Osteoporosis in Clinical Practice

Description:

This book is a quick-reference guide to osteoporosis that equips the reader with easy-to-follow guidelines for lifelong maintenance of skeletal structure and function, with an emphasis on the diagnosis, therapy and prevention of osteoporosis.

Organized into 20 chapters it provides a concise, yet complete evidence-based overview of osteoporosis prevention and management “from paediatrics to geriatrics”. This practical guide is aimed at raising awareness and educate physicians across disciplines about this preventable, treatable and now even curable disease and emphasizing how every doctor can contribute to stop the “osteoporosis treatment gap” recognized over the last ten years.

Covering bone biology, pathophysiology, secondary and drug-induced osteoporosis, as well as risk factors, diagnostic measurements, treatment and monitoring strategies, new drugs, management of osteoporotic fractures, and much more, this book is a must-have for all those involved in the prevention and care of this global threat.

See more ebooks for you:

Implants and Oral Rehabilitation of the Atrophic Maxilla

Pediatric Chronic Kidney Disease

ISO 15189:2022 Medical laboratories — Requirements for quality and competence

Genital Herpes Simplex Virus—An Updated Review

Specimen Considerations in Molecular Oncology Testing

Table of contents :

Preface
Contents
1: Architecture, Remodelling and Regulators of the Skeleton
1.1 Function of the Skeleton
1.2 Architecture of Bone
1.3 Blood Vessels and Nerves of Bone and Marrow
1.4 Modelling and Remodelling of Bone
1.5 Bone Cells
1.6 Bone Remodelling Units
1.7 Regulators of Bone
1.7.1 RANK/RANKL/Osteoprotegerin System
1.7.2 Sclerostin
1.7.3 Leptin
1.7.4 Systemic Hormones
1.7.5 Local Cytokines and Signals
1.7.6 Transcriptional Regulation and Genes
1.7.7 Vitamins and Minerals
1.7.8 Mechanical Loading
1.8 Growth and Ageing of Bone
2: Definition and Pathogenesis of Osteoporosis
2.1 The Global Scope of the Problem
2.2 Definition of Osteoporosis
2.3 Pathogenesis of Osteoporosis
3: Risk Factors and Prevention of Osteoporosis
3.1 Risk Factors for Osteoporosis
3.1.1 Risk Factors Which Cannot (Yet) be Influenced
3.1.2 Risk Factors Which Can be Influenced
3.2 A Step-by-Step Programme for Healthy Bones
4: Clinical Aspects and Diagnosis of Osteoporosis
4.1 Indicative Symptoms
4.2 Role of Conventional X-Rays in Osteoporosis
4.3 Other Useful Imaging Techniques
4.4 Recommended Laboratory Tests
4.5 Significance of Bone Turnover Markers (BTMs)
4.6 Bone and Bone Marrow Biopsy
4.6.1 Indications for Taking a Bone Biopsy
4.6.2 Biopsy Needles and Biopsy Sites
5: Dual-Energy X-Ray Absorptiometry (DXA) and Other Technologies

………………………………

Preface

With the dawn of the twenty-first century has come the realisation that bone and joint diseases are a major cause of pain and physical disability worldwide. The number of people suffering from osteoporosis—already many millions in the developed and underdeveloped countries of the world—is expected to double within the next 20 years. In many countries, this increase will be even greater due to the longer survival and consequently larger numbers of older people in the population. It is therefore inevitable that the already astronomical costs of health care will rise proportionally (Fig. 1).

On the positive side, the enormous amount of work, research and study of bone disorders over the past 30 years or so has contributed greatly to our understanding of the causes, diagnosis, prevention and treatment of osteoporosis. Most importantly, perhaps, the skeleton is now regarded in a new light: as a dynamic organ undergoing constant renewal throughout life from start to finish, “from the cradle to the grave”, and what is more: it is now abundantly clear that the skeleton participates, usually not to its advantage, in almost every condition that may affect the organs and tissues in our body!

This applies especially to osteoporosis, which is now preventable, treatable and even curable at an early stage! How did this come about?
• Because of the elucidation of many of the factors involved in osseous remodelling.
• Because of the development of simple, fast, reliable and non-invasive methods
for measurement of bone density, and for testing other factors such as mineralization, trabecular architecture, cortical thickness and the bone cells themselves.
• Because of the identification of general and individual risk factors so that appropriate measures can be taken to prevent development of osteoporosis and/or its progression, if and when fractures have already occurred.
• And finally, because new and effective drugs for prevention and therapy are now readily available worldwide.

The efficacy of the classes of compounds known as the bisphosphonates, as well as the RANKL-antibody denosumab, the anabolic parathyroid hormones and more recently the sclerostin-antibody romosozumab, has now been unequivocally established by numerous large multicentre trials involving literally millions of patients. In addition, simple methods such as a healthy lifestyle, adequate nutrition, sufficient physical activity, vitamin D and calcium supplements, as required, can be recommended and adopted on a large scale (Fig. 2). Introduction and acceptance of these methods requires public awareness and support and the realisation that every individual is the guardian and caretaker of his/her own bones and responsible for their structural and functional integrity.

Well-diagnostic techniques and effective therapies—both antiresorptive and osteoanabolic—are now available for prevention, diagnosis and treatment of osteoporosis. It should be emphasized that the treatments recommended in this text are all founded on “Evidence-based Medicine” (unless otherwise stated) for which the appropriate references are given at the end of the text in “Literature”.

The aim of this book is to demonstrate that “Bone is EveryBody’s Business” and especially every doctor’s, and to provide evidence-based guidelines for diagnosis, therapy and prevention of osteoporosis in a concise form that practitioners can use to make judgements about the latest tests and treatments. This book will continue to raise awareness and to provide information to anyone seeking it and especially to doctors across disciplines concerning this preventable and now treatable disease. Consequently, we have adhered stringently to simplicity, comprehensiveness, and to our own goal of keeping this text as “user-friendly” as possible so that any doctor seeking information on a particular topic in osteoporosis has uncomplicated and time-saving access to it.

We wish all our readers success in their endeavours to help patients and to reduce suffering on this strife-ridden, beautiful planet of ours.

Osteoporosis—a pandemic whose time has come!
I would like to thank Harald Konopatzki who made significant contribution to this book with numerous high-quality illustrations. Also, I wish to acknowledge H. Henkel for the preparation of the drawings included in this preface.