Osteoporosis: Risk Factors, Symptoms and Management : Risk Factors, Symptoms and Management [1 ed.] 9781620812358, 9781620812105

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Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved. Osteoporosis: Risk Factors, Symptoms and Management : Risk Factors, Symptoms and Management, Nova Science Publishers,

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved. Osteoporosis: Risk Factors, Symptoms and Management : Risk Factors, Symptoms and Management, Nova Science

ENDOCRINOLOGY RESEARCH AND CLINICAL DEVELOPMENTS

OSTEOPOROSIS

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

RISK FACTORS, SYMPTOMS AND MANAGEMENT

No part of this digital document may be reproduced, stored in a retrieval system or transmitted in any form or by any means. The publisher has taken reasonable care in the preparation of this digital document, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained herein. This digital document is sold with the clear understanding that the publisher is not engaged in rendering legal, medical or any other professional services. Osteoporosis: Risk Factors, Symptoms and Management : Risk Factors, Symptoms and Management, Nova Science

ENDOCRINOLOGY RESEARCH AND CLINICAL DEVELOPMENTS Additional books in this series can be found on Nova’s website under the Series tab. Additional e-books in this series can be found on Nova’s website under the e-book tab.

AGING ISSUES, HEALTH AND FINANCIAL ALTERNATIVES

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

Additional books in this series can be found on Nova’s website under the Series tab. Additional e-books in this series can be found on Nova’s website under the e-book tab.

Osteoporosis: Risk Factors, Symptoms and Management : Risk Factors, Symptoms and Management, Nova Science

ENDOCRINOLOGY RESEARCH AND CLINICAL DEVELOPMENTS

OSTEOPOROSIS RISK FACTORS, SYMPTOMS AND MANAGEMENT

ALEJANDRO ROMERO PEÑA Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

AND

VIRGILIO ORTEGA PEREZ EDITORS

Nova Science Publishers, Inc. New York

Osteoporosis: Risk Factors, Symptoms and Management : Risk Factors, Symptoms and Management, Nova Science

Copyright © 2012 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com

NOTICE TO THE READER

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance upon, this material. Any parts of this book based on government reports are so indicated and copyright is claimed for those parts to the extent applicable to compilations of such works. Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS. Additional color graphics may be available in the e-book version of this book.

Library of Congress Cataloging-in-Publication Data Library of Congress Control Number: 2012933168 ISBN: 978-1-62081-235-8 (eBook)

Published by Nova Science Publishers, Inc. † New York

Osteoporosis: Risk Factors, Symptoms and Management : Risk Factors, Symptoms and Management, Nova Science

Contents

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

Preface

vii

Chapter I

The Influence of Osteoporosis in Oral Health Rodrigo Tiossi, Priscila Paganini Costa, and Plauto Christopher Aranha Watanabe

Chapter II

Osteoporosis: Risk Factors, Symptoms and Management A. Unnanuntana and John P. Kleimeyer

Chapter III

Chapter IV

Chapter V

Chapter VI

Management of Osteoporosis: Assessment of Fracture Risk and Therapeutic Effects on Osteoporosis Kazuhiro Imai Current Risk Factor Series and the Adequate Track for Diagnosing Future Bone Fracture Antonio Bazarra-Fernandez Genetic and Environmental Factors in Human Osteoporosis Salvatore Musumeci and Maria Musumeci Secondary Osteoporosis: Fractures and Bone Remodeling in Patients with Endogenous Hypercortisolism. A Link to the Pathogenesis of Glucocorticoid-Induced Osteoporosis Z. E. Belaya, N. V. Dragunova, L. Y. Rozhinskaya, and G. A. Melnichenko

Osteoporosis: Risk Factors, Symptoms and Management : Risk Factors, Symptoms and Management, Nova Science

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Chapter VII

Genetic and Postmenopausal Osteoporosis Risk Nicolás Mendoza, Antonio Martínez-Amat, and Fidel Hita

