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tissue.\tEach\tbone\tcontains\tbone\ttissues\tof\ttwo\tmajor\ttypes,\ttrabecular\tand\tcortical.\tThese\ttissues\nundergo\tbone\tmodeling\tduring\tgrowth\t(height\tgain)\tand\tbone\tremodeling\tafter\tgrowth\tceases.\nBone\tmass\tis\ta\tgeneric\tterm\tthat\trefers\tto\t\nbone\tmineral\tcontent\t(BMC)\n.\t\nBone\tmineral\tdensity\n(BMD)
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bone\tmineral\tcontent\t(BMC)\n.\t\nBone\tmineral\tdensity\n(BMD)\n\tdescribes\tthe\tmineral\tcontent\tof\tbone\tper\tunit\tof\tbone.\tNeither\tBMC\tnor\tBMD\tprovides\ninformation\ton\tthe\tmicroarchitectural\t(three-dimensional)\tstructural\tquality\tof\tbone\ttissue\t(i.e.,\nindex\tof\trisk\tof\tfracture).\nComposition\tof\tbone\nBone\tconsists\tof\tan\torganic\tmatrix\tor\t\nosteoid
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] |
great\tstrength.\tOther\tcomponents\tof\tthe\tbone\tmatrix\tinclude\tosteocalcin,\tosteopontin,\tand\tseveral\nother\tmatrix\tproteins.\nTypes\tof\tbone\ttissue\nApproximately\t80%\tof\tthe\tskeleton\tconsists\tof\tcompact\tor\tcortical\tbone\ttissue.\tShafts\tof\tthe\tlong\nbones\tcontain\tprimarily\t\ncortical\tbone\n,\twhich\tconsists\tof\tosteons\tor\tHaversian\tsystems\tthat\tundergo
|
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0.11431527137756348,
0.04779712110757828,
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] |
provide\ta\tlarge\tsurface\tarea\tthat\tis\texposed\tto\ncirculating\tfluids\tfrom\tthe\tmarrow\tand\tis\tlined\tby\ta\tdisproportionately\tlarger\tnumber\tof\tcells\tthan\ncortical\tbone\ttissue.\tTherefore\ttrabecular\tbone\ttissue\tis\tmuch\tmore\tresponsive\tto\testrogens\tor\tthe\nlack\tof\testrogens\tthan\tcortical\tbone\ttissue\t(\nFig.\t23.1
|
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] |
lack\tof\testrogens\tthan\tcortical\tbone\ttissue\t(\nFig.\t23.1\n).\tThe\tloss\tof\ttrabecular\tbone\ttissue\tlate\tin\tlife\tis\nlargely\tresponsible\tfor\tthe\toccurrence\tof\n\tfractures,\tespecially\tthose\tof\tthe\tspine\t(vertebral\nfractures).
|
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] |
FIG.\t23.1\nSchematic\tdiagram\tof\tthe\tstructure\tof\ta\tlong\tbone\t(hemisection\tof\ta\tlong\tbone,\tsuch\tas\tthe\ttibia).\nThe\tends\tof\tthe\tlong\tbones\tcontain\thigh\tpercentages\tof\ttrabecular\t(cancellous)\tbone\ttissue,\twhereas\tthe\nshaft\tcontains\tpredominately\tcortical\tbone\ttissue.\t\nInset\tA\n\tincludes\tan\tenlarged\tsection\t(approximately\t100-
|
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] |
Inset\tA\n\tincludes\tan\tenlarged\tsection\t(approximately\t100-\nfold)\tof\tthe\tgrowth\tplate\t(epiphysis)\tand\tthe\tsubjacent\thyperproliferative\n\tzone\tcontaining\tcartilage\tcells\nstacked\tlike\tcoins.\t\nInset\tB\n\tincludes\ta\tsection\tof\tcollagen\tmolecules\t(triple\thelices)\tsurrounded\tby\tmineralized
|
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deposits\t(dark\tspheroids)\tat\ta\tmagnification\tof\tapproximately\t1,000,000-fold.\tThese\tcollagen-mineral\ncomplexes\texist\tin\tboth\ttrabecular\tand\tcortical\tbone\ttissues.\t\nInset\tC\n\tshows\tthe\tcross-section\tof\thalf\tof\tthe\nmidshaft\tof\ta\tlong\tbone\t(magnification\t10-fold).\n\tThis\tsection\tof\tcortical\tbone\ttissue\tcontains\tvertical\tHaversian
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This\tsection\tof\tcortical\tbone\ttissue\tcontains\tvertical\tHaversian\nsystems\t(osteons)\tthat\trun\tparallel\twith\tthe\tshaft\taxis;\tmany\tare\trequired\tto\textend\tthis\tsystem\tfrom\tone\tend\nof\tthe\tshaft\tto\tthe\tother.\tAt\tthe\tcenter\tof\teach\tosteon\tis\ta\tcanal\tthat\tcontains\tan\tartery\tthat\tsupplies\tbone
|
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] |
tissues\twith\tnutrients\tand\toxygen,\ta\tvein\tfor\tremoving\twastes,\tand\ta\tnerve\tfor\treturning\tafferent\trelays\tto\n\tthe\nbrain.\n\t\nSource:\n\t(Copyright\tJohn\tJ.\tB.\tAnderson\tand\tSanford\tC.\tGarner.)\nBone\tcells\nOsteoblasts\n\tare\tresponsible\tfor\tthe\tformation\tor\tproduction\tof\tbone\ttissue,\tand\t\nosteoclasts\n\tgovern\nthe\tresorption\tor\tbreakdown\tof\tbone\t(also\tsee
|
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] |
osteoclasts\n\tgovern\nthe\tresorption\tor\tbreakdown\tof\tbone\t(also\tsee\t\nBone\tModeling\n\tand\t\nBone\tRemodeling\n\tlater\tin\tthis\nchapter).\tThe\tfunctions\tof\tthese\ttwo\tcell\ttypes\tare\tlisted\tin\t\nTable\t23.1\n.\nTABLE\t23.1\nFunctions\tof\tOsteoblasts\n\tand\tOsteoclasts\nOsteoblasts\nOsteoclasts\nBone\tFormation\nBone\tResorption\nSynthesis\tof\tmatrix\tproteins:\n•
|
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0.06378188729286194,
0.03848351910710335,
0.025288980454206467,
0.11639569699764252,
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] |
Bone\tFormation\nBone\tResorption\nSynthesis\tof\tmatrix\tproteins:\n•\t\nCollagen\ttype\t1\t(90%);\n•\t\nOsteocalcin\tand\tothers\t(10%)\nDegradation\tof\tbone\ttissue\tvia\tenzymes\tand\tacid\n(H\n+\n)\tsecretion\nMineralization\nCommunication:\tSecretion\tof\tcytokines\tthat\tact\ton\nosteoblasts\nCommunication:\tSecretion\tof\tenzymes\tthat\tact\ton\nosteoclasts\nTwo\tother\timportant
|
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] |
osteoclasts\nTwo\tother\timportant\n\tcell\ttypes\talso\texist\tin\tbone\ttissue,\t\nosteocytes\n\tand\tbone-lining\tcells\t(inactive\nosteoblasts),\tboth\tof\twhich\tare\tderived\tfrom\tosteoblasts.\tThe\torigin\tof\tthe\tosteoblasts\tand\nosteoclasts\tis\tfrom\tprimitive\tprecursor\tcells\tfound\tin\tbone\tmarrow,\tstimulated\tby\thormones\tand
|
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] |
growth\tfactors\tas\tpart\tof\ttheir\tdifferentiation\tto\tbecome\tmature,\tfunctional\tbone\tcells.\nCartilage\nIn\tthe\tembryo,\tcartilage\n\tforms\tthe\tfirst\ttemporary\tskeleton,\tuntil\tit\tdevelops\tinto\ta\tmature\tbone\nmatrix.\tIn\tthe\tadult,\tcartilage\tis\tfound\tas\tflexible\tsupports\tin\tareas\tsuch\tas\tthe\tnose\tand\tear.
