Abstract
Osteoporosis results in low-energy fractures of the spine. The load necessary to cause a vertebral fracture is determined by the characteristics related to the vertebral body structure, mineral content, and quality of bone. Radiographic techniques centered on dual X-ray absorptiometry (DXA) permit a determination of bone mass and fracture risk. Current medical therapies principally using bisphosphonate and pulsatile PTH profoundly decrease the risk of fracture (50+%). Fall prevention strategies can further decrease the possibility of fracture. A comprehensive approach to osteoporosis can favorably alter the disease.
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Adami S, Prizzi R, Colapietro F (2001). Alendronate for the treatment of osteoporosis in men. Calcif Tissue Int 69:239–241
Arnaud CD (1996) Osteoporosis: using ‘bone markers’ for diagnosis and monitoring. Geriatrics 51:24–30
Bagur A, Solis F, Di Gregorio S, Mautalen C (2000) Reference data of vertebral morphometry by X-ray absorptiometry (MXA) in Argentine women. Calcif Tissue Int 66:259–262
Baylink DJ (2000) The diagnosis and management of osteoporosis. J Rheumatol 59 [Suppl 1]:42–44
Bianco AC, Malvestiti LF, Gouveia CH, Wehba S, Lewin S, Marone MM (1999) Morphometric dual-energy X-ray absorptiometry of the spine: report of a large series and correlation with axial bone mineral density. J Bone Miner Res 14:1605–1613
Bidwell J, Feister H, Swartz D, Onyia J, Holden J, Hock J (1996) Parathyroid hormone regulates the expression of rat osteoblast and osteosarcoma nuclear matrix proteins. J Cell Biochem 63:374–383
Black DM, Cummings SR, Karpf DB, et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541
Body JJ, Gaich GA, Scheele WH, et al (2002) A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1–34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 87:4528–4535
Carter DR, Hayes WC (1977) The compressive behavior of bone as a two-phase porous structure J Bone Joint Surg Am 59:954–962
Carter DR, Bouxsein ML, Marcus R (1992) New approaches for interpreting projected bone densitometry data. J Bone Miner Res 7:137–145
Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561
Cauley JA, Norton L, Lippman ME, et al (2001) Continued breast cancer risk reduction in postmenopausal women treated with raloxifene: 4-year results from the MORE trial. Multiple outcomes of raloxifene evaluation. Breast Cancer Res Treat 65:125–134
Chausmer AB (2001) Bone density measurement techniques in the diagnosis and management of osteoporosi. J S C Med Assoc 97:106–110
Chavassieux PM, Arlot ME, Roux JP, et al (2000) Effects of alendronate on bone quality and remodeling in glucocorticoid-induced osteoporosis: a histomorphometric analysis of transiliac biopsies. J Bone Miner Res 15:754–762
Chestnut CH 3rd, Silverman S, Adriano K, Genant H (2002) A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the Prevent Recurrence of Osteoporotic Fractures Study. PROOF Study Group. Am J Med 109:267–276
Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S-17S; discussion 17S-19S
Crandall C (2002) Parathyroid hormone for treatment of osteoporosis. Arch Intern Med 162:2297–2309
Cummings SR, Black DM, Thompson DE, 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 280:2077–2082
Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337:670–676
Delmas PD, Ensrud KE, Adachi JD, et al (2002) Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab 87:3609–3617
Dickler MN, Norton L (2001) The MORE trial: multiple outcomes for raloxifene evaluation—breast cancer as a secondary end point: implications for prevention. Ann N Y Acad Sci 949:134–142
Doggrell SA (2002) Zoledronate once-yearly increases bone mineral density — implications for osteoporosis. Expert Opin Pharmacother 3:1007–1009
Ensrud KE, Thompson DE, Cauley JA, et al (2000) Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. Fracture Intervention Trial Research Group. J Am Geriatr Soc 48:241–249
Ettinger B, Black DM, Mitlak BH, 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 282:637–645
Ferrar L, Jiang G, Barrington NA, Eastell R (2000) Identification of vertebral deformities in women: comparison of radiological assessment and quantitative morphometry using morphometric radiography and morphometric X-ray absorptiometry. J Bone Miner Res 15:575–585
