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The Pathophysiology of Osteoporosis

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Book cover Osteoporosis

Part of the book series: Current Clinical Practice ((CCP))

Abstract

Osteoporosis is a clinical syndrome of reduced bone mass and increased fracture susceptibility. In most cases, the disease is characterized by back pain from recurrent vertebral compressions, although fractures of the distal tibia, hip, ribs, or wrist can be the initial presentation. The vast majority of cross-sectional and longitudinal studies in men and women now confirm an increased risk for fracture if bone mineral density (BMD) (spine, hip, wrist, or total body) is more than 1 SD below predicted for a healthy 35-yrold person. The relative risk/U SD is approx 2.5, and increases exponentially with the number of previous vertebral fractures and the extent of reduction in BMD (1,2)

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References

  1. Cummings SR, Black DM, Rubin SM. Lifetime risks of hip, Colles’ or vertebral fracture and coronary heart disease among white postmenopausal women. Arch Intern Med 1989; 149: 2445–2448.

    Article  PubMed  CAS  Google Scholar 

  2. Ross PD, David JW, Epstein RS, Wasnich RD. Preexisting fractures and bone mass predict vertebral fracture incidence in women. Ann Int Med 1991; 114: 919–923.

    PubMed  CAS  Google Scholar 

  3. Tinetti, ME, Speechley M, Gunter SF. Risk factors for falls among elderly persons living in the community. NEngl JMed 1988; 319: 1701–1707.

    Article  CAS  Google Scholar 

  4. Melton LJ, Chrishilles EA, Cooper C, Lane AW, Riggs BL. Perspective: how many women have osteoporosis? J Bone Miner Res 1992; 7: 1005–1010.

    Article  PubMed  Google Scholar 

  5. Melton LJ III, Atkinson EJ, O’Fallon WM, Wahner HW, Riggs BL. Long term fracture prediction by bone mineral assessed at different skeletal sites. J Bone Miner Res 1993; 8: 1227–1233.

    Article  PubMed  Google Scholar 

  6. Hui SL, Slemenda CS, Johnston CC. Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 1988; 81: 1804–1809.

    Article  PubMed  CAS  Google Scholar 

  7. Manolagas SC, Jilka RL. Bone marrow, cytokines and bone remodeling. N Engl J Med 1995; 332: 305–311.

    Article  PubMed  CAS  Google Scholar 

  8. Rosen CJ, Morrison AM, Zhou H, Storm D, Hunter SJ, Musgrave KO, Chen T, Wen Wei T, Holick MF. Elderly women in northern New England exhibit seasonal changes in bone mass and calciotropic hormones. Bone Miner 1994; 25: 83–92.

    Article  PubMed  CAS  Google Scholar 

  9. Pocock NA, Eisman JA, Hopper JL, Yeates MG, Sambrook PN, Eberl S. Genetic determinants of bone mass in adults: a twin study. J Clin Invest 1987; 80: 706–710.

    Article  PubMed  CAS  Google Scholar 

  10. McKay HA, Bailey DA, Wilkinson AA, Houston CS. Familial comparison of bone mineral density at the proximal femur and lumbar spine. Bone Miner 1994; 24: 95–107.

    Article  PubMed  CAS  Google Scholar 

  11. Hansen MA, Hassager C, Jensen SB, Christiansen C. Is heritability a risk factor for postmenopausal osteoporosis. J Bone Miner Res 1992; 9: 1037–1043.

    Google Scholar 

  12. Smith DM, Nance WE, Kang KW, Christian JC, Johnston CC. Genetic factors in determining bone mass. J Clin Invest 1973; 52: 2800–2808.

    Article  PubMed  CAS  Google Scholar 

  13. Slemenda CW, Christian JC, Williams CJ, Norton JA, Johnston CC. Genetic determinants of bone mass in adult women: a reevaluation of the twin model and the potential importance of gene interaction on heritability estimates. J Bone Miner Res 1991; 6: 561–567.

    Article  PubMed  CAS  Google Scholar 

  14. Slemenda CW, Christian JC, Reed T, Reister TK, Williams CJ, Johnston CC. Long term bone loss in men: effects of genetic and environmental factors. Ann Int Med 1992; 117: 286–291.

    PubMed  CAS  Google Scholar 

  15. Kelly PJ, Hopper JUL, Macaskill GGT, Pocock NA, Sambrook PH, Eisman JA. Genetic factors in bone turnover. J Clin Endocrino! Metab 1991; 72: 808–814.