|
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] |
Cartilage\tis\tnot\tbone,\tand\tit\tis\tneither\tvascularized\tnor\tcalcified.\nCalcium\thomeostasis
|
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Bone\ttissue\tserves\tas\ta\treservoir\tof\tcalcium\tand\tother\tminerals.\t\nCalcium\thomeostasis\n\trefers\tto\tthe\nprocess\tof\tmaintaining\ta\tconstant\n\tserum\tcalcium\tconcentration.\tThe\tserum\tcalcium\tis\tregulated\tby\ncomplex\tmechanisms\tthat\tbalance\tcalcium\tintake\tand\texcretion\twith\tbodily\tneeds.\tWhen\tcalcium
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sources:\treadily\tmobilizable\tcalcium\tions\tin\tthe\nbone\tfluid\tor\tosteoclastic\tresorption\tfrom\tthe\tbone\ttissue\titself.\tThe\tdaily\tturnover\tof\tskeletal\ncalcium\tions\t(transfers\tin\tand\tout\tof\tbone)\tsupports\tthe\tdynamic\tactivity\tof\tbone\ttissue\tin\tcalcium\nhomeostasis.\nSerum\tcalcium\tconcentration\tis\tregulated\tby\ttwo\tcalcium-regulating\thormones—\nparathyroid
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] |
parathyroid\nhormone\t(PTH)\n\tand\t\n1,\t25\tdihydroxy\tvitamin\tD\n3\n\t(calcitriol)\n.\tIf\tserum\tcalcium\tlevels\tfall,\tPTH\nwill\tincrease\treabsorption\tfrom\tthe\tkidney\tand\tbone,\tand\tcalcitriol\twill\tincrease\tgut\tabsorption\tand\ninitiate\tosteoclastic\tactivity\tfor\tbone\tbreakdown.\tIncreased\tserum\tcalcium,\thypercalcemia,\toccurs
|
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0.07135174423456192,
0.10992792993783951,
0.012111964635550976
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primarily\tdue\tto\thyperparathyroidism.\tSerum\tcalcium\tincludes\tfree\tcalcium\t(formerly\tcalled\tionized\ncalcium)\tand\talbumin-bound\tcalcium.\nBone\tmodeling\nBone\tmodeling\n\tis\tthe\tterm\tapplied\tto\tthe\tgrowth\tof\tthe\tskeleton.\tBone\tformation\tand\tresorption\nare\tnot\tlinked\tas\tthey\tare\tin\tremodeling.\tIn\tlong\tbones,\tgrowth\toccurs\tboth\tat\tterminal\tepiphyses
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(growth\tplates\tthat\tundergo\thyperproliferation)\tand\tcircumferentially\tin\tlamellae;\tat\teach\tlocation,\ncells\tundergo\tdivision\tand\tcontribute\tto\tthe\tformation\tof\tnew\tbone\ttissue\t(see\t\nFig.\t23.1\n).\tAlthough\nwe\ttypically\tconsider\n\tbone\tmodeling\tcomplete\tby\tthe\ttime\tmature\theight\tis\tachieved,\tbone\tmodeling
|
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] |
can\toccur\tlater\tin\tlife,\tespecially\tin\tresponse\tto\tphysical\tactivity.\tBone\tmodeling\tresults\tin\tthe\nformation\tof\tnew\tbone,\tbut\tit\tdoes\tnot\tremove\tor\trepair\told\tbone\tas\tis\tseen\tin\tbone\tremodeling\n(\nLangdahl\tet\tal,\t2016\n).\nDuring\tthe\tgrowth\tperiod,\tformation\texceeds\tthe\tresorption\tof\tbone.\t\nPeak\tbone\tmass\t(PBM)\n\tis\nreached\tby\n\t30\tyears\tof\tage\tor\tso\t(
|
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] |
Peak\tbone\tmass\t(PBM)\n\tis\nreached\tby\n\t30\tyears\tof\tage\tor\tso\t(\nFig.\t23.2\n).\tThe\tlong\tbones\tstop\tgrowing\tin\tlength\tby\tapproximately\nage\t18\tin\tfemales\tand\tage\t20\tin\tmales,\tbut\tbone\tmass\tcontinues\tto\taccumulate\tfor\ta\tfew\tmore\tyears\nby\ta\tprocess\tknown\tas\tconsolidation\t(i.e.,\tfilling-in\tof\tosteons\tin\tthe\tshafts\tof\tlong\tbones).\tThe\tage
|
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] |
when\tBMD\tacquisition\tceases\tis\tvariable\tand\tdepends\ton\tdiet\tand\ton\tphysical\tactivity,\tgenetics,\tand\nhormonal\n\tinfluences.\nFIG.\t23.2\nThe\tearly\tgain\tand\tlater\tloss\tof\tbone\tin\tfemales.\tPeak\tbone\tmineral\tdensity\t(BMD)\tis\ttypically\nachieved\tby\tage\t30.\tMenopause\toccurs\tat\tapproximately\tage\t50\tor\twithin\ta\tfew\tyears.\tPostmenopausal
