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PubMed2005

[Knowledge, health belief, and self-efficacy related to osteoporosis].

PURPOSE: This research was conducted to examine the relationship of knowledge, health beliefs, and self-efficacy on osteoporosis. METHOD: The design of this study was a correlative design. The subjects were 1,615 Korean adults over the age of 20 registered in a new town and participants were asked to fill in a questionnaire developed by Kim, Horan & Gendler (1991), translated into Korean. RESULTS: 1) The subjects recorded an average score of 11.10 on osteoporosis knowledge. The average scores on the osteoporosis health beliefs was 15.68 for perceived susceptibility and the respondents recorded an average score of 40.40 for osteoporosis self-efficacy. 2) There were statistically significant differences in the degree of osteoporosis knowledge, self-efficacy and health belief according to gender, age, scholastic achievement, marital state, and jobs. 3) There were statistically significant positive correlations between osteoporosis knowledge and self-efficacy. CONCLUSION: According to these results, an osteoporosis education program improving not only knowledge but also self-efficacy and health beliefs should be developed and applied to decrease the perception of barriers to exercise and intake of calcium.

Adolescent↗

PubMed2000

Prevention and treatment of osteoporosis in women with breast cancer.

Women who have had breast cancer may be at higher risk for osteoporosis than other women. First, they are more likely to undergo early menopause, due to chemotherapy-induced ovarian failure or oopherectomy. In addition, chemotherapy may have a direct adverse effect on bone mineral density (BMD), and osteoclastic activity may increase from the breast cancer itself. While estrogen therapy is considered standard for the prevention and treatment of osteoporosis, use of estrogen in women with a history of breast cancer is usually contraindicated. The approach to osteoporosis in women with breast cancer is also affected by the use of tamoxifen in many, as this drug appears to have opposite effects on BMD in premenopausal and postmenopausal women. We have reviewed therapeutic alternatives for the prevention and treatment of osteoporosis, focusing on patients with a history of breast cancer. Alendronate and raloxifene are currently approved in the United States for the prevention of osteoporosis; alendronate, raloxifene, and calcitonin are approved for treatment. Alendronate has the greatest positive effect on BMD and reduces the incidence of vertebral and nonvertebral fractures. Raloxifene and calcitonin appear to reduce the incidence of vertebral fractures; their effects on the incidence of nonvertebral fractures are not yet proven. Although no published studies specifically address the use of these approved agents for osteoporosis in women with breast cancer, understanding their relative effects on BMD in postmenopausal women in general will facilitate therapy selection in this population. Postmenopausal women with a history of breast cancer should undergo bone mineral analysis. Normal results and absence of other risk factors ensure that calcium and vitamin D intake are adequate. If osteopenia or other risk factors are present, preventive therapy with alendronate or raloxifene should be considered. For osteoporosis, treatment with alendronate should be strongly considered. Raloxifene and calcitonin are alternatives when alendronate is contraindicated. Further studies are needed to evaluate the optimal timing of initial bone mineral analysis in premenopausal women after breast cancer diagnosis and to determine the value of preventive treatment in women scheduled to undergo chemotherapy.

Aged↗

PubMed2004

Development and validation of the ORACLE score to predict risk of osteoporosis.

OBJECTIVE: To develop and validate a composite index, the Osteoporosis Risk Assessment by Composite Linear Estimate (ORACLE), that includes risk factors and ultrasonometric outcomes to screen for osteoporosis. SUBJECTS AND METHODS: Two cohorts of postmenopausal women aged 45 years and older participated in the development (n = 407) and the validation (n = 202) of ORACLE. Their bone mineral density was determined by dual energy x-ray absorptiometry and quantitative ultrasonometry (QUS), and their historical and clinical risk factors were assessed (January to June 2003). Logistic regression analysis was used to select significant predictors of bone mineral density, whereas receiver operating characteristic (ROC) analysis was used to assess the discriminatory performance of ORACLE. RESULTS: The final logistic regression model retained 4 biometric or historical variables and 1 ultrasonometric outcome. The ROC areas under the curves (AUCs) for ORACLE were 84% for the prediction of osteoporosis and 78% for low bone mass. A sensitivity of 90% corresponded to a specificity of 50% for identification of women at risk of developing osteoporosis. The corresponding positive and negative predictive values were 86% and 54%, respectively, in the development cohort. In the validation cohort, the AUCs for identification of osteoporosis and low bone mass were 81% and 76% for ORACLE, 69% and 64% for QUS T score, 71% and 68% for QUS ultrasonometric bone profile index, and 76% and 75% for Osteoporosis Self-assessment Tool, respectively. ORACLE had the best discriminatory performance in identifying osteoporosis compared with the other approaches (P < .05). CONCLUSION: ORACLE exhibited the highest discriminatory properties compared with ultrasonography alone or other previously validated risk indices. It may be helpful to enhance the predictive value of QUS.

