Osteoporosis with

Assess patient risk factors for osteoporosis, with special attention to age, menopausal status, previous history of osteoporotic fracture, smoking status, low body weight, family history of osteoporotic fracture in first-degree relatives, and presence of secondary causes of osteoporosis. 

Lufkin EG, Whitaker MD, Nickelsen T, et al. (1998) Treatment of stablished postmenopausal osteoporosis with Raloxifene a randomized trial. J Bone Miner Res 13 1747-1754... 

Fluoride, Fluoride Is contained In water and In the diet (22,23) Also, fluoride stabilizes the bone crystal (24) and has been shown to decrease bone resorption (25), For these reasons, fluoride has been recommended for the treatment for osteoporosis (26-28), The Importance of the role of fluoride on maintaining the normal bone structure Is also Indicated by a survey which showed that the Incidence of osteoporosis was lower In naturally high fluoride areas than In areas where the fluoride content of the drinking water was low (29) This observation would Indicate that the Intake of certain amounts of fluoride throughout life may be necessary for the maintenance of the normal skeleton, and that fluoride may protect the skeleton from the development of bone loss which leads to osteoporosis with advancing age, particularly In females. 

Bisphosphonates structurally mimic endogenous pyrophosphate, which inhibits precipitation and dissolution of bone minerals. They retard bone resorption by osteoclasts and, in part, also decrease bone mineralizatioa Indications include tumor osteolysis, hypercalcemia, and Paget s disease. Qinical trials with etidronate, administered as an intermittent regimen, have yielded favorable results in osteoporosis. With the newer drugs clodronate, pamidronate, and alendronate, inhibition of osteoclasts predominates a continuous regimen would thus appear to be feasible. 

C.Y.C. Pak, K. Sakheee, B. Adams-Huet, V. Piziak, R.D. Peterson, J.R. Poindexter, Treatment of postmenopausal osteoporosis with slow-release sodium fluoride Final report of a randomized controlled trial, Ann. Intern. Med. 123 (1995) 401-408. 

Treatment of postmenopausal women with osteoporosis with raloxifene (60mg/day or 120mg/day for 36 months) was found to significantly increase bone mineral density in the spine and femoral neck and decrease the risk of vertebral fracture compared to the placebo treatment.Treatment with raloxifene increased the risk of venous thromboembolism compared to the placebo group and was also associated with a lower risk of breast cancer and did not cause breast pain or vaginal bleeding. 

Calcium and phosphate, the major mineral constituents of bone, are also two of the most important minerals for general cellular function. Accordingly, the body has evolved a complex set of mechanisms by which calcium and phosphate homeostasis are carefully maintained (Figure 42-1). Approximately 98% of the 1-2 kg of calcium and 85% of the 1 kg of phosphorus in the human adult are found in bone, the principal reservoir for these minerals. These functions are dynamic, with constant remodeling of bone and ready exchange of bone mineral with that in the extracellular fluid. Bone also serves as the principal structural support for the body and provides the space for hematopoiesis. Thus, abnormalities in bone mineral homeostasis can lead not only to a wide variety of cellular dysfunctions (eg, tetany, coma, muscle weakness) but also to disturbances in structural support of the body (eg, osteoporosis with fractures) and loss of hematopoietic capacity (eg, infantile osteopetrosis). 

Talalaj M, Gradowska L, Marcinowska-Suchowierska E, Durlik M, Gaciong Z, Lao M. Efficiency of preventive treatment of glucocorticoid-induced osteoporosis with 25-hydroxyvitamin D3 and calcium in kidney transplant patients. Transplant Proc 1996 28(6) 3485-7. 

Boutsen Y, Jamart J, Esselinckx W, Stoffel M, Devogelaer JP. Primary prevention of glucocorticoid-induced osteoporosis with intermittent intravenous pami-dronate a randomized trial. Calcif Tissue Int 1997 61(4) 266-71. 

VI. Van Creveld, S., and Arons, P., Further experiences in a special case of renal osteoporosis with amino-aciduria, treated with dihydrotachysterol. Ann. Paediat. 182, 191-202 (1954). 

With regard to the development of osteopenia or osteoporosis with hypogonadism in males, lack of androgens is considered as a risk factor from the point of view of the quality of the bone. Anabolic steroids act on the bone probably through the androgen receptors on the osteoblasts, but an inhibitory effect on the osteoclasts is also possible. The condition affects mainly the cortical phase of the bone. When anabolic steroids are applied in females, they are usually combined with estrogens. Their application acts preventively against the loss of bone mass, stimulates osteoformation, and reduces the risk of hip fracture. 

Clinical Correlations of Osteoporosis with Serum Manganese... 

A schema for the prevention of osteoporosis with HRT beyond 5 years, or other options, appears in Figure 38.1... 

Fig. 38.1 The prevention of osteoporosis.With permission from J Manson, Harvard Medical School and the New England Journal of Medicine...

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. 

Teriparatide Forteo (Lilly) Osteoporosis with fracture risk Bone mass increase in hypogonadal men... 

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