|
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] |
women\ttypically\tenter\tthe\tfracture\trisk\trange\tafter\tage\t60.\tMen\thave\ta\tmore\tgradual\tdecline\tin\tBMD,\twhich\nstarts\tat\t50\tyears.\n\t\nSource:\n\t(Copyright\tJohn\tJ.\tB.\tAnderson\tand\tSanford\tC.\tGarner.)\nPBM\tis\tgreater\tin\tmen\tthan\tin\twomen\tbecause\tof\tmen’s\tlarger\tframe\tsizes.\tThe\tgreater\theight\tof
|
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] |
most\tmales\taccounts\tfor\tthe\tgreater\tPBM.\tThe\tvariation\tin\tBMD\twithin\tan\tethnicity\tis\tgreater\tthan\namong\tethnicities.\tGenetics,\tskeletal\tsize,\tand\tpresence\tor\tabsence\tof\tchronic\tdisease\tinfluence\nBMD,\tand\tsocial,\tenvironmental,\tand\tpersonal\tfactors\talso\tinfluence\tprobability\tof\tfracture\trisk\n(\nLeslie,\t2012\n).\nBone\tremodeling
|
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] |
(\nLeslie,\t2012\n).\nBone\tremodeling\nBone\tis\ta\tdynamic\torgan\tboth\tduring\tgrowth\tand\tmaintenance.\t\nBone\tremodeling\n\tis\ta\tprocess\tin\nwhich\tbone\tis\tcontinuously\tresorbed\tthrough\tthe\taction\tof\tthe\tosteoclasts\tand\treformed\tthrough\tthe\naction\tof\tthe\tosteoblasts.\tThe\tremodeling\tprocess\tis\tinitiated\tby\tthe\t\nactivation\n\tof\tpreosteoclastic
|
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activation\n\tof\tpreosteoclastic\ncells\tin\tthe\tbone\tmarrow.\tInterleukin\t(IL)-1\tand\tother\tcytokines\treleased\tfrom\tbone-lining\n\tcells\tact\tas\nthe\ttriggers\tin\tthe\tactivation\tof\tprecursor\tstem\tcells\tin\tbone\tmarrow.\tThe\tpreosteoclast\tcells\tfrom\nthe\tbone\tmarrow\tmigrate\tto\tthe\tsurfaces\tof\tbone\twhile\tdifferentiating\tinto\tmature\tosteoclasts.\tThe
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rapid,\tand\tit\tis\tcompleted\twithin\ta\tfew\tdays,\twhereas\tthe\trefilling\tof\tthese\tcavities\tby\tosteoblasts\tis
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slow\t(i.e.,\ton\tthe\torder\tof\t3\tto\t6\tmonths\tor\teven\tas\tlong\tas\t1\tyear\tor\tmore\tin\tolder\tadults).\nThe\t\nrebuilding\n\tor\t\nformation\n\tstage\tinvolves\tsecretion\tof\t\ncollagen\n\tand\tother\tmatrix\tproteins\n\tby\tthe\nosteoblasts,\talso\tderived\tfrom\tprecursor\tstem\tcells\tin\tbone\tmarrow.\tCollagen\tpolymerizes\tto\tform
|
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mature\ttriple-stranded\tfibers,\tand\tother\tmatrix\tproteins\tare\tsecreted.\tWithin\ta\tfew\tdays,\tsalts\tof\ncalcium\tand\tphosphate\tbegin\tto\tprecipitate\ton\tthe\tcollagen\tfibers,\tdeveloping\tinto\tcrystals\tof\nhydroxyapatite.\tApproximately\t4%\tof\tthe\ttotal\tbone\tsurface\tis\tinvolved\tin\tremodeling\tat\tany\tgiven\ntime
|
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] |
time\n\tas\tnew\tbone\tis\trenewed\tcontinually\tthroughout\tthe\tskeleton.\tEven\tin\tthe\tmature\tskeleton,\tbone\nremains\ta\tdynamic\ttissue.\tNormal\tbone\tturnover\tis\tillustrated\tin\t\nFig.\t23.3\n.\nFIG.\t23.3\nNormal\tbone\tturnover\tin\thealthy\tadults.\n\t\nSource:\n\t(Copyright\tJohn\tJ.\tB.\tAnderson\tand\tSanford\tC.\tGarner.)
|
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] |
Source:\n\t(Copyright\tJohn\tJ.\tB.\tAnderson\tand\tSanford\tC.\tGarner.)\nWhen\tthe\tresorption\tand\tformation\tphases\tare\tin\tbalance,\tthe\tsame\tamount\tof\tbone\ttissue\texists\tat\nthe\tcompletion\tof\tthe\tformation\tphase\tas\tat\tthe\tbeginning\tof\tthe\tresorption\tphase.\tThe\tbenefit\tto\tthe\nskeleton\tof\tthis\tremodeling\tis\tthe\trenewal\tof\tbone\twithout\tany\tmicrofractures.