    Article  CAS  Google Scholar 

  16. Morrison N, Yeomans R, Kelly PJ, Eisman JA. Osteocalcin levels define functionally different alleles of the human vitamin D receptor. Proc Natl Acad Sci 1992; 89: 6665–6669.

    Article  PubMed  CAS  Google Scholar 

  17. Morrison NA, Qi JC, Tokita A, Kelly PJ, Crofts L, Nguyen TV, Sambrook PN, Eisman JA. Prediction of bone density from vitamin D receptor alleles. Nature 1994; 367: 284–287.

    Article  PubMed  CAS  Google Scholar 

  18. Fleet JC, Harris SS, Wood RW, Dawson-Hughes B. The Bsml Vitamin D receptor restriction fragment length polymorphism (BB) predicts low bone density in premenopausal black and white women. J Bone Miner Res 1995: 10: 985–990.

    Article  PubMed  CAS  Google Scholar 

  19. Riggs BL, Nguyen TV, Melton L, Morrison NA, O’Fallon WM, Kelly P, Egan KS, Sambrook PN, Muhns JM, Eisman JA. The contribution of vitamin D receptor gene alleles to the determination of bone mineral density in normal and osteoporotic women. J Bone Miner Res 1995; 10: 991–996.

    Article  PubMed  CAS  Google Scholar 

  20. Hustmeyer FG, Peacock M, Hui S, Johnston CC, Christian J. Bone mineral density in relation to polymorphism at the vitamin D receptor gene locus. J Clin Invest 1994; 94: 2130–2134.

    Article  Google Scholar 

  21. Bell NH, Shary J, Stevens J, Garza M, Grodon L, Edwards J. Demonstration that bone mass is greater in black than in white children. J Bone Miner Res 1991; 6: 719–723.

    Article  PubMed  CAS  Google Scholar 

  22. Finklestein JS, Neer RM, Biller BMK, Crawford JD, Klibanski A. Osteopenia in men with a history of delayed puberty. NEngl JMed 1992; 326: 600–604.

    Article  Google Scholar 

  23. Stepan JJ, Musilova J, Pacovsky V. Bone demineralization, biochemical indices of bone remodeling and estrogen replacement therapy in adults with Turner’s syndrome. J Bone Miner Res 1989; 4: 193–198.

    Article  PubMed  CAS  Google Scholar 

  24. Johnston CC, Miller JZ, Slemenda CW, Reister TK, Hui S, Christian JC, Peacock M. Calcium supplementation and increases in bone mineral density in children. N Eng! JMed 1992; 327: 82–87.

    Article  Google Scholar 

  25. Albright F. Postmenopausal osteoporosis. JAMA 1941; 116: 2465–2474.

    Article  Google Scholar 

  26. Bachrach LK, Guido D, Katzman D, Litt IF, Marcus R. Decreased bone density in adolescent girls with anorexia nervosa. Pediatrics 1990; 86: 440–447.

    PubMed  CAS  Google Scholar 

  27. Prior JC, Vigna Y, Schechter MT, Burgess AE. Spinal bone loss and ovulatory disturbances. N Engl J Med 1990; 323: 1221–1227.

    Article  PubMed  CAS  Google Scholar 

  28. Bonen A, Calcastro AN, Ling WY, Simpson AA. Profiles of selected hormones during menstrual cycles of teenage athletes. J App! Physiol: Respir Environ Exerc Physiol 1981; 50: 545–551.

    CAS  Google Scholar 

  29. Finkelstein JS, Klibanski A, Neer RM, Greenspan SL, Rosen DI, Crowley WFJ. Osteoporosis in men with idiopathic hypogonadotropic hypogonadism. Ann Int Med 1987; 106: 354–361.

    PubMed  CAS  Google Scholar 

  30. Lindsay R, Tohme J. Estrogen treatment of patients with established postmenopausal osteoporosis. Obstet Gynecol 1990; 76: 290–300.

    PubMed  CAS  Google Scholar 

  31. Felsen DT, Zhang Y, Hannan MT, Kiel DP, Wilson PWF, Andersonn JJ. The effect of postmenopausal and later life estrogen therapy on bone density in elderly women. NEngl JMed 1993; 329: 1141–1145.

    Article  Google Scholar 

  32. Donahue LR, Beamer WG. Growth hormone deficiency in little mice results in aberrant body composition, reduced IGF-I and IGFBP-3, but does not affect IGFBP-2,-4,-1. J Endocrino! 1993; 136: 91–104.

