal calcium absorption. Synthetic PTH (1-34) has been successfully used for the treatment of osteoporosis, where it leads to substantial increases in bone density and a 60-70% reduction in vertebral fractures. 

Summary term for a number of steroid hormones and their precursors with differentiation-inducing activity in many tissues. As regards bone, three components are relevant cholecalciferol ( vitamin D ) 25-hydroxyvi-taminD3 (calcidiol) and 1,25-dihydroxy vitamin D3 (calcitriol). The latter is the biologically active form and increases both intestinal calcium absoiption and bone resorption. Vitamin D preparations are widely used for the treatment of osteoporosis. Daily supplementation with vitamin D reduces bone loss in postmenopausal women and hip fractures in elderly subjects. 

Osteoporosis is a loss of bone density occurring when the loss of bone substance exceeds the rate of bone formation. Bones become porous, brittle, and fragile. Compression fractures of the vertebrae are common. This disorder occurs most often in postmenopausal women, but can occur in men as well. 

Muscle weakness, loss of muscle mass, tendon rupture, osteoporosis, aseptic necrosis of femoral and humoral heads, spontaneous fractures... 

Risk for Injury related to adverse reactions (musde atrophy, osteoporosis, spontaneous fractures)... 

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. 

BMD will increase and the risk of fractures will decrease in women taking HRT. However, when therapy is discontinued, a decline in BMD will resume at the same rate as in women not on HRT. Therefore, therapy for osteoporosis prevention should be considered long term. Since HRT should be maintained only for the short term, alternative therapies such as bisphosphonates or raloxifene should be considered as first-line therapy for the prevention of postmenopausal osteoporosis, in addition to appropriate doses of calcium and vitamin D. Because of the risks associated with HRT, it should not be prescribed solely for the prevention of osteoporosis. 

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. 

Bisphosphonates are hrst-line therapy for postmenopausal osteoporosis owing to their established efficacy in preventing hip and vertebral fractures. 

Alendronate should be considered hrst-line treatment for primary osteoporosis in men owing to its proven benefit in reducing fractures and relative safety. 

Osteoporosis is a common and often silent disorder associated with significant morbidity and mortality and reduced quality of life. It is associated with increased risk and rates of bone fracture and is responsible for over 1.5 million fractures in the United States annually, resulting in direct health care costs of over 17 billion.1 As the population ages, these numbers are expected to increase. It is estimated that postmenopausal Caucasian women have a 50% lifetime chance of developing an osteoporosis-related fracture.1 Common sites of fracture include the spine, hip, and wrist, although almost all sites can be affected. Only a fraction of patients with osteoporosis receive optimal treatment. 

Osteoporosis is a disabling disorder with enormous impact. In addition to the initial pain associated with a new fracture, several adverse long-term complications can occur, including chronic pain, loss of mobility, depression, nursing home placement, and death. Patients with vertebral fractures may experience chronic pain, height loss, kyphosis, and decreased mobility... 

Osteoporosis is the most common skeletal disorder, and approximately one in five Caucasian women in the United States has the disease. The prevalence of vertebral fracture in postmenopausal women is greater than 20%.2 Only one in three patients with osteoporosis has been diagnosed, and only one in seven will receive treatment.2... 

Most hip fractures occur in postmenopausal Caucasian women they also have the highest incidence of fracture when adjusted for age.4 The incidence of osteoporosis and low bone... 

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. 

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