|
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] |
With\taging,\nosteoclastic\tresorption\tbecomes\trelatively\tgreater\tthan\tformation\tby\tosteoblasts.\tThis\timbalance\nbetween\tformation\tand\tresorption\tis\treferred\tto\tas\t“uncoupling”\tof\tthe\tosteoblastic\tand\tosteoclastic\nactivity.\nBecause\tof\tthe\tuncoupling\tof\tcell\tactivity,\tage\tis\tan\timportant\tdeterminant\tof\tBMD.\tCortical\tbone
|
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tissue\tand\ttrabecular\tbone\ttissue\tundergo\tdifferent\tpatterns\tof\taging.\tLoss\tof\n\tcortical\tbone\toccurs\naround\tage\t50,\twith\tan\tincrease\tin\tcortical\tporosity\tin\tboth\tgenders.\tTrabecular\tbone\tloss\tmay\tbegin\nmuch\tearlier.\tIn\tmen\ttrabecular\tbone\tloss\treflects\tthinning\tof\tthe\ttrabecula.\tIn\twomen,\tthe
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trabecular\tbone\tloss\tappears\tto\tbe\tbecause\tof\ttrabecula\tloss\tentirely\t(\nFarr\tand\tKhosla,\t2015\n).\nOsteopenia\tand\tosteoporosis\nThis\tloss\tof\tbone\tcan\tcontinue\tthroughout\taging,\teventually\n\tleading\tto\tosteopenia\tor\tosteoporosis.\nHowever,\tit\tis\timportant\tto\tremember\tthat\tnot\tall\tolder\tpersons\thave\tpoor\tbone\thealth,\tand\tthat
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] |
bone\tdisease\tcan\toccur\tin\tyounger\tpeople,\talthough\trarely.\tDifferences\tbetween\tnormal\tand\nosteoporotic\tbone—both\ttrabecular\tand\tcortical\ttissues—are\tshown\tin\t\nFig.\t23.4\n.\nFIG.\t23.4\nDifference\tbetween\tnormal\tbone\t\n(A)\n\tand\tosteoporotic\tbone\t\n(B)\n.\n\t\nSource:\n\t(From\tMaher\tAB\tet\tal:\t\nOrthopedic\nnursing\n,\tPhiladelphia,\t1994,\tSaunders.)
|
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] |
Prevalence\nThe\tprevalence\tof\tosteoporosis\tdepends\ton\tthe\tdiagnostic\tcriteria.\tPrevalence\testimates\tusing\tBMD\nT-scores\tof\t<2.5\tat\tthe\tfemur\tneck\tand/or\tspine\tsuggest\tthat\t10.3%\tof\tadults\tover\t50\tyears\tin\tthe\nUnited\tStates\thave\tosteoporosis\n\t(\nWright\tet\tal,\t2014\n).\tWhen\tthe\tFracture\tRisk\tAssessment\tTool
|
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] |
(\nWright\tet\tal,\t2014\n).\tWhen\tthe\tFracture\tRisk\tAssessment\tTool\n(FRAX)\tcalculations\tare\tused\tas\tthe\tdiagnostic\tcriteria,\t11.6%\tof\tmen\tand\t13.0%\tof\twomen\tover\tage\n50\twere\tpredicted\tto\thave\tosteoporosis.\tWhen\tidentified\tlow\ttrauma\tfracture\tis\ta\tdiagnosis,\twith\tor
|
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] |
instead\tof\tthe\tlow\tT-score\tor\tFRAX\tscore,\tthe\tosteoporosis\tprevalence\testimates\tincrease\tto\t16%\tof\nmen\tand\t29.9%\tof\twomen\tover\t50\tyears\t(\nWright\tet\tal,\t2017\n).\nTypes\tof\tosteoporosis\nOsteoporosis\tis\tconsidered\tto\thave\ta\tbroad\tspectrum\tof\tvariant\tforms.\t\nPrimary\tosteoporosis\n\toccurs
|
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] |
Primary\tosteoporosis\n\toccurs\nas\ta\tresult\tof\tthe\tnatural\taging\tprocess.\tBMD\tdeclines\tboth\twith\tage\tand\twith\tthe\tloss\tof\testrogen\nafter\tmenopause.\tFor\twomen,\tprimary\tosteoporosis\tis\tmore\tlikely\t10\tto\t15\tyears\tafter\tmenopause,\nand\tin\tmen,\taround\tage\t65\tto\t80\t(\nJi\tand\tYu,\t2015\n).\tHowever,\tlifestyle\tfactors\n\tand\tgenetics\talso
|
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] |
Ji\tand\tYu,\t2015\n).\tHowever,\tlifestyle\tfactors\n\tand\tgenetics\talso\ninfluence\tif\tand\twhen\tosteoporosis\tmay\toccur.\t\nSecondary\tosteoporosis\n\tresults\twhen\tan\tidentifiable\ndrug\tor\tdisease\tprocess\tcauses\tloss\tof\tbone\ttissue\t(\nBox\t23.1\n).\nBOX\t23.1\nMedical\tConditions\tthat\tDeplete\tCalcium\tand\tPromote\tRisk\tof\nOsteoporosis
|
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0.02909693866968155,
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0.03662491217255592
] |
Osteoporosis\nChronic\tdiarrhea\tor\tintestinal\tmalabsorption\nChronic\tobstructive\tlung\tdisease\nChronic\trenal\tdisease\nDiabetes\nHemiplegia\nHyperparathyroid\tdisease\nHyperthyroidism\nScurvy\nSubtotal\tgastrectomy\nCauses\tand\trisk\tfactors\nOsteoporosis\tis\ta\tcomplex,\theterogeneous\tdisorder\tand\tmany\trisk\tfactors\tcontribute\tduring\ta
|
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] |
lifetime.\tLow\tBMD\tis\tcommon\tto\tall\ttypes\tof\tosteoporosis,\tbut\tan\timbalance\tbetween\t\nbone\nresorption\n\tand\tformation\tresults\tfrom\tan\tarray\tof\tfactors\tcharacteristic\tof\teach\tform\tof\tthis\tdisease.\nRisk\tfactors\n\tfor\tosteoporosis\tinclude\tage,\trace,\tgender,\tand\tfactors\tnoted\tin\t\nBox\t23.2\n.\nBOX\t23.2\nRisk\tFactors\tfor\tDeveloping\tOsteoporosis
|
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] |