    Article  CAS  Google Scholar 

  33. Wright NM, Renault J, Pandey J, Willi S, Veldius JD, Gordon L, Key LL, Bell NH. Greater secretion of GH in black than in white men: possible factor in great bone mineral density. J Clin Endocrino! Metab 1995; 80: 2291–2297.

    Article  CAS  Google Scholar 

  34. Rudman D, Feller AG, Nagraj HS, Gergens GA, Lalitha PY, Goldberg AF, Schlenker RA, Chn L, Rudman IW, Mattson DE. Effects of human GH in men over 60 years of age. NEngl JMed 1990; 323: 1–8.

    Article  CAS  Google Scholar 

  35. Borst SE, Millard WJ, Lowenthal DT. Growth hormone, exercise and aging: the future of therapy for the frail elderly. JAm Geriatr Soc 1994; 42: 528–535.

    CAS  Google Scholar 

  36. Bing-you RG, Denis MC, Rosen CJ. Low bone density in adults with previous hypothalamic-pituitary tumors: correlations with serum growth hormone response to GHreleasing hormone, IGF-I and IGFBP-3. Calclf Tissue Int 1993; 52: 183–187.

    Article  CAS  Google Scholar 

  37. Johansson G, Burman P, Westermark K, Ljunghall S. The bone mineral density in acquired GH deficiency correlates with circulating levels of IGF-I. Jbit Med 1992; 232: 447–452.

    CAS  Google Scholar 

  38. Diamond T, Nery L, Posen S. Spinal and peripheral bone mineral densities in acromegaly: the effects of excess GH and hypogonadism. Ann Intern Med 1989: 11: 567–573.

    Google Scholar 

  39. Johansson AG, Forslund A, Hambraeus L. Blum WF, Ljunghall S. GH dependent IGFBP is a major determinant of bone mineral density in healthy men. J Bone Miner Res 1994; 9: 915–921.

    Article  PubMed  CAS  Google Scholar 

  40. Rosen T, Johannsson G, Hallgren P, Caidahl K, Bosaeus I, Bengtsson B-A. Beneficial effects of 12 months replacement therapy with rh GH to GH deficient adults. Endocrino! Metabol 1994; 1: 55–66.

    CAS  Google Scholar 

  41. Brown EM, Gamaba G, Riccardi D. Cloning and characterization of an extracellular Cat+-sensing receptor from bovine parathyroid. Nature 1993; 366: 575–580.

    Article  PubMed  CAS  Google Scholar 

  42. Brown EM, Pollak M, Seidman CE, et al. Calcium ion sensing cell surface receptors. N Eng! J Med 1995; 333: 234–238.

    Article  CAS  Google Scholar 

  43. Nussbaum SR, Zahradnick RJ, Lavigne JL. Highly sensitive two site immunoradiometric assay of parathyrin and its clinical utility in evaluating patients with hypercalcemia. Clin Chem 1987; 33: 1364–1367.

    PubMed  CAS  Google Scholar 

  44. Quesada JM, Coopmans W, Ruiz B, Aljiama P, Jans I, Bouillon R. Influence of vitamin D on parathyroid function in the elderly. J Clin Endocrino! Metab 1992; 75: 494–501.

    Article  CAS  Google Scholar 

  45. Chapuy MC, Arlot ME, Duboeuf F, Brim J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ. Vitamin D and calcium to prevent hip fractures in elderly women. NEngl JMed 1992; 327: 1637–1642.

    Article  CAS  Google Scholar 

  46. Dawson-Hughes B, Harris S, Krall E, et al. Rates of bone loss in postmenopausal women randomly assigned to one of two dosages of vitamin D. Am J Clin Nutr 1995; 61: 1140–1145.

    PubMed  CAS  Google Scholar 

  47. Martinez ME, Delcampo MJ, Sanchez-Calbezudo, MJ. Relation between serum calcidiol levels and bone mineral density in post menopausal women with low bone density. Calclf Tiss Int 1994; 55: 253–256.

    Article  CAS  Google Scholar 

  48. Meunier PJ, Chapuy MC, Arlot ME, Delmas PD, Duboeuf F. Can we stop bone loss and prevent hip fractures in the elderly. Osteoporosis lilt 1994; 4(S 1), S76–78.

    Google Scholar 

  49. Kamel S, Brazier M, Picar C, Boitte F, Sarzason L, Desmet G, Sebert JL. Urinary excretion of pyridinoline cross-link measured by immunoassay and HPLC techniques in normal subjects and elderly patients with vitamin D deficiency. Bone Miner 1994; 26: 197–208.

