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.
Author(s): Reiner Bartl
Publisher: Springer
Year: 2023
Language: English
Pages: 236
City: Cham
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
5.1 Methods for Measurement
5.1.1 Dual-Energy X-Ray Absorptiometry (DEXA, DXA)
5.2 Skeletal Sites of Measurement
5.3 TBS (Trabecular Bone Score): A Bone Analysis Assessing Bone Microarchitecture
5.4 The FRAX® Risk Calculation Tool
5.5 Indications for Bone Density Measurement (DXA)
6: Treatment Strategies and Drugs in Osteoporosis
6.1 Evidence-Based Strategies for Therapy of Osteoporosis
6.2 Comprehensive Approach to Therapy of Osteoporosis
6.3 Indication for Treatment: Combining BMD with Clinical Factors
6.4 The Osteoporosis Treatment Gap
7: Management of Pain in Osteoporosis
7.1 Acute Phase
7.2 Chronic Phase: Short Term
7.3 Chronic Phase: Long Term
7.4 Mechanical Loading and Electromagnetic Fields on Bone
7.5 Hydrotherapy
8: Calcium and Vitamin D Deficiency and Osteomalacia
8.1 Calcium and Osteoporosis
8.2 Vitamin D and Osteoporosis
8.2.1 Functions, Sources and Deficiency of Vitamin D
8.2.2 Rickets, Osteomalacia and Osteoporomalacia
8.2.3 Recommended Vitamin D and Calcium Intake
8.2.4 Active Vitamin D Metabolites in Chronic Renal and Hepatic Disorders
8.2.5 Other Vitamins and Elements Involved in Skeletal Health
9: Hormone Replacement Therapy (HRT) and SERMs
9.1 Oestrogen and Progesterone
9.1.1 Which Oestrogens and Progestins and How to Take Them?
9.1.2 Which Women to Treat?
9.1.3 How Long to Treat?
9.1.4 How to Monitor HRT?
9.1.5 What Are the Risks and Adverse Events of HRT?
9.1.6 What Are the Main Contraindications?
9.2 Natural Oestrogens
9.3 Testosterone
9.4 Anabolic Steroids
9.5 Selective Oestrogen Receptor Modulators (SERMs)
10: Bisphosphonates (BP) and Denosumab
10.1 Bisphosphonates (BP)
10.1.1 A Brief Survey of BP
10.1.2 Pharmacokinetics of BP
10.1.3 Side Effects, Toxicity and Contraindications of BP
10.1.4 BP Currently Used in Osteoporosis
10.2 Denosumab
10.2.1 Pharmacokinetics of Denosumab
10.2.2 Clinical Use of Denosumab
10.2.3 Bone Loss After Discontinuation of Denosumab
10.2.4 Side Effects and Contraindications of Denosumab
11: Parathyroid Hormone (PTH) and Romosozumab
11.1 Peptides of the Parathyroid Hormone Family
11.2 Parathyroid Hormone (PTH)
11.3 Teriparatide
11.4 Abaloparatide
11.5 Romosozumab
12: Monitoring of Patients on Treatment
12.1 Adherence to Treatment
12.2 Monitoring of Treatment
12.3 Monitoring of Antiresorptive Therapy
12.3.1 “Drug Holiday” in Patients on Treatment with BP
12.4 Monitoring of Osteoanabolic Therapy
13: Risk Factors and Healing of Osteoporotic Fractures
13.1 Epidemiology and Cost of Osteoporotic Fractures
13.2 Risk Factors of Osteoporotic Fractures
13.3 Fracture Risk Assessment (FRAX® Tool)
13.4 Sequence of Events in Fracture Healing
13.5 Effects of Drugs and Ultrasound on Fracture Healing
14: Localisation and Management of Osteoporotic Fractures
14.1 General Guidelines for the Management of Osteoporotic Fractures
14.2 Hip Fractures
14.3 Atypical Femoral Fracture (AFF)
14.4 Vertebral Compression Fractures (VCFs)
14.5 Distal Radius Fractures (DRFs)
14.6 Proximal Humerus Fractures
14.7 Other Fractures
14.8 Peri-Implant Bone Loss
14.8.1 Pathogenesis
14.8.2 Diagnosis
14.8.3 Treatment Strategies
14.9 Prevention of Further Fragility Fractures
15: Variants of Osteoporosis According to Sex and Age
15.1 Osteoporosis in Men
15.1.1 Pathogenesis
15.1.2 Diagnosis
15.1.3 Risk Factors
15.1.4 Special Features in Men
15.1.5 Prevention
15.1.6 Therapy
