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PubMed1989

Contributing diagnoses in osteoporosis. The value of a complete medical evaluation.

Osteoporosis often occurs as a consequence of, or is accelerated by, many medical diseases, drug exposures, or other conditions. We called these conditions contributing diagnoses. Although technological advances permit the accurate measurement of bone density, identifying osteoporosis without searching for contributing diagnoses may result in remediable diseases being missed or in the initiation of inadvisable therapy. The value of comprehensive medical evaluation in conjunction with appropriate diagnostic studies was demonstrated in an osteoporosis referral center. We studied 300 consecutive persons who presented to an osteoporosis clinic. Using strict criteria, 180 patients (60%) had osteoporosis. Of these 180 patients, 83 (46%) had one or more contributing diagnosis, ie, a condition thought to accelerate bone loss. The largest single group was composed of persons with past or present exposure to glucocorticoids; the second largest group consisted of women who had undergone premature menopause. In all, 27 different contributing diagnoses were identified. Additionally, in 19 (11%) of the 180 patients with osteoporosis, a contributing diagnosis new to those patients was made. The evaluation of osteoporosis does not only entail measurement of bone density but must also take into consideration a patient's entire medical milieu.

Adult↗

PubMed1989

[The significance of magnesium in orthopedics. V. Magnesium in osteoporosis].

The authors submit an investigation of 60 patients with senile, post-menopausal and drug-induced osteoporosis. Using the method of absorption spectrophotometry, they found a reduced level of Mg in red blood cells in 63.6% of senile, 66.7% postmenopausal and only in 22.2% drug-induced osteoporoses. Also the mean level of red cell magnesium was significantly lower in the group of senile (1.94 mmol) and postmenopausal (1.85 mmol) osteoporosis as compared with drug-induced osteoporosis (2.25 mmol). The authors revealed moreover that the level of red cell magnesium in the former two groups declines in proportion to the severity of osteoporosis and correlates thus with the clinical and X-ray finding. For treatment of osteoporisis the authors used magnesium lactate alone (in 37 patients) and combined with sodium fluoride (in 23 patients). In the majority of patients they had very favourable results. Based on laboratory and therapeutic results, consistent with data in the experimental literature, the authors assume that magnesium as a catalyst of bone metabolism and as one of the most important factors controlling the formation of bone matrix and its mineralization plays a significant role in the aetiopathogenesis of senile and postmenopausal osteoporosis. The authors assume that Mg deficiency which is increasing in recent years in soil as well as in foodstuffs and water may be the main cause of the increasing number of patients with osteoporosis in civilized countries. Magnesium should have its firm place not only in therapy but also in prevention of the majority of osteoporosis.

Aged↗

PubMed1986

Pathogenesis and management of primary osteoporosis.

The pathophysiology of primary osteoporosis and the various therapeutic regimens that have been used are reviewed. Osteoporosis is a major public health problem because the incidence of hip, wrist, and vertebral fractures associated with bone loss is high. Postmenopausal women are at increased risk for developing osteoporosis because bone mineral content is lower in women than in men, dietary calcium intake is frequently insufficient, intestinal absorption of calcium decreases with age, and the rate of bone loss accelerates at menopause. The efficacy of many single and combination therapies in preventing or treating osteoporosis has been studied. Differences in study design and diagnostic techniques and the heterogeneous nature of osteoporosis make evaluation of clinical trials difficult. Exercise helps to maintain skeletal mass, but amenorrhea caused by vigorous activity may be harmful. The efficacy of estrogen replacement therapy is documented best; many studies have shown that estrogens slow the rate of bone loss and reduce the incidence of fractures, but the association of estrogen use with endometrial cancer and breast cancer is of concern. Progesterones may protect against endometrial cancer, but undesirable effects of oral contraceptives have resulted in a hesitancy to use combination hormonal therapy. All adults should meet daily nutritional requirements for calcium, but this intake may be insufficient for elderly persons and is below recommended doses for treating osteoporosis. A daily intake of at least 1000-1500 mg of elemental calcium has been shown to slow the rate of bone loss. Nutritional requirements for vitamin D should be met, but benefits from pharmacologic doses have not been demonstrated. The role of fluoride, calcitonin, anabolic steroids, and vitamin D metabolites is unclear. Fluoride has the potential to increase bone mass, but effects on bone histology and fracture rates require further study. The major goals for the management of osteoporosis are maintenance of bone mass and prevention of fractures. An adequate intake of calcium and regular weight-bearing exercise are important preventive measures. Despite the documented effectiveness of estrogens, risks associated with long-term use are of concern.