    Article  PubMed  CAS  Google Scholar 

  50. Rosen CJ, Donahue LR, Hunter SJ, Holick MF, Kavookjian H, Kirshenbawnn A, Mohan S, Baylink DI. The 24/25 kd serum IGFBP is increased in elderly women with hip and spine fractures. J Clin Endocrino! Metab 1992; 74: 24–28.

    Article  CAS  Google Scholar 

  51. Allain TJ, McGregor AM. Thyroid hormones and bone. JEndocrinol 1993; 139: 9–18.

    Article  CAS  Google Scholar 

  52. Harvey RD, McHardy KC, Reid IW. Measurement of bone collagen degradation in hyperthyroidism and during thyroxine replacement therapy using pyridinium cross-links as specific urinary markers. J Clin Endocrino! Metab 1991; 72: 1189–1194.

    Article  CAS  Google Scholar 

  53. Solomon BL, Wartofsky L, Burman KD. Prevalence of fractures in postmenopausal women with thyroid disease. Thyroid 1993; 3: 1723.

    Article  Google Scholar 

  54. Rosen CJ, Adler RA. Longitudinal changes in lumbar bone density among thyrotoxic patients after attainment of euthyroidism. J Clin Endocrinol Metab 75: 1531–1534.

    Google Scholar 

  55. Ross DS, Neer RM, Ridgeway EC, Daniels GH. Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged suppression of the pituitary-thyroid axis with t-30 thyroxine. Am J Med 1987; 82: 1167–1170.

    CAS  Google Scholar 

  56. Paul LT, Kerrigan J, Kelly AM, Braverman LE, Baran DT. Long term thyroxine therapy is associated with decreased hip bone density in premenopausal women. JAMA 1988; 259: 31373141.

    Google Scholar 

  57. Marcocci C, Golia F, Bruno-Bossio G, Vignali E, Pinchera A. Carefully monitored levothyroxine suppressive therapy is not associated with bone loss in premenopausal women. J Clin Endocrino! Metab 1994; 78: 818823.

    Google Scholar 

  58. Stall GM, Harris S, Sokoll Li, Dawson-Hughes B. Accelerated bone loss in hypothyroid patients over-treated with 1-thyroxine. Ann Intern Med 1990; 113: 265–269.

    PubMed  CAS  Google Scholar 

  59. Schneider DL, Barrett-Connor EL, Morton DJ. Thyroid hormone and bone mineral density in elderly women. J Bone Miner Res 1993; 8(51): 259.

    Google Scholar 

  60. Jensen J, Christiansen C, Rodbro P. Cigarette smoking, serum estrogens, and bone loss during hormone replacement therapy early after menopause. N Engl JMed 1985; 313: 107–129.

    Article  Google Scholar 

  61. Krall EA, Dawson-Hughes B. Smoking and bone loss among postmenopausal women. JBone Miner Res 1991; 6: 331–338.

    Article  CAS  Google Scholar 

  62. Daniell HW. Osteoporosis of the slender smoker. Arch Int Med 1976; 136: 298–304.

    Article  CAS  Google Scholar 

  63. Hopper JL, Seeman E. The bone density of female twins discordant for tobacco use. N Engl J Med 1994; 330: 387–392.

    Article  PubMed  CAS  Google Scholar 

  64. Johnston JD. Smokers have less dense bones and fewer teeth. J Res Soc Health 1994; 114: 265–269.

    Article  CAS  Google Scholar 

  65. Hollenbach KA, Barrett-Connor E, Edelstein SL, Holbrook T. Cigarette smoking and bone mineral density in older men and women. Am J Public Health 1993; 83: 1266–1270.

    Article  Google Scholar 

  66. Landin-Wilhelmsen K, Wilhelmsen L, Lappas G, Rosen T, et al. Serum intact parathyroid hormone in a random population sample of men and women: relationship to anthropometry, life-style factors, blood pressure, and vitamin D. Calcif Tiss Int 1995; 56: 104–108.

    Article  CAS  Google Scholar 

  67. Ortego-Centeno N, Munoz-Torres M, Hernandez-Quero J, Jurado-Duce A, de la Higuera Torres-Puchol J. Bone mineral density, sex steroids, and mineral metabolism in premenopausal smokers. Calcif Tiss Int 1994; 55: 403–407.

    Article  CAS  Google Scholar 

  68. Labib M, Abdel-Kader M, Ranganath L. Bone disease in chronic alcoholism: the value of plasma osteocalcin measurement. Alcohol 1989; 24: 924–928.