Box\t23.2\n.\nBOX\t23.2\nRisk\tFactors\tfor\tDeveloping\tOsteoporosis\nAge,\tespecially\tolder\tthan\tage\t60\nAmenorrhea\tin\twomen\tas\ta\tresult\tof\texcessive\texercise\nAndrogen\tdepletion\twith\thypogonadism\tin\tmen\nCigarette\tsmoking\nEstrogen\tdepletion\tfrom\tmenopause\tor\tearly\toophorectomy\nEthnicity:\twhite\tor\tAsian\nExcessive\tintake\tof\talcohol,\n\tcaffeine,\tfiber
|
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] |
Excessive\tintake\tof\talcohol,\n\tcaffeine,\tfiber\nFemale\tgender\nFamily\thistory\tof\tosteoporosis\nInadequate\tcalcium\tor\tvitamin\tD\tintake\nLack\tof\texercise\nProlonged\tuse\tof\tcertain\tmedications\t(see\t\nBox\t23.3\n)\nSarcopenia\nUnderweight,\tlow\tbody\tmass\tindex,\tlow\tbody\tfatness\nAlcohol
|
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Sarcopenia\nUnderweight,\tlow\tbody\tmass\tindex,\tlow\tbody\tfatness\nAlcohol\nExcessive\talcohol\tconsumption\tis\ta\trisk\tfactor\tfor\tdeveloping\tosteoporosis,\tprobably\tbecause\tof\ttoxic\neffects\ton\tosteoblasts.\tModerate\talcohol\n\tintake\tseems\tto\thave\tno\tdetrimental\teffect\ton\tbone,\tand
|
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] |
intake\tseems\tto\thave\tno\tdetrimental\teffect\ton\tbone,\tand\nsome\tstudies\tshow\ta\tmodest\tpositive\teffect.\tThree\tor\tmore\tdrinks\tper\tday\tis\tassociated\twith\nincreased\trisk\tof\tfalling\tand\tmay\tpose\tother\tthreats\tto\tbone\thealth\t(\nAbrahamsen\tet\tal,\t2014\n).\nBody\tweight
|
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] |
There\tis\ta\tstrong\tcorrelation\tbetween\tBMD\tand\tBMI\tsuggesting\tthat\ta\tBMI\tof\t<21\tkg/m\n2\n\tis\nassociated\twith\tlow\tBMD\tand\tgreater\tfracture\trisk\n\tin\twomen.\nCigarette\tsmoking\nThere\tare\tdirect\tand\tindirect\tcellular\teffects\ton\tbone\tcaused\tby\tsmoking,\tas\twell\tas\tpossible
|
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] |
hormonal\tchanges\tand\tlower\tdietary\tcalcium\tabsorption.\tSmoking\tmay\talso\tbe\tassociated\twith\tlower\nbody\tweight,\tdecreased\tphysical\tactivity,\tand\tpoor\tdiet\t(\nAbrahamsen\tet\tal,\t2014\n).\nEthnicity\nOsteoporosis\tis\ta\tmultifactorial\tdisease,\tand\tdetermining\tthe\trole\tof\tethnicity\n\tin\tosteoporosis,\tBMD,
|
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in\tosteoporosis,\tBMD,\nbone\tstrength,\tbone\tquality,\tand\tfracture\tincidence\tis\tdifficult.\tWhile\tgenetics\thave\tmade\tstrides\tin\ndetermining\tthe\trole\tof\tethnicity\tor\trace\tin\tthese\toutcomes,\tthe\tblending\tof\tethnicities\tand\traces\talso\nmakes\tdefinitive\tstatements\telusive.\tIn\taddition,\tethnicity\thas\tan\tinfluence\ton\tmany\tlifestyle\tfactors
|
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that\tcould\talso\taffect\tthese\toutcomes,\tsuch\tas\tdiet\tand\tphysical\tactivity.\n\tA\trelated\tissue\tis\tbody\tframe\nsize,\toften\tassociated\twith\tan\tethnic\tgroup\t(\nRivadeneira\tand\tUitterlinden,\t2017\n).\nLimited\tweight-bearing\texercise\nAccrual\tand\tmaintenance\tof\thealthy\tbone\trequires\texposure\tto\tweight-bearing\tpressures\tthroughout
|
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extremities;\tappropriate\texercise\tis\ta\tfeature\tof\ttheir\tdaily\troutines.\nLoss\tof\tmenses\nAcceleration\tof\tbone\tloss\tcoincides\twith\tmenopause,\teither\tnatural\tor\tsurgical,\tat\twhich\ttime\tthe\novaries\tstop\tproducing\testrogen.\tIn\tassociation\twith\tthe\tdecline\tin\testrogen,\tmore\n\tbone\tsites\tare
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bone\tsites\tare\nundergoing\tresorption\tand\tfor\ta\tlonger\ttime,\twith\tbone\tformation\tdiminished.\tCompensatory\nmechanisms\tfor\tthe\tefflux\tof\tcalcium\tfrom\tbone\tduring\tthis\tperiod\tof\tenhanced\tresorption\tinclude\ndecreased\trenal\tcalcium\treabsorption,\tdecreased\tintestinal\tcalcium\tabsorption,\tand\treduced\tPTH\nsecretion\t(\nDrake\tet\tal,\t2015\n).
|
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secretion\t(\nDrake\tet\tal,\t2015\n).\nAny\tinterruption\tof\tmenstruation\tfor\tan\textended\tperiod\tresults\tin\n\tbone\tloss.\tThe\tamenorrhea\tthat\naccompanies\texcessive\tweight\tloss\tseen\tin\tpatients\twith\tanorexia\tnervosa\tor\tin\thypothalamic\namenorrhea,\twhich\toccurs\tin\tindividuals\twho\tparticipate\tin\thigh-intensity\tsports\tor\tdance,\tis\toften
|
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] |
associated\twith\tlifetime\tlow\tbone\tdensity,\tcompromised\tbone\tarchitecture,\tand\tincreased\tfracture\nrisk\t(\nChou\tand\tMantzoros,\t2018\n).\nNutrients\nMany\tnutrients\tand\tseveral\tnonnutrients\n\thave\tbeen\timplicated\tas\tcausal\trisk\tfactors\tfor\nosteoporosis.\tPoor\tcalcium\tand\tvitamin\tD\tintake\thave\tbeen\tlinked\tto\tpoor\tbone\thealth,\tosteoporosis,
|
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] |