Androgens↗

PubMed1985

The coexistence and characteristics of osteoarthritis and osteoporosis.

We defined the clinical features and radiographic coexistence of osteoarthritis and osteoporosis in fifty women with primary coxarthrosis and fifty age-matched women (average age, 69 +/- 5 years) with idiopathic osteoporosis. The patients with osteoarthritis had undergone total hip replacement. The diagnosis of primary osteoarthritis was established by clinical, radiographic, and histological criteria, and the diagnosis of osteoporosis was confirmed by histomorphometric analysis of specimens taken at iliac-bone biopsy. In the arthritic patients, spinal osteoporosis was identified by radiographic evidence of compression fractures, kyphosis, and scoliosis. Femoral osteoporosis was demonstrated by the index of Singh et al. and the femoral canal-shaft ratio. In the osteoporotic patients coxarthrosis was measured radiographically by the scale of Kellgren and Lawrence. On the average, the osteoporotic patients were twelve kilograms lighter than the osteoarthritic patients. Fifty-eight per cent of the osteoporotic and 18 per cent of the osteoarthritic patients had a scoliotic curve of at least 10 degrees. The prevalence of osteoarthritis of the hip in the osteoporotic women was 4 per cent, and the prevalence of compression fractures in the arthritic women was 6 per cent, which was approximately one-quarter of the expected incidence. These results show that: (1) osteoporosis does not protect against the development of coxarthrosis, (2) coxarthrosis is a negative risk factor for osteoporotic compression fractures, and (3) scoliosis and an ectomorphic habitus are clinical markers that identify a risk for osteoporosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1995

[Transient osteoporosis of the hip in magnetic resonance imaging].

This study was aimed at assessing the MR patterns of transient osteoporosis of the hip and, consequently, the role of MRI in the diagnosis and follow-up of this condition. Even though this condition was originally observed in pregnant women, young or middle-aged men are most frequently affected. There is a spontaneous onset of pain, usually progressing over several weeks. The patients have no risk factors for osteonecrosis; they may have a history of minor trauma and there is a possible relationship to the third trimester of pregnancy. Laboratory values are negative. Pain may be severe enough to cause the patient to limp and to impair joint function. The possible causes of transient osteoporosis have been debated by many authors and include trauma, synovitis, neurovascular dysfunction and transient or reversible ischemia. Transient osteoporosis is a self-limiting disease which does not require surgical treatment. The differential diagnosis of transient osteoporosis of the hip is very important because this condition may simulate cancer, septic arthritis, osteomyelitis or avascular necrosis. We report the initial and follow-up features of transient osteoporosis of the hip on the MR images of 6 patients (M/F = 5/1; age: 37-49 years, mean: 41.8 years). The right side was involved in 3 patients, the left side in 2 patients. The patient with bilateral transient osteoporosis was a woman in the 3rd trimester of pregnancy. In all patients, MRI was performed with an 0.5 T MR unit. The MR changes in our 6 patients were rather uniform and included heterogeneous decrease in the signal intensity of the affected bone marrow on T1-weighted images and increased signal intensity on T2-weighted and STIR images, with no evidence of focal lesions. This pattern is known as the "bone marrow edema" (BME) pattern. All the patients received conservative treatment. The clinical symptoms and the MR abnormalities regressed completely within 6-10 months, with no late sequelae. To conclude, this follow-up MR study demonstrates the transient, reversible character of transient osteoporosis of the hip. Until the natural history of the BME pattern is better understood, we suggest a conservative management of this condition, especially in the patients with no risk factors for osteonecrosis. Radiographic and MR follow-up is recommended.