Absorptiometry, Photon↗

PubMedDate not supplied

[Transient regional osteoporosis].

Transient osteoporosis of the hip and regional migratory osteoporosis are uncommon and probably underdiagnosed bone diseases characterized by pain and functional limitation mainly affecting weight-bearing joints of the lower limbs. These conditions are usually self-limiting and symptoms tend to abate within a few months without sequelae. Routine laboratory investigations are unremarkable. Middle aged men and women during the last months of pregnancy or in the immediate post-partum period are principally affected. Osteopenia with preservation of articular space and transitory edema of the bone marrow provided by magnetic resonance imaging are common to these two conditions, so they are also known by the term regional transitory osteoporosis. The appearance of bone marrow edema is not specific to regional transitory osteoporosis but can be observed in several diseases, i.e. trauma, reflex sympathetic dystrophy, avascular osteonecrosis, infections, tumors from which it must be differentiated. The etiology of this condition is unknown. Pathogenesis is still debated in particular the relationship with reflex sympathetic dystrophy, with which regional transitory osteoporosis is often identified. The purpose of the present review is to remark on the relationship between transient osteoporosis of the hip and regional migratory osteoporosis with particular attention to the bone marrow edema pattern and relative differential diagnosis.

Diagnosis, Differential↗

PubMed1998

Genetic and acquired predisposing factors and treatment of osteoporosis in thalassaemia major.

We have previously shown a high incidence of osteopenia and osteoporosis in patients with thalassaemia major. These bone changes, were more severe in males than females, in those with diabetes mellitus and with hypogonadal-hypogonadism. Our recent studies concern the relationship of erythroid activity, assessed by serum transferrin receptors as an overall measure of anaemia, to osteoporosis. Serum transferrin receptor levels correlated with the mean pre-transfusion haemoglobin level, but there was no correlation with the incidence of osteopenia and osteoporosis. As osteoporosis has a strong genetic component we have also studied the COLIA1 and COLIA2 genes which code for the major protein of bone (type 1 collagen). Studies by others have shown in non-thalassaemic patients that a polymorphism G-->T or TT in a regulatory region of COLIA1 at the recognition site for transcription factor Sp1 is associated with the presence of osteoporosis. Our studies suggest that Sp1 polymorphism is not specific to any one ethnic group; the polymorphism occurs more commonly in females (female to male ratio 2:1). In male thalassaemia major patients the presence of the Sp1 mutation was associated with more severe osteoporosis of the spine and the hip compared with female patients. There is failure of improvement in spinal osteoporosis with bisphosphonate therapy (intravenous Pamidronate) in male patients with the Sp1 mutation.

Adolescent↗

PubMed1999

Osteoporosis risk assessment by family practice faculty and residents: a chart review.

OBJECTIVE: To assess the frequency of osteoporosis risk assessment of postmenopausal women by family practice faculty and residents. METHODS: Review of 263 charts of women over 50 from 3 residency clinics. Charts were evaluated for evidence of osteoporosis risk assessments or discussion of prevention strategies during the past 2 years. RESULTS: Overall, 35% of the charts contained documentation of some discussion of osteoporosis. Female physicians discussed osteoporosis more than their male colleagues (p < 0.05). Documentation of osteoporosis discussions decreased as women aged (p < 0.05). There was no difference in rates among clinics or between residents and faculty. CONCLUSIONS: The documentation of osteoporosis discussions with high risk women was low in this sample. Strategies to improve osteoporosis screening are necessary.

Aged↗

PubMed2000

Osteoporosis and men. Don't forget the blokes.

