Handbook of Osteoporosis
Handbook of Osteoporosis provides a concise but highly illustrated and essential resource for clinicians in the management of postmenopausal osteoporosis. Opening with overviews of epidemiology, clinical features and pathophysiology, the book then discuss
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Handbook of Osteoporosis David M Reid Professor of Rheumatology Head, Division of Applied Medicine University of Aberdeen Medical School Aberdeen, UK
Published by Springer Healthcare Ltd, 236 Gray’s Inn Road, London, WC1X 8HB, UK. www.springerhealthcare.com ©2011 Springer Healthcare, a part of Springer Science+Business Media. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the copyright holder. British Library Cataloguing-in-Publication Data. A catalogue record for this book is available from the British Library. ISBN 978-1-907673-07-8 Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication, the ultimate responsibility rests with the prescribing physician. Neither the publisher nor the authors can be held responsible for errors or for any consequences arising from the use of the information contained herein. Any product mentioned in this publication should be used in accordance with the prescribing information prepared by the manufacturers. No claims or endorsements are made for any drug or compound at present under clinical investigation. Commissioning editor: Dinah Alam Project editor: Alison Whitehouse Designer: Joe Harvey Artworker: Sissan Mollerfors Production: Marina Maher Printed in xxx by xxx
Contents Author biographies
1
Introduction
1
Epidemiology of osteoporosis
1
Prevalence of osteoporosis in postmenopausal women?
2
Risk factors for postmenopausal osteopaenia and osteoporosis
2
Clinical features of osteoporosis Quality-of-life issues in women with postmenopausal osteoporosis
2
3
4
5
vii
Pathophysiology
4 10
13
Normal bone remodelling cycle
13
Inhibitors and stimulators of bone remodelling
16
Age-related changes in bone mineral density
16
Role of oestrogen in bone remodelling
19
Prevention
23
Population strategies
23
Targeted approaches
27
Investigation and diagnosis
33
Definition and diagnostic criteria
33
Assessment of osteoporosis
35
The gold standard for diagnosis
45
Fracture risk assessment
49
BMD and fracture risk
49
Limitations of BMD
52
Biochemical markers of bone turnover
52
Biochemical markers and fracture risk
53
Biochemical markers and treatment response
56
WHO fracture Risk Assessment Tool (FRAX)
57
6
7
Non-pharmacological and adjunctive management
61
Non-pharmacological approaches to postmenopausal osteoporosis
61
Goals of intervention
61
Diet and nutrition
62
Exercise
70
Smoking cessation
72
Alcohol consumption
72
Prevention of and protection against falls
72
Pharmacological treatment Bisphosphonates
78
Oestrogen
93
Calcitonin Calcium plus vitamin D
8
77
99 101
Parathyroid hormone derivatives
102
Strontium ranelate
105
Denosumab
107
Guidelines for treatment of postmenopausal osteoporosis
110
Current thinking about combination therapy
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