Adult↗

PubMed1995

How to reduce the risk factors of osteoporosis in Asia.

Osteoporosis can be predicted to be a new burden to public health in Asia. Currently, the incidence of osteoporosis-related fractures is lower there than in most western communities. By the year 2050, however, 50% of the 6.3 million hip fractures which occur worldwide will be in Asians as a result of an aging population, a decrease in physical activity and westernization of lifestyles. The cost of treatment and cure of these patients will be enormous, a sufficient financial burden to consume current economic gain and cripple the future advancing development of Asian countries. Individual risk factors for osteoporosis have been identified by the extensive Mediterranean Osteoporosis Study (MEDOS). Fortunately, Asians, the rural population and farmers in particular, have the favorable lifestyle identified by the study, including high physical activity and exposure to sunlight. Strikingly, tea drinking, a daily habit in Asia, is also identified as a protective factor against osteoporosis. In addition, bioflavonoids and phytoestrogen-rich soybeans and vegetables are consumed in large quantities by Asians. A soy diet reduces mortality in breast and prostate cancer because it contains weak estrogens. The weakly estrogenic phytoestrogens require further study to demonstrate their pharmacological effect in reducing the rate of osteoporosis. Public health education, however, is needed to encourage the Asian population to maintain their traditionally good lifestyle and to reduce the risk factors for osteoporosis. In turn, these steps may reduce the public health burden by 2050.

Estrogens, Non-Steroidal↗

PubMed1994

[Pharmacologic therapy of osteoporosis].

This paper reviews the pharmacologic therapies for the prevention and the treatment of osteoporosis. Vitamin D metabolites, estrogen, estrogen-progestin, calcitonin and ipriflavone are effective regimens for the prevention of bone loss and the treatment of osteoporosis. Since estrogen deficiency is the main cause for postmenopausal osteoporosis, estrogen supplementation is the most effective therapy for postmenopausal osteoporosis. Estrogen progestin combination therapy is one of the most potent therapies to increase both cortical and trabecular bone mass. Vitamin D has efficacy on increasing intestinal calcium absorption and decreasing fracture rate in osteoporotic patients. Calcitonin inhibits osteoclastic bone resorption and also has inherent analgesic properties. Several studies have suggested that new delivery systems of estrogen (transdermal) and calcitonin (transnasal) are effective in osteoporosis. Recent studies revealed that bisphosphonate and hPTH (1-34) were new potent agents for the treatment of osteoporosis. Bisphosphonate would be effective to osteoporosis by reducing bone resorption. hPTH may have a primary action to increase bone formation. Treated patients should be monitored using bone mineral density and biochemical markers for evaluating the response to therapy.

Bone Density↗

PubMed1994

Corticosteroid-induced osteoporosis.

The pathogenesis, prevention, and treatment of corticosteroid-induced osteoporosis are reviewed. Prolonged administration of corticosteroids causes osteoporosis, resulting in significant morbidity and mortality. Cumulative corticosteroid doses greater than 10 g, age greater than 50 years, and pre-existing low bone mass are risk factors for corticosteroid-induced osteoporosis. Long-term, prospective, controlled studies on prevention and treatment of corticosteroid-induced osteoporosis are limited. Measures for preventing corticosteroid-induced osteoporosis include correcting modifiable risk factors and using the lowest effective oral or inhaled corticosteroid dose for the shortest period of time. Routine use of fluoride, anabolic steroids, vitamin D, thiazide diuretics, injected calcitonin, or calcium supplements alone is not recommended. Intranasal calcitonin and pamidronate are possibilities for future treatment of corticosteroid-induced osteoporosis. Estrogen replacement therapy should be considered in postmenopausal women receiving corticosteroids. Deflazacort, a new synthetic corticosteroid, may provide a promising alternative to existing systemic corticosteroid therapy. More long-term, controlled, prospective trials are needed to determine the effectiveness of treatments for corticosteroid-induced osteoporosis and to develop improved methods for monitoring response to therapy.

Adrenal Cortex Hormones↗

PubMed1998

[Management for osteoporosis in a society composed largely of elderly people--from a practical orthopaedic point of view].