    Google Scholar 

  69. Heaney R. Prevention of osteoporotic fracture in women. In: Avioli LV, ed., The Osteoporotic Syndrome,3rd ed. New York: Wiley-Liss, 1993, pp. 89–107.

    Google Scholar 

  70. Bunker VW. The role of nutrition in osteoporosis. Br JBiomed Sci 1994; 51: 228–240.

    CAS  Google Scholar 

  71. Laitinen K, Tahtela R, Luomanmaki K, Valimaki MJ. Mechanisms of hypocalcemia and markers of bone turnover in alcohol-intoxicated drinkers. Bone Miner 1994; 24: 171–179.

    Article  PubMed  CAS  Google Scholar 

  72. Gonzalez-Calvin JL, Garcia-Sanchez A, Bellot V, Munoz-Torres M, et al. Mineral metabolism, osteoblastic function and bone mass in chronic alcoholism. Alcohol 1993; 28: 571–579.

    CAS  Google Scholar 

  73. Peris P, Pares A, Guanabens N, Pons F, et al. Reduced spinal and femoral bone mass and deranged bone mineral metabolism in chronic alcoholics. Alcohol 1992; 27: 619–625.

    CAS  Google Scholar 

  74. Abbott L, Nadler J, Rude RK. Magnesium deficiency in alcoholism: possible contribution to osteoporosis and cardiovascular disease in alcoholics. Alcohol Clin Exp Res 1994; 18: 1076–1082.

    Article  PubMed  CAS  Google Scholar 

  75. Slemenda CW. Adult bone loss. In: Marcus R, ed., Osteoporosis. Boston: Blackwell Scientific, 1994, pp. 107–124.

    Google Scholar 

  76. Raisz L, Kream BE. Regulation of bone formation. NEngl JMed 1983; 30: 83–89.

    Article  Google Scholar 

  77. Reid IR, Veale AG, France JT. Glucocorticoid osteoporosis. JAsthma 1994; 31: 7–18.

    Article  CAS  Google Scholar 

  78. Delaney AM, Dong Y, Canalis E. Mechanisms of glucocorticoid action in bone cells. J Cell Biochem 1994; 56: 295–302.

    Article  Google Scholar 

  79. Fitzpatrick LA. Glucocorticoid-Induced osteoporosis. In: Marcus R, ed., Osteoporosis. Boston: Blackwell Scientific, 1994, pp. 202–226.

    Google Scholar 

  80. Bachrach L. Bone acquisition in childhood and adolescence. In: Marcus R, ed., Osteoporosis. Boston: Blackwell Scientific, 1994, pp. 69–106.

    Google Scholar 

  81. Boe JE, Skoogh BE. Is long-term treatment with inhaled steroids in adults hazardous? Eur Respir J 1992; 5: 1037–1039.

    PubMed  CAS  Google Scholar 

  82. Boulet LP, Giguere MC, Milot J, Brozazn J. Effects of long-term use of high dose inhaled steroids on bone density and calcium metabolism. JAllergy Clin Immunol 1994; 94: 796–803.

    Article  CAS  Google Scholar 

  83. Barnes PJ. Inhaled glucocorticoids for asthma. N Engl JMed 1995; 332: 868–875.

    Article  CAS  Google Scholar 

  84. Movsowitz C, Epstein S, Ismail F, Fallon M, Thomas S. Cyclosporin A in the oophorectomized rat: unexpected severe bone resorption. J Bone Miner Res 1989; 5: 393–398.

    Google Scholar 

  85. Schlosberg M, Movsowitz C, Epstein S, Ismall F, Fallon M, Thomas S. The effect of cyclosporin A administration and its withdrawal on bone mineral metabolism in the rat. Endocrinology 1989; 124: 2179–2184.

    Article  PubMed  CAS  Google Scholar 

  86. Kaplan FS. Prevention and management of osteoporosis. Clin Symp 1992; 47(1): 2–32.

    Google Scholar 

  87. Riggs BL. Overview of osteoporosis. West JMed 1991; 154: 63–77.

    CAS  Google Scholar 

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Kessenich, C.R., Rosen, C.J. (1996). The Pathophysiology of Osteoporosis. In: Rosen, C.J. (eds) Osteoporosis. Current Clinical Practice. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-4612-0221-9_4

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  • DOI: https://doi.org/10.1007/978-1-4612-0221-9_4

  • Publisher Name: Humana Press, Totowa, NJ

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