Abstract
One of the cardinal manifestations of old age in humans is bone loss leading to fragility of the skeleton and increased risk of fractures, a disease known as osteoporosis. It is estimated that approximately 45% of all women will suffer at least one osteoporotic fracture during their lifetime. Genetic, environmental, nutritional, biomechanical and hormonal factors determine the integrity of the skeleton and age-related bone loss and thus the risk for developing osteoporosis. Several pharmacological agents that are capable for decreasing the risk of fractures are currently available and have proven their efficacy in randomized clinical studies. Among these are the anti-catabolic drugs e.g., calcium, vitamin-D, estrogen, raloxifen, and bisphosphonates (e.g., etidronate, alendronate, risedronate, ibandronate, and pamidronate), anabolic drugs e.g., parathyroid hormone (1–34) and strontium ranelate which has both anti-catabolic and anabolic effects. Also, evidence suggests that individualized advice on lifestyle modification, e.g., increased physical exercise, cessation of smoking, fall prevention and use of hip protectors, should be offered to most patients
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References
Bennett, A.E., Wahner, H.W., Riggs, B.L., Hintz, R.L. (1984) Insulin-like growth factors I and II: aging and bone density in women. J.Clin.Endocrinol.Metab 59: 701–704.
Beral, V. (2003) Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet 362: 419–27.
Brixen, K.T., et al. (2004) Teriparatide (biosynthetic human parathyroid hormone 1–34): a new paradigm in the treatment of osteoporosis. Basic Clin.Pharmacol.Toxicol. 94: 260–70.
Cohen-Solal, M.E., Shih, M.S., Lundy, M.W., Parfitt, A.M. (1991) A new method for measuring cancellous bone erosion depth: application to the cellular mechanisms of bone loss in postmenopausal osteoporosis. J.Bone Miner.Res. 6: 1331–1338.
Copeland, K.C., Colletti, R.B., Devlin, J.T., McAuliffe, T.L. (1990) The relationship between insulin-like growth factor-I, adiposity, and aging. Metabolism 39: 584–587.
Cummings, S.R., Nevitt, M.C. (1989) A hypothesis: the causes of hip fractures. Journal of Gerontology 44: M107–M111.
Cummings, S.R., et al. (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280: 2077–82.
Ebbesen, E.N., Thomsen, J.S., Beck-Nielsen, H., Nepper-Rasmussen, H.J., Mosekilde, L. (1999) Age- and gender-related differences in vertebral bone mass, density, and strength. Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research 14: 1394–1403.
Eriksen, E.F., Melsen, F., Mosekilde, L. (1984) Reconstruction of the resorptive site in iliac trabecular bone: a kinetic model for bone resorption in 20 normal individuals. Metabolic Bone Disease & Related Research 5: 235–242.
Eriksen, E.F., Gundersen, H.J., Melsen, F., Mosekilde, L. (1984) Reconstruction of the formative site in iliac trabecular bone in 20 normal individuals employing a kinetic model for matrix and mineral apposition. Metabolic Bone Disease & Related Research 5: 243–252.
Eriksen, E.F., Hodgson, S.F., Eastell, R., Cedel, S.L., O’Fallon, W.M., Riggs, B.L. (1990) Cancellous bone remodeling in type I (postmenopausal) osteoporosis: quantitative assessment of rates of formation, resorption, and bone loss at tissue and cellular levels. J.Bone Miner.Res. 5: 311–319.
Eriksen, E.F., Langdahl, B., Vesterby, A., Rungby, J., Kassem, M. (1999) Hormone replacement therapy prevents osteoclastic hyperactivity: A histomorphometric study in early postmenopausal women. J.Bone Miner.Res. 14: 1217–1221.
Ettinger, B., et al. (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 282: 637–45.
Finkelstein, J.W., Roffwarg, H.P., Boyar, R.M., Kream, J., Hellman, L. (1972) Age-related change in the twenty-four-hour spontaneous secretion of growth hormone. J.Clin.Endocrinol.Metab 35: 665–670.
Florini, J.R., Prinz, P.N., Vitiello, M.V., Hintz, R.L. (1985) Somatomedin-C levels in healthy young and old men: relationship to peak and 24-hour integrated levels of growth hormone. J.Gerontol. 40: 2–7.
Frost, H.M., Vilanueva, A.R., Jett, S., Eyring, E. Tetracycline-based analysis of bone remodelling in osteopetrosis. Clin.Orthop. 65: 203–217.
Frost, H.M. (2001) The Utah paradigm of skeletal physiology: what is it? Veterinary and Comparative Orthopaedics and Traumatology 14: 179–184.
Gilsanz, V., Kovanlikaya, A., Costin, G., Roe, T.F., Sayre, J., Kaufman, F. (1997) Differential effect of gender on the sizes of the bones in the axial and appendicular skeletons. J.Clin.Endocrinol.Metab 82: 1603–1607.
Heshmati, H.M., Khosla, S., Burritt, M.F., O’Fallon, W.M., Riggs, B.L. (1998) A defect in renal calcium conservation may contribute to the pathogenesis of postmenopausal osteoporosis. J Clin Endocrinol Metab. 83: 1916–20.