Aging of Japanese population in recent years is advancing at unexpected speed. The incidence of osteoporosis and fracture increase rapidly with aging of the population. Since 1970, at opening of our department, I have expected that a society would be composed largely of elderly people. To prevent elderly people from being beg-ridden and demented, I have made efforts to prevention and treatment of osteoporosis. Purpose of this paper is to show concerning the screening of osteoporosis in this area of Hakodate city and southern part of Hokkaido, and to report our treatment for osteoporosis. There are many ways of measuring bone mineral density (BMD), and dual energy X-ray absorptiometry (DEXA) is the simplest and the most accurate. Concerning of diagnosis of osteoporosis, we investigated the change of the BMD after hip surgery. On the other hand, we also reported the effectiveness of Vitamin-K for osteoporosis. No studies have ever been tried to clarify about this treatment. We are making efforts to enlighten the people on prevention, early diagnosis and treatment of osteoporosis.

Absorptiometry, Photon↗

PubMed1998

[Genetic studies in osteoporosis].

Osteoporosis is one of the complex disease which has many responsible fractors to develop this disease. Among the causative factors for osteoporosis, genetic background is believed as the most important factor for osteoporosis. In 1994, Morrison et al reported their pioneering work looking at the close relationship between VDR genotype and bone mass. This report has generated a considerable amount of interest and conflict. The reasons for these conflicts are depending upon the nature of osteoporosis. Namely, the genetic association to the cause of osteoporosis is polygenic. Furthermore, the contribution of a gene to achieve low bone mass is polyphasic. For example, estrogen-receptor gene polymorphisms may show varied importance in the different stage of women's life span. The environmental factors may interefere the penetration of a gene effect and the presence of the other gene effect may also blunt the effect of the candidate gene. To overcome these difficulties in the research work to search osteoporosis gene, we have pay keen attention to the selections of the method of gene analysis and the subjects. The specific gene marker showed the possibility to predict the effect of the treatment of osteoporosis. This may indicate the marker gene itself or the other gene(s) linked with this marker gene regulate the biological response to the treatment. So, gene markers may utilize not only in the field of epidemiological studies but also in clinical practice in near future.

Genetic Linkage↗

PubMed1998

[Gammopathies of indeterminant significance and osteoporosis: association or coincidence?].

OBJECTIVES: Osteoporosis is common in subjects over 70 years of age. Likewise, the incidence of monogammapathies of undetermined signification (MGUS) increases with age. We conducted this study to determine whether the biological and histomorphometric characteristics of osteoporosis in patients with MGUS are different from those in primary osteoporosis and to ascertain whether any cause and effect relationships could exist between MGUS and osteoporosis, excluding signs of active myeloma. PATIENTS AND METHODS: Serum and urinary phosphorus and calcium, histomorphometric measurements, hormone levels and serum cytokines (IL1, IL6 and TNF alpha) were determined in 7 patients (mean age 71.8 years, 2 men and 5 women) with MGUS associated with osteoporosis with vertebral fractures (OP) and compared with those in 7 osteoporosis patients without MGUS matched for age, sex, and osteoporosis severity and 7 other age and sex matched patients with MGUS without OS. The MGUS + PS patients were followed for 9 years (4.5 to 20) so slowly progressive myeloma could be excluded. RESULTS: Cytokine levels were the same in the three groups of patients but MGUS + OP patients had higher urinary calcium levels (ca/cr = 0.21 +/- 0.08 vs 0.12 +/- 0.1 (OP) and 0.13 (MGUS); p = 0.04), decreased osteocalcin levels (7 +/- 4.6 ng/ml vs. 12 +/- 4 (OP) and 11.5 +/- 5 (MGUS); p = 0.01) and increased surface resorption (8 +/- 1.4 vs. 3.6 +/- 1.2 (OP) and 5.5 +/- 1.7 (MGUS); p = 0.05). DISCUSSION: It has been demonstrated that MGUS in patients with increased resorption and lower osteocalcin levels frequently progresses to active myeloma. The question is raised as to whether, in certain cases of MGUS, in situ stimulation of bone cells by monoclonal plasma cells could exist without ongoing transformation to active myeloma.