and\tfracture\trisk.\tVitamin\tC\tassists\tin\tthe\tformation\tof\tcollagen,\twhich\tis\tnecessary\tfor\thealthy\nbones.\tOther\tnutrients\tthat\tmay\tplay\ta\trole\tinclude\tprotein\t(when\tit\tis\ttoo\thigh\tor\ttoo\tlow),\tvitamins\nA,\tB\n6\n,\tB\n12\n,\tE,\tand\tK,\tas\twell\tas\tthiamin\t(\nAbrahamsen\tet\tal,\t2014\n).\nMedications
|
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] |
Abrahamsen\tet\tal,\t2014\n).\nMedications\nA\tnumber\tof\tmedications\tcontribute\tadversely\tto\tosteoporosis,\teither\tby\tinterfering\twith\tcalcium\nabsorption\tor\tby\tactively\tpromoting\tcalcium\tloss\tfrom\tbone\t(\nBox\t23.3\n).\tFor\texample,\tcorticosteroids\naffect\tvitamin\tD\tmetabolism\tand\tcan\tlead\tto\tbone\tloss.\tExcessive\tamounts\tof\texogenous\tthyroid
|
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] |
hormone\tcan\tpromote\tloss\tof\tbone\tmass\tover\ttime.\nBOX\t23.3\nMedications\tthat\tIncrease\n\t\nCalcium\tLoss\tand\tPromote\tRisk\tof\nOsteoporosis\nAluminum-containing\tantacids\nCorticosteroids\nCyclosporine\nHeparin\nLasix\tand\tthiazide\tdiuretics\nLithium\nMedroxyprogesterone\tacetate\nMethotrexate\nPhenobarbital\nPhenothiazine\tderivatives\nPhenytoin\t(Dilantin)
|
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] |
Phenobarbital\nPhenothiazine\tderivatives\nPhenytoin\t(Dilantin)\nThyroid\thormone\nTetracycline\nSarcopenia\nSarcopenia\n\tis\tdefined\tas\ta\tloss\tof\tskeletal\tmuscle,\twith\tassociated\tdecline\n\tin\tmuscle\tfunction.\tThis
|
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] |
results\tin\tincreased\trisk\tfor\tfalls\tand\tdisability.\tSarcopenia\tis\tassociated\twith\tlow\tbone\tmass,\nosteoporosis,\tand\thip\tfractures\tin\tmost\tstudies\t(\nOliveira\tand\tVaz,\t2015\n).\nDiagnosis\tand\tmonitoring\nBone\tdensitometry\n\tmeasures\tbone\tmass\ton\tthe\tbasis\tof\ttissue\tabsorption\tof\tphotons\tproduced\tby
|
[
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] |
x-ray\ttubes.\tDual-energy\tx-ray\tabsorptiometry\t(DEXA)\t(see\t\nChapter\t5\n)\tis\tavailable\n\tin\tmost\thospitals\nand\tmany\tclinics\tfor\tthe\tmeasurement\tof\tthe\ttotal\tbody\tand\tregional\tskeletal\tsites\tsuch\tas\tthe\nlumbar\tvertebrae\tand\tthe\tproximal\tfemur\t(hip).\tResults\tof\tDEXA\tmeasurements\tare\tcommonly
|
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] |
expressed\tas\tT-scores.\tWhen\tthe\tBMD\tT-score\tis\t2.5\tstandard\tdeviations\t(SDs)\tbelow\tthe\tmean,\ta\ndiagnosis\tof\tosteoporosis\tis\tmade;\tbetween\t1\tand\t2.5\tSD\tis\tconsidered\tlow\tbone\tmass\tor\tosteopenia;\nand\twithin\t1\tSD\tof\tthe\tadult\tmean\tis\tconsidered\tnormal.\nDefinitions
|
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] |
and\twithin\t1\tSD\tof\tthe\tadult\tmean\tis\tconsidered\tnormal.\nDefinitions\nWhen\tBMD\tfalls\tsufficiently\tbelow\thealthy\tvalues\t(1\tSD\taccording\tto\tWorld\tHealth\tOrganization\n[WHO]\tstandards)\tlow\tbone\tmass\tor\t\nosteopenia\n\texists.\t\nOsteoporosis\n\toccurs\twhen\tthe\tBMD\nbecomes\tso\tlow\t(greater\tthan\t2.5\tSDs\tbelow\thealthy\tvalues)\tthat\tthe\tskeleton\tis\tunable\tto\tsustain
|
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ordinary\tstrains.\tHowever,\tthe\tNational\tOsteoporosis\n\tFoundation\t(NOF)\tstates\tthat\tthe\tWHO\tBMD\ndiagnostic\tclassification\tshould\tnot\tbe\tapplied\tto\tpremenopausal\twomen,\tmen\tyounger\tthan\t50\tyears\nof\tage,\tor\tchildren.\tClinical\tassessment\tand\tethnically\tadjusted\tZ-scores\tare\tthought\tto\tbe\tmore\nreflective\tof\tthe\tnorms\tin\tother\tgroups.
|
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reflective\tof\tthe\tnorms\tin\tother\tgroups.\nUltrasound\tmeasurements\tof\tbone\nUltrasound\tinstruments\tmeasure\tthe\tvelocity\tof\tsound\twaves\ttransmitted\tthrough\tbone\n\tand\nbroadband\tultrasound\tattenuation\t(BUA).\tMeasurements\tat\tthe\tcalcaneus\t(heel)\tcorrelate\tfairly\twell\nwith\tBMD\tmeasurements\tat\tthis\tsame\tskeletal\tsite.\tHowever,\tultrasound\tmeasurements\tare
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considered\tscreening\ttools,\twhereas\tDEXA\tmeasurements\tare\tconsidered\tdiagnostic.\nFracture\trisk\tassessment\nThe\tWHO\tCollaborating\tCentre\tfor\tMetabolic\tBone\tDisease,\thoused\tat\tthe\tUniversity\tof\tSheffield,\nUnited\tKingdom,\tdeveloped\tan\talgorithm\tto\tpredict\tfracture\tby\tusing\tfemoral\thead\tBMD\tand\tclinical\nindicators\tof\tlow\tbone\tmass\t(\nKanis\tet\tal,\t2011
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indicators\tof\tlow\tbone\tmass\t(\nKanis\tet\tal,\t2011\n).\tThis\tuses\teconomic\tmodeling\tto\tguide\tthe\tmost\tcost-\neffective\tinstances\tto\tbegin\tmedications\t(\nBorgström\tet\tal,\t2011\n).\tVertebral\tfractures\tthat\tare\nconfirmed\tby\tx-rays\tare\ta\tstrong\tpredictor\tof\tfuture\tvertebral\tfractures,\tas\twell\tas\tfractures\tat\tother\nsites\t(\nKanis\tet\tal,\t2011\n).