Ho, K.Y., Evans, W.S., Blizzard, R.M., Veldhuis, J.D., Merriam, G.R., Samojlik, E., Furlanetto, R., Rogol, A.D., Kaiser, D.L., Thorner, M.O. (1987) Effects of sex and age on the 24-hour profile of growth hormone secretion in man: importance of endogenous estradiol concentrations. J.Clin.Endocrinol.Metab 64: 51–58.
Hughes, D.E., Dai, A., Tiffee, J.C., Li, H.H., Mundy, G.R., Boyce, B.F. (1996) Estrogen promotes apoptosis of murine osteoclasts mediated by TGF-beta. Nat.Med. 2: 1132–1136.
Iranmanesh, A., Lizarralde, G., Veldhuis, J.D. (1991) Age and relative adiposity are specific negative determinants of the frequency and amplitude of growth hormone (GH) secretory bursts and the half-life of endogenous GH in healthy men. J.Clin.Endocrinol.Metab 73: 1081–1088.
Khosla, S., Melton, L.J., III, Atkinson, E.J., O’Fallon, W.M., Klee, G.G., Riggs, B.L. (1998) Relationship of serum sex steroid levels and bone turnover markers with bone mineral density in men and women: a key role for bioavailable estrogen. The Journal of Clinical Endocrinology and Metabolism 83: 2266–2274.
Lu, P.W., Cowell, C.T., LLoyd-Jones, S.A., Briody, J.N., Howman-Giles, R. (1996) Volumetric bone mineral density in normal subjects, aged 5–27 years. J.Clin.Endocrinol.Metab 81: 1586–1590.
Matkovic, V., Jelic, T., Wardlaw, G.M., Ilich, J.Z., Goel, P.K., Wright, J.K., Andon, M.B., Smith, K.T., Heaney, R.P. (1994) Timing of peak bone mass in Caucasian females and its implication for the prevention of osteoporosis. Inference from a cross-sectional model. J.Clin.Invest 93: 799–808.
McClung, M.R., et al. (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N.Engl.J.Med. 344: 333–40.
Meunier, P.J., et al. (2004) The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N.Engl.J.Med. 350: 459–68.
Mosekilde, L., Mosekilde, L., Danielsen, C.C. (1987) Biomechanical competence of vertebral trabecular bone in relation to ash density and age in normal individuals. Bone 8: 79–85.
Mosekilde, L. (1990) Consequences of the remodelling process for vertebral trabecular bone structure: a scanning electron microscopy study (uncoupling of unloaded structures). Bone Miner. 10: 13–35.
Mosekilde, L. (2005) Vitamin D and the elderly. Clin.Endocrinol. 62: 265–81.
Neer, R.M., et al. (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N.Engl.J.Med. 344: 1434–1441.
Nguyen, T.V., Blangero, J., Eisman, J.A. (2000) Genetic epidemiological approaches to the search for osteoporosis genes. J.Bone Miner.Res. 15: 392–401.
Pacifici, R. (1996) Estrogen, cytokines, and pathogenesis of postmenopausal osteoporosis. Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research 11: 1043–1051.
Parfitt, A.M. (1991) Bone Forming Cells in Clinical Conditions. In: B.K.Hall (ed) In Bone, The Osteoblast and Osteocyte. The Telford Press, London, pp 351–426.
Ralston, S.H. (2002) Genetic control of susceptibility to osteoporosis. J.Clin.Endocrinol.Metab. 87: 2460–2466.
Reginster, J.Y., et al. (2005) Strontium ranelate reduces the risk of nonvertebral fractures in post-menopausal women with osteoporosis: TROPOS study. J.Clin.Endocrinol.Metab.
Riggs, B.L., Melton, L.J., III (1986) Involutional osteoporosis. N.Engl.J Med. 314: 1676–1686.
Riggs, B.L., Khosla, S., Melton, L.J., 3rd. (1998) A unitary model for involutional osteoporosis: estrogen deficiency causes both type I and type II osteoporosis in postmenopausal women and contributes to boneloss in aging men. J Bone Miner Res. 13: 763–73.
Rossouw, J.E., et al. (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288: 321–33.
Rudman, D., Feller, A.G., Nagraj, H.S., Gergans, G.A., Lalitha, P.Y., Goldberg, A.F., Schlenker, R.A., Cohn, L., Rudman, I.W., Mattson, D.E. (1990) Effects of human growth hormone in men over 60 years old. N.Engl.J.Med. 323: 1–6.
Slovik, D.M., et al. (1981) Deficient production of 1,25-dihydroxyvitamin D in elderly osteoporotic patients. The New England Journal of Medicine 305: 372–374.
Stenderup, K., Justesen, J., Clausen, C., Kassem, M. (2003). Aging is associated with decreased maximal life span and accelerated senescence of bone marrow stromal cells Bone 33: 919–927.
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Kassem, M., Brixen, K. (2006). Pathophysiology, prevention and treatment of age-related osteoporosis in women. In: Rattan, S.I., Kassem, M. (eds) Prevention and Treatment of Age-related Diseases. Springer, Dordrecht. https://doi.org/10.1007/1-4020-5058-5_6
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DOI: https://doi.org/10.1007/1-4020-5058-5_6
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