Aged↗

PubMed1998

Variations in physicians' judgments about corticosteroid induced osteoporosis by physician specialty.

OBJECTIVE: Longterm corticosteroid use is associated with an increased risk of osteoporosis and fractures. Calcium and vitamin D supplementation and estrogen replacement therapy can decrease this risk, but the majority of patients receiving longterm corticosteroid treatment do not receive treatments to prevent bone loss. We assess whether this is due to variations in physicians' judgments about risks and efficacy of treatments to prevent corticosteroid-induced osteoporosis. METHODS: Questionnaires were mailed to 425 physicians, who were sampled so that half were generalists and half were specialists. Physicians were given hypothetical clinical scenarios involving patients taking corticosteroids and asked to judge the importance of osteoporosis as a risk of corticosteroid treatment, the importance of discussing this side effect with patients, and to indicate how often they would use calcium with vitamin D and estrogen for a hypothetical postmenopausal patient receiving longterm corticosteroid treatment. RESULTS: In total 198 physicians (50%) responded to this survey. Most physicians rated osteoporosis as one of the 3 most significant side effects of corticosteroid treatment for postmenopausal women, but there was significant variation in physician judgments about the importance of corticosteroid induced osteoporosis for premenopausal women (p=0.03) and men (p=0.001). There was also significant variation in physician judgments about the importance of discussing osteoporosis as a side effect with patients (p=0.001), and their use of both calcium and vitamin D (p=0.002) and estrogen replacement therapy (p=0.001) for a hypothetical postmenopausal patient. The physician characteristics most associated with these differences were physician specialty and experience with corticosteroid use. Primary care physicians and physicians who more commonly prescribe corticosteroids were more likely to report that they would use estrogen and calcium to prevent corticosteroid induced bone loss. Physician age, sex, and university affiliation had no association with physician assessments. CONCLUSION: Physicians' judgments varied significantly by physician specialty and experience with corticosteroid use. These data suggest that patients cared for by physicians in different specialties will get varying advice about osteoporosis risk and preventive treatments when receiving longterm corticosteroid treatment.

Adrenal Cortex Hormones↗

PubMed2005

Glucocorticoid-induced osteoporosis: skeletal manifestations of glucocorticoid use and 2004 Japanese Society for Bone and Mineral Research-proposed guidelines for its management.

Glucocorticoid (GC) is widely used to treat a variety of inflammatory and allergic diseases, and about 0.9% of the adult population in Japan (approximately one million people) are known to take oral GC at any given time. GC causes a number of significant side effects, among which are skeletal manifestations such as osteoporosis and degenerative bone fracture, maor complications of GC therapy. Although the population of GC-induced osteoporosis patients is estimated to be approximately one-fifth of patients with primary osteoporosis, few physicians are aware of the increased risk of fracture caused of GC, and there is inadequate information concerning the effetiveness of prevention and treatment of GC-induced osteoporosis. Recently, mechanisms of GC-induced osteoporosis have been clarified, and treatment strategies have been developed. Accordingly, the 2004 Japanese Society for Bone and Mineral Research (JSBMR)-proposed guidelines for the management and treatment of GC-induced osteoporosis have been developed based on the results of a longitudinal study by subcommittee members and the results of an analysis of patients collected by the Subcommittee to Study Diagnostic Criteria for Corticosteroid-induced Osteoporosis, together with evidence obtained overseas and in Japan. The present guideline is prepared for clinical practice.

Journal Article↗

PubMed2006

Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review.