BACKGROUND: There is a clear analogy between osteoporosis and hypertension. After all, the fractures associated with osteoporosis can be as disastrous as a cardiovascular event associated with hypertension and both fractures and cardiovascular events, can be greatly reduced by modern treatment. However, osteoporosis is still relatively underdiagnosed, especially in men where it may not be considered an important aspect of men's health. OBJECTIVE: This case study may trigger readers to look for osteoporosis in men at risk and to use the available medications and interventions to preserve bone and avoid falls in such men, thus reducing fractures and associated disability and pain. DISCUSSION: The risk factors for osteoporosis and fracture are known and easily identified and measurement of bone mineral density quantifies bone loss and fracture risk. There are well established strategies to protect bone, to prevent fractures and to maintain comfort. Osteoporosis is already a major public health problem in Australia and will become more important as the proportion of old and the 'old old' increase over the next two decades. Osteoporosis is recognised as an important component of the health of older women and should not be forgotten in older men.

Aged↗

PubMedDate not supplied

Gender differences in osteoporosis treatment: a review of clinical research.

Morbidity from osteoporosis in the aging population is substantial in both men and women; however, therapeutic options approved by the Food and Drug Administration are open only for use in women. A literature search was performed to define gender differences in pharmacologic osteoporosis treatments in published research. Only two studies on the efficacy of pharmacologic osteoporosis interventions in both genders were found, both of which involved glucocorticoid-treated patients. There is clearly a lack of information on osteoporosis treatment approaches in men compared to women, despite the increasingly recognized risk of osteoporosis in men. Although there are no approved therapies for osteoporosis in men in the United States, the scant but promising evidence suggests potential benefit from alendronate and risedronate in men as well as women. Further gender-comparative research regarding nonestrogenic approaches to osteoporosis is warranted.

Alendronate↗

PubMedDate not supplied

[Sex hormones and male osteoporosis. A physiologic prospective for prevention and therapy].

BACKGROUND: Male osteoporosis is often an underestimate and non-acknowledged pathology because it is less frequent then post-menopausal women osteoporosis. The causes of osteoporosis in males were reviewed, considering the importance of the assessment of sexual hormones, even without symptoms of hypogonadism. METHODS: Sixty-two patients ranging in age from 45 to 75 years, males, were studied. None of them had assumed steroids nor other drugs causing osteoporosis. These patients have been subjected to bone mineral analysis (BMA) together with the following sexual hormones: LH, FSH, total testosterone, free testosterone, SHBG, estrone, estradiol. Two methods of BMA have been employed (Norland 2780 and UBA 575 Walker and Sonix). RESULTS: When osteoporosis or osteopenia were present, always there were modifications of sex hormones values. Statistic evaluation (linear regression, Pearson coefficient, Multiple regression, Backward Stepwise Multiple Regression), showed that there was a significant association between total testosterone and osteoporosis. CONCLUSIONS: Total testosterone resulted the most predictive sex hormone for the loss of bone mass; therefore, it is important to evaluate sex hormones in males with osteoporosis, for a correct and "physiological" therapy.

Aged↗

PubMed2001

The use of estrogen, DHEA, and diosgenin in a sustained delivery setting as a novel treatment approach for osteoporosis in the ovariectomized adult rat model.

It is well established that the pattern of bone loss from the cortex in osteoporotic bone begins from the endosteal surface of the cortex, where there is enlargement of the medullary canal at the expense of the inner cortex. Bone loss does not occur at the periosteal surface. The objective of the following study was to induce osteoporosis in female rats by ovariectomy, followed by treatment with sustained delivery of Diosgenin (DG), dehydroepiandrosterone (DHEA), or estrogen (E) after clinical signs of osteoporosis. Female Sprague Dawley rats were divided randomly into five groups containing four rats/group. Rats comprising group 1 were left intact and served as a control group. Animals in groups 2-5 were ovariectomized (OVX) and, after a 14 day delay to allow for induction of osteoporosis, were implanted with TCPL capsules containing DG, DHEA, and E, respectively. The experiment was ceased after 33 days of treatment, at which time the vital and reproductive organs for each group were collected, weighed, and analyzed histomorphometrically for differences. Further analysis of the progression of osteoporosis in the experimental animals was obtained by performing x-ray analysis of each group on a semi-weekly basis. By collecting and analyzing the femurs from each animal, we were also able to obtain important information about the histologic changes associated with osteoporosis (left femur), as well as data regarding the effects of osteoporosis on the mechanical strength of bone via three point bending analysis (right femur). The data generated by this study revealed important information as to the efficacy and safety of the alternative treatments DHEA, E, and DG for osteoporosis. First, histomorphometric analysis revealed that treatment with DHEA, E, and DG reduced the endosteal perimeter and cortical area to values very similar to controls (intact). Second, results of the bending stress and modulus in OVX and treated animals were not statistically different from the intact control animals, which suggests that the material properties of the bone were unaltered. Third, there is an increase in total body weight associated with OVX that is reduced to control levels after replacement therapy. Finally, OVX also resulted in reproductive tissue atrophy, which was reversed by all three of the treatment regimens in this study. These data suggest that bone loss after OVX can be significantly reduced by supplementation with sustained levels of DHEA, E, and DG without jeopardizing other body organs.