15.2 Osteoporosis in Children and Adolescents
15.2.1 Diagnosis
15.2.2 Therapy
15.2.3 Idiopathic Juvenile Osteoporosis (IJO) and Idiopathic Juvenile Arthritis (IJA)
15.2.4 Osteogenesis Imperfecta (OI)
15.3 Premenopausal Osteoporosis
15.3.1 Pathogenesis
15.3.2 Secondary Causes
15.3.3 Therapy
15.4 Pregnancy-Associated Osteoporosis
15.4.1 The Skeleton Under Pregnancy and Lactation
15.4.2 Pathogenesis
15.4.3 Prevention and Therapy
15.4.4 Transient Osteoporosis of the Hip
15.4.5 Involutional (Age-Related, Type II) Osteoporosis
16: Secondary Osteoporosis in Medical Disciplines
16.1 Secondary Osteoporosis in Cardiology
16.2 Secondary Osteoporosis in Endocrinology
16.2.1 Hyperthyroidism and Hypothyroidism
16.2.2 Primary Hyperparathyroidism (pHPT)
16.2.3 Diabetes Mellitus (DM)
16.2.4 Cushing’s Syndrome and Primary Aldosteronism
16.3 Secondary Osteoporosis in Gastroenterology
16.4 Secondary Osteoporosis in Haematology
16.4.1 The Bone and Marrow System
16.4.2 Myelogenous Osteopathies
16.4.3 Secondary Osteopathy in Systemic Mastocytosis
16.5 Secondary Osteoporosis in Infectious Disorders
16.6 Secondary Osteopathies in Nephrology
16.6.1 Chronic Kidney Disease: Mineral and Bone Disorder (CKD-MBD)
16.6.1.1 Management of Hyperphosphataemia
16.6.1.2 Management of Secondary HPT
16.6.1.3 Management of Chronic Metabolic Acidosis
16.6.1.4 Management of Osteoporosis
16.6.2 Kidney Stones and Osteoporosis
16.7 Secondary Osteoporosis in Neurology and Psychiatry
16.8 Secondary Osteoporosis in Oncology
16.9 Secondary Osteoporosis in Pulmonology
16.10 Secondary Osteoporosis in Rheumatology and Immunology
16.11 Osteoporosis Immobilisation (Disuse Osteoporosis, Disuse Atrophy)
17: Drug-Induced Osteoporosis and Transplantation
17.1 Corticosteroid-Induced Osteoporosis
17.1.1 Pathogenesis
17.1.2 Treatment
17.2 Transplantation Osteoporosis
17.2.1 Pathogenesis
17.2.2 Heart Transplantation
17.2.3 Liver Transplantation
17.2.4 Bone Marrow Transplantation
17.2.5 Renal Transplantation
17.3 Tumour Therapy-Induced Osteoporosis
17.3.1 Hypogonadism and Breast Cancer
17.3.2 Hypogonadism and Prostate Cancer
17.3.3 Hypogonadism in Hodgkin’s Disease and Other Malignant Lymphomas
17.3.4 Antitumour Therapy with Direct Effect on the Bone
17.4 Antiepileptic Drug-Related Osteopathy
17.5 Other Drugs Associated with Osteoporosis
18: Osteoporosis and SREs in Multiple Myeloma (MM)
18.1 Pathogenesis of MM
18.2 Clinical Findings in MM
18.3 Diagnosis of Skeletal Manifestations in MM
18.4 Myeloma Variants
18.5 Bisphosphonates in MM
18.6 Denosumab and Bortezomib in MM
19: Osteoporosis and SREs in Metastatic Carcinomas
19.1 Incidence and Development of Bone Metastases
19.2 Skeletal Metastases of Breast Cancer
19.2.1 Bone Reactions in Breast Cancer
19.2.2 Treatment Strategies in Metastatic Breast Cancer
19.2.2.1 Bisphosphonates (BP) for Prevention of Metastasis
19.2.2.2 BP for Prevention of Skeletal Complications
19.2.2.3 BP for Treatment of Skeletal Complications (SREs)
19.3 Skeletal Metastases of Prostatic Cancer
19.4 Other Tumours with Osteotropic Metastases
19.4.1 Bronchial Carcinoma
19.4.2 Renal Cell Carcinoma
20: Bone Marrow Oedema (BME), CRPS and Osteoporosis
20.1 Bone Marrow Oedema (BME)
20.1.1 Definition and Pathogenesis of BME
20.1.2 Clinical Findings, Imaging and Diagnosis
20.1.3 Treatment Strategies
20.2 Complex Regional Pain Syndrome (CRPS, Sudeck’s Disease)
20.2.1 Definition and Pathogenesis
20.2.2 Diagnosis and Clinical Findings
20.2.3 Course of Disease
20.2.4 Treatment Strategies
20.3 Other Local Bone Disorders and Osteoporosis
Bibliography
Index