INTRODUCTION: Prevalence estimates of osteopenia and osteoporosis (reduced bone mineral density; BMD) in HIV-infected patients and the role of antiretroviral therapy (ART) varies in the literature. METHODS: We conducted a meta-analytical review of cross-sectional studies published in English to determine the pooled odds ratios (OR) of reduced BMD and osteoporosis in the following groups: HIV-positive versus HIV-negative; ART-treated versus ART-naive; protease inhibitor (PI)-treated versus PI-untreated. We searched the MEDLINE, PubMed, and EMBASE databases for eligible references between January 1966 and November 2005. Random effects models were used to generate pooled OR estimates and confidence intervals. RESULTS: Of 37 articles identified, 20 met the inclusion criteria. Of the 884 HIV-infected patients, 67% had reduced BMD, of whom 15% had osteoporosis, yielding a pooled OR of 6.4 and 3.7, respectively, compared with HIV-uninfected controls (n = 654) using 11 studies with available data. Compared with ART-naive patients (n = 202, 10 studies), ART-treated individuals (n = 824) had a 2.5-fold increased odds of prevalent reduced BMD. The risk of prevalent osteoporosis (seven studies) was similarly elevated in ART-treated individuals. Compared with non-PI-treated HIV patients (n = 410, 14 studies), PI-treated patients (n = 791) had increased odds of reduced BMD and osteoporosis (12 studies). Few studies adjusted for important covariates such as HIV disease severity or treatment duration. CONCLUSION: The prevalence of osteoporosis in HIV-infected individuals is more than three times greater compared with HIV-uninfected controls. ART-exposed and PI-exposed individuals had a higher prevalence of reduced BMD and osteoporosis compared with their respective controls. The influence of other disease and treatment variables on these estimates could not be determined.

Adult↗

PubMed2004

Management of osteoporosis.

Osteoporosis or osteopenia occurs in about 44 million Americans, resulting in 1.5 million fragility fractures per year. The consequences of these fractures include pain, disability, depression, loss of independence, and increased mortality. The burden to the healthcare system, in terms of cost and resources, is tremendous, with an estimated direct annual USA healthcare expenditure of about $17 billion. With longer life expectancy and the aging of the baby-boomer generation, the number of men and women with osteoporosis or low bone density is expected to rise to over 61 million by 2020. Osteoporosis is a silent disease that causes no symptoms until a fracture occurs. Any fragility fracture greatly increases the risk of future fractures. Most patients with osteoporosis are not being diagnosed or treated. Even those with previous fractures, who are at extremely high risk of future fractures, are often not being treated. It is preferable to diagnose osteoporosis by bone density testing of high risk individuals before the first fracture occurs. If osteoporosis or low bone density is identified, evaluation for contributing factors should be considered. Patients on long-term glucocorticoid therapy are at especially high risk for developing osteoporosis, and may sustain fractures at a lower bone density than those not taking glucocorticoids. All patients should be counseled on the importance of regular weight-bearing exercise and adequate daily intake of calcium and vitamin D. Exposure to medications that cause drowsiness or hypotension should be minimized. Non-pharmacologic therapy to reduce the non-skeletal risk factors for fracture should be considered. These include fall prevention through balance training and muscle strengthening, removal of fall hazards at home, and wearing hip protectors if the risk of falling remains high. Pharmacologic therapy can stabilize or increase bone density in most patients, and reduce fracture risk by about 50%. By selecting high risk patients for bone density testing it is possible to diagnose this disease before the first fracture occurs, and initiate appropriate treatment to reduce the risk of future fractures.

Journal Article↗

PubMed2001

[Diagnosis of osteoporosis in the elderly; an overview.].

Measurement of bone mineral density (BMD) is the basis of the diagnosis of osteoporosis. WHO classification of osteoporosis is based on dual energy X-ray absorptiometry (DEXA) using the BMD of young women (20-30 years) as the reference value (T-score). For clinical purpose it is better to use age-matched control (Z-score) to evaluate future fracture risk in relation to other individuals of the same age. A further facility of the new bone densitometry technique is the option of vertebral morphometry, which makes it possible to assess previous vertebral fractures with similar precision as conventional X-ray. Such an assessment is of the greatest importance as patients with previous fractures and low BMD have several fold increased risk of further fractures and benefit most from medical therapy. There are errors of accuracy in all bone densitometry techniques and also in the interpretation of the data. Osteoarthritis in the lumbar spine, common in the elderly, creates false increment in BMD as measured by DEXA. For this reason the hip is the site of choice for BMD measurement in the elderly, especially as it predicts best femoral fractures, a major concern in the elderly. Quantitative computed tomography has the advantage of measuring separately cancellous and cortical bone. Ultrasound of bone (at present mostly in calcaneus) may provide new measures of bone fragility. Ultrasound has the advantage of no exposure to radiation and the equipment is portable. Although useful bone ultrasound cannot replace bone densitometry in the diagnosis and monitoring of therapy. Biochemical bone markers are not useful in the diagnosis of osteoporosis, but they can be useful in deciding on intervention and in monitoring the efficacy of treatment. Biochemistry is videly used in the differential diagnosis of secondary osteoporosis. History and physical examination are insufficient in diagnosing osteoporosis, but they are of utmost importance in finding individuals of high risk who might benefit most from undergoing bone densitometry. History and physical examination are also important in targeting other investigations to exclude secondary forms of osteoporosis. Although bone densitometry is usually necessary for the diagnosis of osteoporosis intervention by drugs should be based in addition on general assessment of the patient taking notice of other important independent risk factors for fractures.