Animals↗

PubMed2001

[Osteoporosis in patients admitted to an internal medicine service of a university general hospital].

OBJECTIVE: To ascertain the incidence of osteoporosis and epidemiological factors in patients admitted to an Internal Medicine Service of a University General Hospital in Madrid, Spain. We also took into account the reasons for admission, associated diseases, and the preventive and therapeutic diagnostic implications. PATIENTS AND METHODS: The analytical, descriptive, retrospective and transversal study of one hundred patients over fifty years of age admitted to an internal medicine service during 1997, obtaining in addition to the clinical discharge report, epidemiological data with regard to the radiological diagnosis of osteoporosis, the reason for admission, past history, the prevention and treatment of the initial complaint as well as the osteoporosis previous diagnosis. RESULTS: 26% of those patients included in the survey had radiologic criteria of osteoporosis although only in 1 per cent of them had osteoporosis been diagnosed previously. The main risk factors, apart from the age and sex, are the associated illnesses which cause malnutrition and immobilization, and the use of drugs, especially heparin. CONCLUSIONS: Osteoporosis is a condition common in patients above 50 especially women, who are admitted to an Internal Medicine Service. A quarter of those patients admitted have osteoporosis. Very few are diagnosed and treated. In this group of patients apart from the habitual risk factors, are added those for the associated disease generally chronic, and the treatment they receive. During their stay in the hospital osteoporotic patients are three times more likely to receive heparin and other drugs which aggravate osteoporotic, than non osteoporotic patients. For that reason the risk of fractures is greater and the need for prospective diagnostic studies is even more necessary in this group of patients.

Aged↗

PubMed2001

[Study on the level of plasma calcitonin gene-related peptide and adrenomedullin in subjects with primary osteoporosis].

OBJECTIVES: To explore if there is any change of the level of plama CGRP and ADM in primary osteoporosis. METHODS: 75 female subjects complaining of back pain, aged from 34-70 years, were included in present study. The plasma level of CGRP and ADM was determined by radioimmunoassay. The bone mineral density (BMD) of lumber spine and hip of these patients was also examined by dual-energy X-ray absorptiometry (DEXA). According to the WHO osteoporosis criteria, these patients were divided into three groups: normal BMD (as control), osteopenia and osteoporosis. RESULTS: Plasma level of CGRP and ADM of lumbar osteoporosis are 37 ng/L +/- 7 ng/L and 50 ng/L +/- 11 ng/L respectfully, while those of lumber osteopenia are 38 ng/L +/- 7 ng/L and 49 ng/L +/- 11 ng/L, they are significantly higher than those of normal lumber bone mineral density, which are 29 ng/L +/- 6 ng/L and 38 ng/L +/- 8 ng/L(F = 5.60 or 9.60, P < 0.05 or 0.01). The plasma level of ADM of hip and ward's osteoporosis (49 ng/L +/- 13 ng/L and 49 ng/L +/- 11 ng/L) is also higher than that of the control (F = 5.43 and 4.66, P < 0.05). Group of lumbar osteopenia also has higher level of CGRP and ADM than the control. (37 ng/L +/- 7 ng/L) and 38 ng/L +/- 6 ng/L, P < 0.05). CONCLUSIONS: Plasma level of CGRP and ADM is significantly increased in subjects with osteoporosis. CGRP and ADM may play a role in the mechanism of etiology of primary osteoporosis.

