The outcome of recent clinical trials in osteoporosis was the impetus for this volume. In these studies of two bisphosphonates, an interaction between bone mineral density (BMD) and the treatment effect was seen, such that these agents appeared to lose their effect as BMD increased. To practitioners this is counter-intuitive. Why should treatment work and not prevention? This book uses a solid evidence base to explore such issues, without limiting itself to specialist concerns. It tackles other facets of the disease as well, such as the economic aspects. Prevention and Treatment of Osteoporosis in the High-Risk Patient is intended for physicians of all specialties who see patients who have or might be at risk of developing osteoporosis.
Author(s): Cyrus Cooper, Stephen H. Gehlbach, Robert Lindsay
Edition: 1
Publisher: Informa Healthcare
Year: 2005
Language: English
Pages: 122
Book Cover......Page 1
Title......Page 2
Copyright......Page 3
Contents......Page 4
Contributors......Page 5
1 Perspectives on the problem......Page 7
THE BONE DENSITY PERSPECTIVE......Page 9
THE FRACTURE PERSPECTIVE......Page 11
2. Distal forearm fracture......Page 12
3. Vertebral fracture......Page 13
Fracture burden......Page 14
REFERENCES......Page 15
FREQUENCY OF OSTEOPOROSIS......Page 17
Osteoporosis and race/ethnicity......Page 18
Osteoporosis and sex......Page 19
Hip fracture......Page 20
Wrist fracture......Page 21
FRACTURE-RELATED MORBIDITY......Page 22
FRACTURE-RELATED MORTALITY......Page 24
FRACTURE-RELATED COST......Page 25
REFERENCES......Page 27
Peak bone mass......Page 31
BONE AS A TISSUE......Page 32
Collagen......Page 34
Non-collagen proteins......Page 35
BONE CELLS......Page 36
The osteoclast......Page 37
Bone cell conversation......Page 38
CALCIUM AND PHOSPHATE BALANCE......Page 40
Calcitonin......Page 41
BIOCHEMICAL MEASUREMENTS OF BONE CELL ACTIVITY......Page 42
REFERENCES......Page 43
INTRODUCTION......Page 46
DIAGNOSIS OF OSTEOPOROSIS......Page 47
ASSESSMENT OF FRACTURE RISK......Page 48
AGE AND BONE MINERAL DENSITY......Page 49
OTHER RISK FACTORS......Page 51
INTEGRATING RISK FACTORS......Page 53
CONCLUSIONS......Page 55
REFERENCES......Page 56
INTRODUCTION......Page 59
Vitamin D......Page 60
Hormone replacement therapy (HRT)......Page 61
Tamoxifen......Page 62
Tibolone......Page 63
Alendronate......Page 64
Risedronate......Page 67
Calcitonin......Page 68
Other treatments......Page 69
Exercise......Page 71
WHICH AGENT FOR WHICH PATIENT?......Page 72
Women without a history of low trauma fractures......Page 73
PERSPECTIVES AND CONCLUSIONS......Page 74
REFERENCES......Page 76
Cost-effectiveness......Page 84
Cost-utility......Page 85
Addressing uncertainty......Page 86
COST-EFFECTIVENESS OF TREATMENTS FOR FRACTURE PREVENTION......Page 87
Estrogen replacement therapy......Page 88
BISPHOSPHONATES......Page 90
CALCIUM WITH VITAMIN D......Page 92
Economic evaluations: vitamin D with calcium......Page 95
Economic evaluations: validity of results......Page 100
TARGETING TREATMENTS......Page 101
CONCLUSIONS......Page 102
REFERENCES......Page 103
RISK FACTORS......Page 106
Physical activity......Page 107
Cigarette smoking and alcohol use......Page 108
Bone mineral density determinations and clinical risk factors......Page 109
Pharmacologic intervention......Page 111
COMBINING RISK FACTORS......Page 112
RELATIVE RISK, ABSOLUTE RISK AND RISK DIFFERENCE......Page 117
CONCLUSIONS......Page 119
REFERENCES......Page 120
Index......Page 122