English Abstract↗

PubMed2001

[Community use of oral glucocorticosteroids in Iceland and prophylactic treatment for steroid-induced osteoporosis in daily clinical pratice.].

OBJECTIVE: The use of oral corticosteroids is one of the most common causes of iatrogenic osteoporosis. Recently, therapeutic guidelines dealing with the skeletal complication of corticosteroids have been published. Therefore, it is of interest to evaluate indication for long-term therapy with corticosteroids and the frequency of active intervention against steroid induced osteoporosis in daily clinical practise. MATERIAL AND METHODS: After approval by the Committee on Medical Ethics and the Comission of Data Protection all recipes on corticosteroids in drugstores during two years period in the area of North-east Iceland (population 26,664) were gathered. Thereafter, information was collected from medical records at the Health Care Centres and the local Hospital. Patients who were taking corticosteroids for at least three months per year or in a repeated periods (totally three months annually) were included in the study. These patients also received a questionnaire concerning hormone relpacement therapy and dieatary consumption of calcium and D-vitamin. RESULTS: One hundred and ninety-one patients were included in the study or 0.7% of the population. The mean age was 66 years (17-93) and 55% were females. Rheumatic and pulmonary disorders were the most frequent indication of the corticosteroid treatment. Twenty percents of the patients had expired an osteoporosis related fractures and 26% of the patients had supposed corticosteroids induced osteoporosis. Fifty-two percents of the patients were on sublimentary D-vitamin (fish liver oil) and 37% were taking calcium-tablets, while 91% of the patients were consuming milk products regularly. Nine percents of the patients were taking bisphosphonates and 21% of postmenopausal women were on hormone replacement therapy. CONCLUSIONS: Relatively few patients on long term corticosteroids are on primary prevention against corticosteroids induced osteoporosis, although several patients are on D-vitamin and calcium sublimentation. Specific treatment against osteoporosis was in most cases instituted secondary to osteoporotic complications. Thus, corticosteroids prescribing doctors are urged to applicate the new therapy alternatives against corticosteroid-induced osteoporosis to their patients.

English Abstract↗

PubMed2003

[Diagnosis and therapy of osteoporosis. Strategy for effective treatment after fragility fractures].

Until about 20 years ago osteoporosis was considered an inevitable disease of ageing. Now the situation has completely changed and osteoporosis is classified as a disorder which is easily diagnosed and treated in the early stages of its development that is,before a skeletal fracture has occurred. Two types of medication are available today for prophylaxis and therapy of osteoporosis: the antiresorptive and the osteoanabolic drugs whose efficacy has been demonstrated in large randomized clinical trials (RCTs). These drugs are effective not only in the early stages of osteoporosis i.e. for prevention, but also when fractures have already occurred, to reduce the risk of further skeletal fractures. However, in this setting only about 7% of patients in Germany are being treated although all are at significant risk of sustaining additional fractures. Consequently all patients with osteoporosis-related fractures should be thoroughly investigated during their hospitalisation and effective treatment instituted. In addition, treatment should be continued and monitored by the family doctor. The strategy for the administration of therapy for successful prevention of secondary fractures in osteoporosis is presented.

Absorptiometry, Photon↗