Adrenomedullin↗

PubMed1975

The aetiology of senile osteoporosis: secondary hyperparathyroidism due to renal failure.

The aetiology of senile osteoporosis was investigated in a series of elderly normal persons (mean age 76.8 years) who were compared to 18-19 year old normal controls. Osteoporosis was estimated by standard radiological morphometric and densitometric techniques, in the metacarpals and thoraco-lumbar vertebrae. Serum parathyroid hormone levels were significantly higher in the elderly group, and correlated well with morphometric and densometric measurements of osteoporosis. Creatinine clearance was reduced in seven out of nine of the elderly group, and correlated well with the degree of osteoporosis. Serum thyrocalcitonin levels were reduced in the elderly. Tubular reaborption of phosphate and TmP/GFR were in the hyperparathyroid range in the elderly group and correlated well with the degree of osteoporosis. The hypothesis is advanced that the osteoporosis of old age is a result of parathyroid overactivity, caused by asymptomatic chronic renal failure. The suggestion is made that a diet low in phosphorus might reduce the incidence of osteoporosis in old age by reducing the parathyroid overactivity.

Adolescent↗

PubMed2001

The magnitude of osteoporosis in middle aged women.

OBJECTIVE: This study aims to increase the body of knowledge regarding osteoporosis in the Jordanian context by investigating the magnitude of osteoporosis amongst perimenopausal women, as well as the risk factors associated with the disease. METHODS: Two hundred and fifty one women between the ages of 40 to 60 years were randomly selected from the Orthopedics and Rheumatology out patient clinics at the Major Teaching Hospital in Amman, Jordan. A structured questionnaire, which focused upon risk factors and preventive measures for osteoporosis, was administered by a trained staff nurse to all women. Index women were then referred to a private hospital, also in Amman, for a dual energy x-ray absorptiometry of the lumbar spine (Lumbar 1-4) and hip. RESULTS: Results show the magnitude of osteoporosis was 13% according to the bone mineral density of the lumbar spine. Women with osteoporosis were older (p< 0.00) and smaller in build (p<0.00) than women with low or normal bone density. Osteoporotic women were also more likely to be menopausal (p<0.00) and to have taken corticosteroids for a prolonged period of time (p<0.00). Logistic regression showed being menopausal (p<0.00), taking corticosteroids (p<0.05), and having a relatively lower body mass index (p<0.00) were significantly related to being osteoporotic in this group of women. CONCLUSION: The authors conclude that this study was not only able to report upon the magnitude of osteoporosis among women sampled, and the risk factors for low bone density, but also raised issues related to inconsistencies in how the health care system deals with women who are at risk for osteoporosis. Study findings are discussed in their socio-cultural context, and implications of the study findings are presented.

Adult↗

PubMed2001

Depressive disorder as possible risk factor of osteoporosis.

Hypothalamo-pituitary-adrenal (HPA) axis is a very complicated control system playing an important role in stress reaction, where glucocorticoids suppress the autonomic (vegetative), endocrine, immunologic and psychic responses to stressful stimuli. We described the marked clinical, physiological, and biochemical connection between osteoporosis and major depressive disorder (MDD). Both conditions are associated with a hyperactive HPA axis and LC/NE system, and hence with increased CRH, cortisol, and catecholamine secretion. There are numerous states or diseases associated with osteoporosis and we were looking for a hypercorticism value as a one of these. Some recent studies demonstrated that earlier history of MDD was associated with marked osteoporosis. In MDD there are two well-documented biochemical abnormalities: hypercortisolism and its resistance to dexamethasone suppression. The present study included 31 MDD patients (19 males and 12 females, mean age 37 +/- 1.3, age range 29-41 years), and 17 healthy male volunteers (mean age 39 +/- 1.6, age range 34-45 years). In each of our patients 24-hour urinary free cortisol, serum cortisol level at 8 a.m. and 5 p.m., cortisol in dexamethasone suppression test and bone mineral density were measured. We have, therefore, analyzed a group of young men and women with normal menstrual cycles, who were without signs of osteoporosis in the beginning, and who received anti-depressive therapy for many years. Analysis showed that increased levels of cortisol and the occurrence of osteoporosis, that developed as the result of elevated cortisol level. For our workshop we used nonparametric rang-correlation with Spearman's rho = -0.805, with statistic significant at the 0.01 level (2-tailed). Patients under long-term history of depression could develop a very stronger type of osteoporosis i.e. it is before known that the patients with untreated Cushing syndrome developed hard osteoporosis.