Chapter VIII

Severely Suppressed Bone Turnover Associated with Bisphosphonate Therapy for Osteoporosis Kazuhiro Imai

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

Index

Osteoporosis: Risk Factors, Symptoms and Management : Risk Factors, Symptoms and Management, Nova Science

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153 165

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

Preface Osteoporosis is a systemic, debilitating disease of the skeleton, characterized by significantly decreased bone mass in combination with the deterioration of bone microarchitecture. This process results in weakened bone with a great propensity for fracture under low-energy stress. This book presents current research in the study of the risk factors, symptoms and management of osteoporosis. Topics include the influence of osteoporosis in oral health; assessment of risk fracture risk and therapeutic effects on osteoporosis; diagnosing future bone fracture; genetic and environmental factors in human osteoporosis; the pathogenesis of skeletal complications in patients with endogenous hypercorticism; genetic and postmenopausal osteoporosis risk; and severely suppressed bone turnover associated with bisphosphonate for osteoporosis. Chapter I - Elderly patients have decreased bone regenerative capabilities. Osteoporosis, characterized by the reduction in the bone mineral density and microarchitectural deterioration, is more frequent in elderly rather than in younger patients. Bone mineral density can be measured using different radiographic techniques, such as panoramic radiography and dual-energy x-ray absorptiometry. Panoramic radiography is a common exam in oral practice and allows practitioners to routinely analyze the components of the stomatognathic system. According to literature, the amount of mandibular bone mass is directly related with skeletal bone mass. Osteoporosis, though not being the primary cause or the initial factor for periodontitis, has been shown to be a risk indicator that may contribute to the progression of periodontal disease, for being an indicative for the reduction of crestal bone levels. However, the evaluation of the relationship between osteoporosis and periodontitis is complex. Multiple systemic factors influence the progression of osteoporosis, including age, race, diet, gender, hormone therapy, smoking, genetic factors,

Osteoporosis: Risk Factors, Symptoms and Management : Risk Factors, Symptoms and Management, Nova Science

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

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Contents

exercise, and body weight. Several of these factors are also risk factors for severe periodontal disease. Local factors, such as bacterial plaque and calculus, may also disguise the effect of osteoporosis in the periodontal status. The consequences of systemic bone loss in the success of dental implants are poorly understood. The diagnosis of low bone mineral density is therefore necessary before implant rehabilitation because of the increased bone fragility and susceptibility to fracture. Low bone mineral density may also compromise the primary stability of oral implants. This review of the literature aims to investigate current diagnosis techniques of low bone mineral density available to the oral practitioner. The relationship between osteoporosis and periodontitis, tooth loss and the risk factors for implant placement in osteoporotic patients will also be reviewed. Chapter II - Osteoporosis is a systemic, debilitating disease of the skeleton, characterized by significantly decreased bone mass in combination with the deterioration of bone microarchitecture. This process results in weakened bone with a great propensity for fracture with low-energy stress. As the average life expectancy and median age of the population rises, fractures secondary to underlying osteoporosis are becoming increasingly commonplace. Several risk factors for osteoporosis have been identified including low body weight, a history of premature menopause, cigarette or excessive alcohol use, an eating disorder, a sedentary lifestyle, use of anticonvulsants and lifelong low calcium intake. Once a patient has been diagnosed with osteoporosis, a complete evaluation should be obtained. This includes a thorough medical history with particular attention to the risk of osteoporosis, a physical examination, and essential laboratory investigations. If secondary osteoporosis is suspected based on the clinical findings, further investigations are required directed at the secondary cause. Calcium and vitamin D supplement is the cornerstone of all treatment modalities for osteoporosis. All patients with osteoporosis should take adequate calcium intake of 1000-1500 mg/day and vitamin D of 1000 – 2000 IU/day. Bisphosphonates are strong anti-resorptive agents which have been shown to reduce both the vertebral and nonvertebral fracture risk. Therefore, they are the first-line drugs for the treatment of postmenopausal osteoporosis, unless contraindicated. An anabolic agent such as teriparatide should be considered in patients with fracture despite bisphosphonate treatment. Chapter III - Osteoporosis is a major public health problem affecting all countries and giving rise to fractures. The World Health Organization (WHO) published a set of diagnostic criteria to define osteoporosis in postmenopausal Caucasian women, using bone mineral density (BMD) values measured by

