The book distills the available information on osteoporosis into an easily comprehensible format that serves as a practical guide for busy clinicians.
Contents:Definition & epidemiology -- Basic bone ...pathophysiology -- Bone densitometry -- Diagnosis -- Identifying patients at risk of fractures -- Non-pharmacologic management of osteopenia and osteoporosis -- Pharmacologic management of osteoporosis, part 1 -- Pharmacologic management of osteoporosis, part 2 -- Monitoring patients on treatment -- Vertebral augmentation procedures -- Corticosteroid-induced bone loss -- Primary hyperparathyroidism -- Premenopausal women -- Men -- Atypical femoral shaft fractures -- Osteonecrosis of the jaw -- Osteoporosis in children and adolescents.
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Since the advent of autoanalyzers for biochemical screening in the 1970s, osteitis fibrosa cystica has become a rare finding, with about 80% of PHPT in Western countries now being identified through ...routine laboratory testing in patients without well-defined skeletal symptoms 1. These patients most often have mild or sometimes intermittent hypercalcemia. It is important to distinguish between PHPT and familial hypocalciuric hypercalcemia (FHH). Patients with FHH typically have inappropriately normal PTH levels, although 10–20% have been reported to have absolute elevation of serum PTH 2. FHH is associated with normal parathyroid glands, and does not require surgery or medical treatment. It is differentiated from PHPT by performing a 24-h measurement of urine calcium and creatinine and determining the ratio of the clearance of calcium to the clearance of creatinine. Data compiled from five studies showed that a ratio of less than 0.01 had a sensitivity of 85%, a specificity of 88%, and a positive predictive value of 85% to detect FHH; a ratio of greater than 0.02 essentially ruled out the possibility of FHH 3. In the same review, about 12% of patients with PHPT had a ratio below 0.01 and 49% had a ratio above 0.02, with the remainder between the two values. The clinical utility of urinary calcium/creatinine clearance ratios is described in more detail in the chapter on diagnosis. This is an important differential diagnosis in order to avoid an unnecessary neck exploration. Some patients with normal serum calcium and inappropriately high PTH levels are being detected in the evaluation for factors contributing to osteoporosis. These patients have been classified as having “normocalcemic primary hyperparathyroidism,” a disorder associated with substantial skeletal involvement that may represent the earliest form of primary hyperthyroidism. In a longitudinal cohort study of 37 such patients (age 32–78, median 58 years; 95% female) followed for 1–8 years (median 3 years), 7 (19%) became hypercalcemic, all within the first 3 years of observation 4. Three of the hypercalcemic patients had parathyroid surgery, with excision of a single parathyroid adenoma in two and excision of two hyperplastic glands in the third. Four normocalcemic patients also had surgery, with a single adenoma excised in one patient, a single hyperplastic gland excised in two others, and two hyperplastic glands removed from the fourth.
Pruritus. A manifestation of iron deficiency Lewiecki, E M; Rahman, F
JAMA : the journal of the American Medical Association,
1976-Nov-15, Letnik:
236, Številka:
20
Journal Article
This review summarizes and updates data presented at recent annual Southern Medical Association conferences on postmenopausal osteoporosis. As part of any osteoporosis treatment program, it is ...important to maintain adequate calcium and 25-hydroxyvitamin D levels either through diet or supplementation. Among the available pharmacologic therapies, the bisphosphonates alendronate and risedronate have demonstrated the most robust fracture risk reductions- approximately 40 to 50% reduction in vertebral fracture risk, 30 to 40% in nonvertebral fracture risk, and 40 to 60% in hip fracture risk. Ibandronate, a new bisphosphonate, has demonstrated efficacy in reducing vertebral fracture risk. Salmon calcitonin nasal spray and raloxifene demonstrated significant reductions in vertebral fracture risk in pivotal studies. Teriparatide significantly reduced vertebral and nonvertebral fracture risk. Drugs on the horizon include strontium ranelate, which has been shown to reduce vertebral and nonvertebral fracture risk, and zoledronic acid, an injectable bisphosphonate that increased bone density with once-yearly administration.
As fraturas vertebrais são o tipo mais comum de fratura osteoporótica. As mulheres na pós‐menopausa têm um risco aumentado de fraturas vertebrais osteoporóticas em comparação com as mulheres em idade ...fértil. As fraturas vertebrais estão associadas a um aumento na morbidade e mortalidade e à elevação do risco de fratura vertebral subsequente, independentemente da densidade mineral óssea. Apesar da ocorrência comum e das graves consequências das fraturas vertebrais, elas muitas vezes passam despercebidas ou são erroneamente diagnosticadas pelos radiologistas. Além disso, as fraturas vertebrais podem ser descritas com uma terminologia variável, que pode confundir em vez de esclarecer o médico solicitante. Foi feito um levantamento dos laudos das radiografias de coluna vertebral de um grupo de mulheres na pós‐menopausa selecionadas para participar de um estudo de osteoporose no Centro de Pesquisa Clínica do Brasil. A análise descritiva avaliou a variabilidade dos laudos em sete pacientes. Quatro radiologistas gerais independentes emitiram laudos de avaliação das fraturas vertebrais por meio de uma análise cega. O objetivo deste estudo foi avaliar a consistência desses laudos. A análise descobriu uma acentuada variabilidade no diagnóstico das fraturas vertebrais e na terminologia usada para descrevê‐las. Na prática clínica da comunidade, essa variabilidade poderia levar a diferenças no tratamento de pacientes com osteoporose, com o potencial de subtratamento ou tratamento exagerado, a depender das circunstâncias clínicas. Laudos precisos e inequívocos de fraturas vertebrais são susceptíveis de estar associados a melhores desfechos clínicos.
Vertebral fractures are the single most common type of osteoporotic fracture. Postmenopausal women are at increased risk for osteoporotic vertebral fractures compared with women of childbearing age. Vertebral fractures are associated with an increase in morbidity, mortality, and high risk of a subsequent vertebral fracture, regardless of bone mineral density. Despite the common occurrence and serious consequences of vertebral fractures, they are often unrecognized or misdiagnosed by radiologists. Moreover, vertebral fractures may be described by variable terminology that can confuse rather than enlighten referring physicians. We conducted a survey of spine X‐ray reports from a group of postmenopausal women screened for participation in a study of osteoporosis at Centro de Pesquisa Clínica do Brasil. A descriptive analysis evaluated the variability of reports in 7 patients. Four independent general radiologists issued reports assessing vertebral fractures through a blinded analysis. The objective of this study was to evaluate for consistency in these reports. The analysis found marked variability in the diagnosis of vertebral fractures and the terminology used to describe them. In community medical practices, such variability could lead to differences in the management of patients with osteoporosis, with the potential for undertreatment or overtreatment depending on clinical circumstances. Accurate and unambiguous reporting of vertebral fractures is likely to be associated with improved clinical outcomes.
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