|
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] |
sites\t(\nKanis\tet\tal,\t2011\n).\nIn\tthe\tUnited\tStates\tthe\tNational\tBone\tHealth\tAlliance\trecognizes\tFRAX\tas\ta\tmeans\tto\tdiagnose\nosteoporosis\trisk;\thowever,\texperiencing\tprevious\tfractures\tand\tBMD\ttesting\tare\tother\ttools\tthat\tcan\nbe\tused\t(\nSiris\tet\tal,\t2014\n).\tSeveral\tadditional\tscreening\tmeasures\thave\tbeen\tdeveloped\tand
|
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] |
).\tSeveral\tadditional\tscreening\tmeasures\thave\tbeen\tdeveloped\tand\nsuggested\tby\tthe\tU.S.\tPreventative\tServices\tTask\tForce\tas\tbeing\tmoderately\taccurate\n\tat\tpredicting\nosteoporosis\t(\nCurry,\t2018\n).\tSee\t\nTable\t23.2\n.\nTABLE\t23.2\nScreening\tTools\tfor\tOsteoporosis\nTool\tName\nAbbreviation\nFull\tName\nAuthors\nVariables\tUsed\nFRAX\nFracture\tRisk\nAssessment\nTool
|
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] |
Full\tName\nAuthors\nVariables\tUsed\nFRAX\nFracture\tRisk\nAssessment\nTool\nKanis\tet\tal,\n2011\nGender,\tage,\tBMI,\tparental\thistory\tof\thip\tfracture,\ntobacco\tsmoking,\tuse\tof\toral\tglucocorticoids,\ncauses\tof\tsecondary\tosteoporosis,\talcohol\nORAI\nOsteoporosis\tRisk\nAssessment\nInstrument\nCadarette\tet\nal,\t2000\nAge,\tweight,\testrogen\nOSIRIS\nOsteoporosis\nIndex\tof\tRisk
|
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] |
al,\t2000\nAge,\tweight,\testrogen\nOSIRIS\nOsteoporosis\nIndex\tof\tRisk\nSedrine\tet\nal,\t2002\nAge,\tweight,\testrogen,\tprevious\tfracture\nOST\nOsteoporosis\nSelf-\nAssessment\nTool\nRichy\tet\tal,\n2004\nAge,\tweight\nSCORE\nSimplified\nCalculated\nRisk\nEstimation\nScore\nVon\tMühlen,\net\tal,\n1999\nAge,\tweight,\tprevious\tfracture,\trheumatoid\tarthritis,\nestrogen,\trace\nBMI
|
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estrogen,\trace\nBMI\n,\tBody\tmass\tindex\nBone\tmarkers\nEnzymes\tor\tdegradation\tproducts\tin\tserum\tor\turine\thave\tbeen\tused\tfor\tresearch\tand\tare\n\tbeginning\nto\tbe\tused\tmore\toften\tto\tmonitor\tdrug\ttreatment\teffectiveness.\tFor\tbone\tformation,\tserum\nosteocalcin,\tserum\tbone\talkaline\tphosphatase,\tand\tserum\tprocollagen\ttype\tI\tN-terminal\tpropeptide
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] |
(P1NP)\tare\toften\tused.\tFor\tbone\tresorption,\tserum\tand\turine\tC-telopeptide\tof\ttype\t1\tcollagen\tand
|
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] |
urine\tN-telopeptide\tof\ttype\t1\tcollagen\tare\tused.\tFormation\tmarkers\tare\tuseful\tin\tmonitoring\tthe\neffectiveness\n\tof\tanabolic\tmedications,\twhereas\tresorptive\tmarkers\tare\tuseful\tfor\tmonitoring\nantiresorptive\tmedications\t(\nChapurlat\tand\tConfavreux,\t2016\n).\nClinical\tInsight\nPostmenopausal\tWomen\tat\tHigh\tRisk\tfor\tHip\tFracture
|
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Clinical\tInsight\nPostmenopausal\tWomen\tat\tHigh\tRisk\tfor\tHip\tFracture\nIt\tis\timportant\tto\tidentify\twomen\twho\tare\tat\trisk\tof\tdeveloping\tosteoporosis\tas\tearly\tas\tpossible\nso\tthat\tmeasures\tcan\tbe\ttaken\tto\tmonitor\tbone\tstatus\tand\tto\tprevent\tfurther\tbone\tloss.\n\tBecause
|
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0.04394098371267319
] |
Because\nlow\tbone\tmineral\tdensity\t(BMD)\tis\ta\tmajor\trisk\tfactor\tfor\tosteoporosis,\tits\tassessment\tis\tclinically\nuseful.\tAssessment\tof\tbone\tstatus\tbased\ton\tthe\texistence\tof\tone\tor\tmore\trisk\tfactors\tsuch\tas\tage,\nheight,\tweight,\tsmoking\tstatus,\talcohol\tconsumption,\tdrug\tuse,\tcalcium\tintake,\texercise,\tframe
|
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] |
size,\tand\tselected\tbone\tmarkers\tis\tnot\tsufficiently\taccurate.\tBMD\tas\tmeasured\tby\tbone\ndensitometry\n\tis\tmore\tclinically\tuseful.\tTypically,\ttotal\tbody\tBMD\tand\tthe\tregional\tsites\tsuch\tas\tthe\nproximal\tfemur\tand\tlumbar\tvertebrae\tare\tmeasured\tby\tdual-energy\tx-ray\tabsorptiometry.