Osteoporosis: Risk Factors, Symptoms and Management : Risk Factors, Symptoms and Management, Nova Science

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

Preface

ix

dual energy X-ray absorptiometry (DXA). Currently, measurement of BMD by DXA (g/cm2) has been the standard method for diagnosing osteoporosis, in addition to assessing fracture risk and therapeutic effects. Quantitative computed tomography (QCT) can quantify volumetric BMD (mg/cm3), and cancellous bone can be measured independently of surrounding cortical bone and aortic calcification. Recently, quantitative ultrasound (QUS) is emerging as a relatively low-cost and readily accessible alternative means to identify osteoporosis and evaluate fracture risk. More recently, finite element (FE) method based on data from computed tomography (CT) has been used to assess bone strength, fracture risk, and therapeutic effects on osteoporosis. In this chapter, management of osteoporosis, assessment of fracture risk, and assessment of therapeutic effects are reviewed. The recent study of CT-based FE method (CT/FEM) is also reviewed. Vertebral strength by CT/FEM was analyzed in vivo in 123 postmenopausal women and the discriminatory power for vertebral fracture was assessed cross-sectionally. Alendronate effects on osteoporosis were also prospectively assessed in 33 patients. Chapter IV - Osteoporosis, which literally means "porous bone", is a disease in which the density and quality of bone are reduced. As the bones become more porous and fragile, the risk of fracture is greatly increased. The loss of bone occurs "silently" and progressively. Often there are no symptoms until the first fracture occurs. IOF does not officially endorse national or regional guidelines. This is because osteoporosis prevalence and some aspects of the prevention and treatment of fractures are country or region-specific. There may be multiple guidelines from any one country or region. A 72-year-old woman presents with a 2-month history of increasing pain in her lower back, which has not improved with ibuprofen and is causing difficulty with walking and dressing. On questioning, she reports having lost about 5 cm (2 in.) of height since she was a young woman. On examination, there is mild kyphosis in her lower thoracic spine but no point tenderness. A lateral spine radiograph reveals that the L2 vertebra is biconcave in appearance, a finding that is consistent with a vertebral fracture. How should this case be managed?. The question should be: How should be avoided this case?. Chapter V - Osteoporosis is a reduction in skeletal mass associated with bone micro-architectural deterioration. Often, it is most considered a bone disorder of postmenopausal women. However, younger women can also be affected. There are a lot of genetic and non-genetic risk factors, contributing to the development of osteoporosis. The aim of this study is to determinate the

Osteoporosis: Risk Factors, Symptoms and Management : Risk Factors, Symptoms and Management, Nova Science

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

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prevalence of known polymorphisms, associated to osteoporosis in different healthy postmenopausal women from Sub Saharan to Mediterranean areas. Moreover a control group of Mediterranean women with documented osteoporosis was also included in this study. From the analysis of these results and comparing the life habits of these women, it has been possible to identify some characteristics which influence the appearance of this debilitating disease (bone fracture in all districts) with devastating health and economic consequences. The statistical analysis of allele frequencies showed that the Vitamin D receptor (VDR B) polymorphism was significantly lower in healthy African women with respect to healthy Mediterranean (P < 0.001) and osteoporotic Mediterranean (P< 0.01) women. The estrogens receptor (ER X) allele frequency was significantly lower in both healthy African and healthy Mediterranean than in osteoporotic Mediterranean women (P< 0.001). In contrast, the estrogens receptor (ER P) allele frequency was significantly lower only in healthy when compared to osteoporotic Mediterranean women (P