Adult↗

PubMed2001

[Osteoporosis in the man].

Osteoporosis in men is a severe condition probably more frequent than generally expected. The life-time risk of a low trauma fracture in a 60 year old man is 25%; moreover, approximately one third of hip fractures occurs in men. In contrast to postmenopausal osteoporosis, osteoporosis in men is frequently a secondary condition. In approximately 50% of cases, male osteoporosis is associated with an underlying disease or condition such as hypogonadism or long-term glucocorticoid treatment. Data from our group indicate that low serum estradiol levels and elevated sex hormone binding globulin levels may play a role in the pathogenesis of idiopathic male osteoporosis. Potential treatment modalities of osteoporosis in men include calcium and vitamin D supplementation, testosterone, fluoride, bisphophonates, calcitonin and parathyroid hormone. Currently, the data available favor the use of an aminobisphosphonate for the treatment of (idiopathic or glucocorticoid induced) osteoporosis.

Aged↗

PubMed2001

Serum insulin/like growth factor I, bone mineral density and biochemical markers of bone metabolism in children with idiopathic osteoporosis.

OBJECTIVE: To determine whether the serum concentration of insulin-like growth factor I (IGF-I) correlates with the occurrence of idiopathic osteoporosis in children, and whether serum levels of IGF-I correlate with selected bone metabolism markers in patients with osteoporosis. METHODS: The study comprised 24 patients aged 7-18 years, including 12 with idiopathic osteoporosis and 12 control children. Bone mineralisation disorders were diagnosed on the basis of complex clinical, densitometric and biochemical evaluation. In all children serum concentration of IGF-I was estimated by radioimmunoassay and the third fraction of IGF binding proteins (IGFBP3) by immunoradiometry. In children with osteoporosis the indices of bone metabolism were also assessed, e.g. serum levels of osteocalcin and activity of bone isoenzyme of alkaline phosphatase (bone formation markers) and urine concentration of pyridinoline and deoxypyridinoline and collagen type I crosslinked C-telopeptyde (resorption markers). RESULTS: It was found that in children with osteoporosis IGF-I concentration was significantly lower than in the control group (mean values were 583 and 850 ng/ml, respectively; P<0.05). These differences were independent on biological age of the studied children and were present in all adolescence stages. Concentrations of IGFBP3 did not differ significantly between groups (3593 vs. 3955 ng/ml), while that of IFG-I correlated positively with total and spinal bone mineral density (R=0.85 and R=0.80, respectively; P<0.00001). In children with osteoporosis there was also a significant relationship between IGF-I concentration and elimination of pyridinoline and deoxypyridinoline with urine (R=0.64 and R=0.65, respectively; P<0.05). There was no significant correlation between the concentration of IGF-I and IGFBP3 and other studied bone metabolism markers. CONCLUSIONS: The conducted study revealed that lower IFG-I concentrations correlate with higher bone resorption markers values and decreased mineralisation. These results suggest the importance of insulin-like growth factor in the ethiopathogenesis of idiopathic osteoporosis, which needs to be confirmed in further studies.

Adolescent↗

PubMed2002

Osteoporosis prevention project: a model multidisciplinary educational intervention.

Osteoporosis is a systemic metabolic disease resulting in low bone mass, which increases the risk for fracture. Evidence suggests that lifestyle changes to prevent or delay development of osteoporosis should be implemented throughout the life span. The purpose of this study was to evaluate the effectiveness of a multidisciplinary primary osteoporosis prevention program for community-dwelling women aged 25 to 75 years to determine if osteoporosis prevention program participants (treatment group) increased their knowledge of osteoporosis, calcium intake, and exercise compared with a control group. Other outcomes included participants' willingness to adopt lifestyle changes and ability to view themselves as able to make behavioral changes. Subjects in the treatment group versus control subjects increased their knowledge of osteoporosis over time. At posttest, subjects in the treatment group were more likely to be planning to change calcium intake, and at follow-up, they were more likely to be changing their calcium intake. No other group differences were found between the two groups. These findings suggest that a multidisciplinary education program may have an impact on knowledge and behaviors that may help to delay the development of osteoporosis.

Adult↗