|
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bone-preserving\tmedication\tor\tcalcitonin.\nNutrition\tand\tbone\nEnergy\nCalories\n\tdo\tnot\thave\ta\tdirect\teffect\ton\tbone;\trather,\tinadequate\tcalories\tleading\tto\tlow\tbody\tweight\nor\ttoo\tmany\tcalories\tleading\tto\toverweight\tboth\thave\teffects\ton\tbone.\tBeing\tunderweight\tis
|
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0.038157057017087936,
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0.02639021724462509,
0.09082665294408798,
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-0.03779539838433266,
0.0626344159245491,
0.05946555733680725,
0.01625615730881691,
0.022406117990612984,
0.016655031591653824,
0.06360785663127899,
0.030431820079684258,
0.10699553787708282,
-0.02502330020070076
] |
considered\ta\trisk\tfactor\tfor\tosteoporosis,\twhile\tbeing\toverweight\tmay\tbe\tprotective.\tWhile\tBMI\tand\nBMD\tare\tpositively\tcorrelated,\tand\tfracture\trisk\tfor\thip\tand\tspine\tis\tlower\tin\tobese\tversus\tnonobese,\nfracture\trisk\n\tis\thigher\tin\tobese\tindividuals\tat\tthe\tproximal\thumerus,\tupper\tleg,\tand\tankle\t(\nFassio\tet\nal,\t2018\n).\nProtein
|
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0.041020482778549194,
0.10368286818265915,
0.0646018236875534
] |
Fassio\tet\nal,\t2018\n).\nProtein\nBoth\tprotein\tand\tcalcium\tare\timportant\tcomponents\tof\tPBM,\tespecially\tbefore\tpuberty.\tAdequate\nprotein\tintake,\twith\tadequate\tcalcium\tintake,\tis\tneeded\tfor\toptimal\tbone\thealth.\tProtein\tintakes\ngreater\tthan\tthe\trecommended\tdietary\tallowance\t(RDA)\tmay\tbe\tbeneficial\tin\tolder\tadults\tto\tslow\n\tthe
|
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the\nloss\tof\tBMD,\treduce\tthe\trisk\tof\thip\tfracture,\tand\tpromote\tbone\thealth,\tproviding\tthat\tcalcium\tintakes\nare\talso\tadequate\t(\nRizzoli\tet\tal,\t2018\n).\tHowever,\tvery-high-protein\tdiets\tused\tspecifically\tfor\tweight\nloss\thave\tbeen\tlinked\tto\tdecreased\tBMD\t(\nCampbell\tand\tTang,\t2010\n).\nMinerals\nCalcium
|
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0.09724242240190506,
0.004933877382427454
] |
Campbell\tand\tTang,\t2010\n).\nMinerals\nCalcium\nCalcium\tintake\tin\tthe\tprimary\tprevention\tof\tosteoporosis\thas\treceived\tmuch\tattention.\tThe\tInstitute\nof\tMedicine\t(IOM)\tdietary\treference\tintakes\t(DRIs)\tfor\tcalcium\tand\tvitamin\tD\tare\tgiven\tas\tRDAs.\tThe\nRDA\tfor\tcalcium\tfrom\tpreadolescence\t(age\t9\tyears)\tthrough\tadolescence\t(up\tto\t19\tyears)\twas
|
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] |
increased\tto\t1300\tmg/day\tfor\tboth\tgenders\t(\nIOM,\t2011\n).\tThe\tRDAs\tfor\tcalcium\tin\tadults,\tpregnant\nand\tlactating\twomen,\tand\tchildren\tare\tlisted\ton\tthe\tinside\tcover.\nThe\tDietary\tGuidelines\tfor\tAmericans\tidentified\n\tcalcium\tas\tan\tunderconsumed\tnutrient\t(\nU.S.\nDepartment\tof\tHealth\tand\tHuman\tServices\tand\tU.S.\tDepartment\tof\tAgriculture,\t2015
|
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] |
).\tFood\tsources\nare\trecommended\tfirst\tfor\tsupplying\tcalcium\tneeds\tbecause\tof\tthe\tcoingestion\tof\tother\tessential\nnutrients\tthat\taid\tin\tabsorption.\tIn\tthe\tUnited\tStates\tthe\tprimary\tsource\tof\tcalcium\tis\tdairy\tfoods.\nHowever,\tcalcium\tfortification\tof\tnondairy\tfoods\tsuch\tas\tnondairy\n\tmilks\tand\tother\tbeverages,\tjuices,
|
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] |
milks\tand\tother\tbeverages,\tjuices,\nbreakfast\tcereals,\tbread,\tand\tsome\tcrackers\tis\tcommon.\nCalcium\tbioavailability\tfrom\tfoods\tis\tgenerally\tgood,\tand\tthe\tamount\tof\tcalcium\tin\tthe\tfood\tis\tmore\nimportant\tthan\tits\tbioavailability.\tHowever,\tthe\torder\tof\tconcern\trelative\tto\tcalcium\tabsorption
|
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efficiency\tis\tfirst\tthe\tindividual’s\tneed\tfor\tcalcium,\tsecond\tthe\tamount\tconsumed\tbecause\tabsorption\nefficiency\n\tis\tinversely\trelated\tto\tamount\tconsumed,\tand\tthird\tthe\tintake\tof\tabsorption\tenhancers\tor\ninhibitors.\tFor\texample,\tabsorption\tfrom\tfoods\thigh\tin\toxalic\tand\tphytic\tacid\t(certain\tvegetables\tand\nlegumes)\tis\tlower\tthan\tfrom\tdairy\tproducts.
|
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] |
legumes)\tis\tlower\tthan\tfrom\tdairy\tproducts.\nThe\tamount\tof\tcalcium\tin\tfoods\tvaries\twith\tthe\tbrand,\tserving\tsize,\tand\tfortification.\tRead\tthe\nNutrition\tFacts\tlabel\tto\tdetermine\tthe\tamount\tof\tcalcium\tper\tserving.\n\tMultiply\tthe\tdaily\tvalue\t(DV)\npercentage\tby\t10\tto\tdetermine\tthe\tmilligrams\tof\tcalcium.\tFor\texample,\ta\t20%\tDV\tequals\t200\tmg\tof
|
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] |
calcium\t(see\t\nChapter\t12\n).\tLabeling\tfor\t“excellent”\t(>200\tmg/serving)\tand\t“good”\t(100\tto\t200\nmg/serving)\tsources\tof\tcalcium\tare\tregulated\tby\tthe\tFood\tand\tDrug\tAdministration\t(FDA)\t(\nFDA,\n2013\n).\nReaching\tRDA\tlevels\tof\tcalcium\tfrom\tfoods\tshould\tbe\tthe\tfirst\tgoal,\tbut\tif\tinsufficient\n\tamounts\tof
|
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amounts\tof\ncalcium\tfrom\tfoods\tare\tconsumed,\tsupplements\tof\tcalcium\tare\trecommended\tto\treach\tthe\tage-\nspecific\tRDA.\tAn\tincreasing\tpercentage\tof\tthe\tpopulation\tis\ttaking\tcalcium\tsupplements.\tPersons\nwho\tshould\ttake\tsupplements\tinclude\tthose\tnot\tmeeting\tthe\tRDA\ton\tmost\tdays,\tthose\ttaking
|
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] |
corticosteroids,\tthose\twith\tlow\tbone\tmass\tor\tosteoporosis,\twomen\twho\tare\tperimenopausal\tor
|
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] |
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