Bone Health

Provides information on bone density and the prevention and treatment of osteoporosis. Cases with images are available. Post-test included.Sponsored by University of Washington.

Discussion: - most common metabolic bone dz; - definition: - what appears to be a characteristic of osteoporosis is an uncoupling of the osteoblastic and osteoclastic processes; - WHO definition: a bone mineral density that is 2.5 SD below the mean peak value in young adults of the same race and sex (T-score of -2.5); - Z score: bone mineral density compared with the mean value in normal subjects of the same age and sex; - Z-score of less than -1 indicates patient is in the lowest 25%, and a score of less than -2 indicates patient is in the lowest 2.5%; Wheeless' Textbook of Orthopaedics

SIGN Guideline Management of Osteoporosis (pdf file)

This continuing medical education Webcast uses an innovative panel discussion format to review meta-analyses that address osteoporosis, bisphosphonate comparative dosing, and the bridging concept for extended dosing.
Mone Zaidi, MD, PhD, Program Chair/Moderator; Jonathan D. Adachi, MD, FRCPC; Steven T. Harris, MD, FACP

From American Journal of Roentgenology
Diagnosis of Osteoporotic Vertebral Fractures: Importance of Recognition and Description by Radiologists Posted 10/06/2004 (full text) Leon Lenchik; Lee F. Rogers; Pierre D. Delmas; Harry K. Genant

The purpose of this study was to determine the prevalence of contributors to secondary osteoporosis (eg osteomalacia) in patients presenting with a clinical vertebral or non-vertebral fracture. Identifying and correcting these contributors will enhance treatment effect aimed at reducing the risk of subsequent fractures.
We conclude that more than one in two patients presenting with a clinical vertebral or non-vertebral fracture and BMD-osteoporosis have secondary contributors to osteoporosis, most of which were correctable. Identifying and correcting these associated disorders will enhance treatment effect aimed at reducing the risk of subsequent fractures in patients older than 50 years.
Bianca Dumitrescu; Svenjhalmar van Helden; Rene ten Broeke; Arie Nieuwenhuijzen-Kruseman; Caroline Wyers; Gabriela Udrea; Sjef van der Linden; Piet Geusens BMC Musculoskelet Disord. 2008

Vertebral compression fracture is the most common complication of osteoporosis. More than 700,000 new vertebral compression fractures occur every year in the United States alone, accounting for more than 100,000 hospital admissions and resulting in close to $1.5 billion in annual costs.
Synonyms and related keywords: osteoporosis, back pain, osteoporotic vertebral compression fractures, diminished bone density, vertebroplasty, kyphoplasty, wedge-shaped compression fractures, acquired kyphosis, general height loss, central crush fracture, bone density loss
Authors Cooper Lin & Lane 2008

One of the inevitable complications of spinal cord injury (SCI) is the associated osteoporosis that occurs predominantly in the pelvis and the lower extremities. The acute treatment of patients with SCI has always focused on the injury itself and on the immediate complications that subsequently arise. Bone loss as a consequence of SCI has been of secondary concern historically. Osteoporosis in persons with SCI was first studied in relation to calcium metabolism and the associated hypercalcemia and renal calculi that followed. The differences between SCI-induced osteoporosis and other causes of bone loss (disuse), such as prolonged bed rest, space travel, and lower motor neuron disorders, have since become clearer. New technologies allow monitoring of osteoblastic and osteoclastic activity at the microscopic level, while modern radiographic techniques have allowed more refined studies to be undertaken at the macroscopic level.
Synonyms and related keywords: spinal cord injury, osteoporosis, osteoporosis and SCI, SCI-induced osteoporosis, functional electrical stimulation, FES, dual-energy radiographic absorptiometry scan, dual-energy X-ray absorptiometry scan, DRA, DXA
Author David Weiss, MD 2008

Osteoporosis is the most common metabolic bone disease and represents an increasingly serious problem, particularly as the population ages. It has been most commonly recognized in elderly white women, although it does occur in both sexes, all races, and all age groups. Osteoporosis is defined by the World Health Organization as a T-score of -2.5. T-score is the value compared to control subjects who are at their peak bone mineral density, while Z-score reflects a value compared to patients matched for age and sex.
Osteoporosis can result in devastating physical, psychosocial, and economic consequences. Despite its adverse effects, it is a condition that is often overlooked and undertreated, in large part because it is a clinically silent disease until it manifests in the form of fracture.
Synonyms and related keywords: porous bones, weak bones, metabolic bone disease, hip fracture, vertebral compression fracture, dowager hump, dowager's hump, scoliosis, collagen defect, bone fragility, decreased bone mass, decreased bone mineral density, decreased BMD
Lin & Lane 2008

the official definition of osteoporosis does not pertain to children at the present time. However, at an NIH Consensus Conference in 2000, osteoporosis was defined as a skeletal disorder characterized by compromised bone strength that predisposes to an increased risk of fracture. Adult-onset osteoporosis also involves loss of bone trabecular structure; however, no evidence indicates that this occurs in children. Therefore, children exhibiting low bone mass are defined as osteopenic, not osteoporotic.
Synonyms and related keywords: osteoporosis, low bone mass, osteopenia, juvenile osteoporosis, paediatric
Gordon L Klein, MD, MPH 2006

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to bone fracture.
Bone tissue undergoes constant remodeling. Under the physiologic conditions, bone formation and resorption are in a fair balance. After the third decade of life, bone resorption exceeds bone formation and leads to osteopenia and, in severe situations, osteoporosis. Women lose 30-40% of their cortical bone and 50% of their trabecular bone over their lifetime, as opposed to men who lose 15-20% of their cortical bone and 25-30% of trabecular bone.
Synonyms and related keywords: osteoporosis, metabolic bone disorder, metabolic bone disease, bone mass, bone density, osteopenia
Srinivas R Nalamachu, MD & Shireesha Nalamasu, MD 2006

Osteoporosis, a chronic progressive disease, is the most common metabolic bone disease in the United States. Osteoporosis can affect almost the entire skeleton. Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility. The disease often does not become clinically apparent until a fracture occurs. Consequently, many individuals, both male and female, experience pain, disability, and diminished quality of life as a result of having osteoporosis. The economic burden of the disease in the United States is considerable and will grow as the population ages. Prevention and recognition of the secondary causes of osteoporosis are first-line measures to lessen the impact of osteoporosis.
Synonyms and related keywords: metabolic bone disease, fracture, vertebral compression fracture, hip fracture, secondary osteoporosis, bone mineral density, BMD
Serota et al 2006

Grading of osteoporosis based on the X-ray appearance of the hip
Wheeless' Textbook of Orthopaedics

Vertebroplasty and kyphoplasty are radiologic procedures for the treatment of the intense pain caused by vertebral compression fracture in patients whose pain has been refractory to medical management or bracing. Vertebroplasty and kyphoplasty involve the US Food and Drug Administration (FDA) approved intraosseous injection of acrylic cement under local anesthesia and fluoroscopic guidance to control the pain of vertebral fractures associated with osteoporosis, tumors, and trauma.
Synonyms and related keywords: back pain treatment, vertebral compression fracture, vertebral fracture, acrylic cement injection, lumbar vertebroplasty, thoracic vertebroplasty
Author Jeffrey P Kochan, MD 2006

Archive Copy AAOS On-Line Service - 1999 Annual Meeting Scientific Program. Osteoporosis and the Orthopaedic Surgeon: Recent Advances in Diagnosis and Treatment