Ferrar L, Jiang G, Eastell R (2001) Longitudinal evaluation of morphometric X-ray absorptiometry for the identification of vertebral deformities. Osteoporos Int 12:661–671
Finkelstein JS, Klibanski A, Arnold AL, Toth TL, Hornstein MD, Neer RM (1998) Prevention of estrogen deficiency-related bone loss with human parathyroid hormone-(1–34): a randomized controlled trial. JAMA 280:1067–1073
Follin SL, Black JN, McDermott MT (2003) Lack of diagnosis and treatment of osteoporosis in men and women after hip fracture. Pharmacotherapy 23:190–198
Fujita T, Inoue T, Morii H, et al (1999) Effect of an intermittent weekly dose of human parathyroid hormone (1–34) on osteoporosis: a randomized double-masked prospective study using three dose levels. Osteoporos Int 9:296–306
Galante J, Rostoker W, Ray RD (1970) Physical properties of trabecular bone. Calcif Tis Res 5:236–246
Gardner MJ, Flik KR, Mooar P, Lane JM (2002) Improvement in the undertreatment of osteoporosis following hip fracture. J Bone Joint Surg Am 84:1342–1348
Gass R (2001) The early preclinical diagnosis of osteoporosis measuring the pure trabecular bone density. Eur J Med Res 6:228–230
Geusens P, Autier P, Boonen S, Vanhoof J, Declerck K, Raus JN (2002) The relationship among history of falls, osteoporosis, and fractures in postmenopausal women. Arch Phys Med Rehabil 83:903–906
Giannoukos G, Williams LJ, Chilco PJ, Abou-Samra AB (1999) Characterization of an element within the rat parathyroid hormone/parathyroid hormone-related peptide receptor gene promoter that enhances expression in osteoblastic osteosarcoma 17/2.8 cells. Biochem Biophys Res Commun 258:336–340
Gonnelli S, Cepollaro C, Montagnani A, et al (2003) Alendronate treatment in men with primary osteoporosis: a three-year longitudinal study. Calcif Tissue Int
Grados F, Fardellone P, Benammar M, Muller C, Roux C, Sebert JL (1999) Influence of age and sex on vertebral shape indices assessed by radiographic morphometry. Osteoporos Int 10:450–455
Greenspan SL, von Stetten E, Emond SK, Jones L, Parker RA (2001) Instant vertebral assessment: a noninvasive dual X-ray absorptiometry technique to avoid misclassification and clinical mismanagement of osteoporosis. J Clin Densitom 4:373–380
Greenspan SL, Bone G 3rd, Schnitzer TJ, et al (2002) Two-year results of once-weekly administration of alendronate 70 mg for the treatment of postmenopausal osteoporosis. J Bone Miner Res 17:1988–1996
Guermazi A, Mohr A, Grigorian M, Taouli B, Genant HK (2002) Identification of vertebral fractures in osteoporosis. Sem Musculoskeletal Radiol 6:241–252
Harris ST, Watts NB, Genant HK, et al (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 282:1344–1352
Hasserius R, Karlsson MK, Nilsson BE, Redlund-Johnell I, Johnell O (2003) Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int 14:61–68
Hayes WC, Myers ER, Robinovitch SN, van den Kroonenberg A, Courtney A, McMahon T (1996) Etiology and prevention of age-related hip fractures
Heijckmann AC, Juttmann JR, Wolffenbuttel BH (2002) Intravenous pamidronate compared with oral alendronate for the treatment of postmenopausal osteoporosis. Neth J Med 60:315–319
Holzer G, Majeska RJ, Lundy MW, Hartke JR, Einhorn TA (1999) Parathyroid hormone enhances fracture healing. A preliminary report. Clin Orthop 258–263
Horwitz MJ, Tedesco MB, Gundberg C, Garcia-Ocana A, Stewart AF (2003) Short-term, high-dose parathyroid hormone-related protein as a skeletal anabolic agent for the treatment of postmenopausal osteoporosis. J Clin Endocrinol Metab 88:569–575
Ito M, Tsurusaki K, Hayashi K (1997) Peripheral QCT for the diagnosis of osteoporosis. Osteoporos Int 7 [Suppl 3]:120–127
Jahng JS, Kim HW (2000) Effect of intermittent administration of parathyroid hormone on fracture healing in ovariectomized rats. Orthopedics 23:1089–1094
Jalava T, Sarna S, Pylkkanen L, et al (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18:1254–1260
Jordan KM, Cooper C (2002) Epidemiology of osteoporosis Best Pract Res Clin Rheumatol 16:795–806
Kado DM, Duong T, Stone KL, Ensrud KE, et al (2003) Incident vertebral fractures and mortality in older women: a prospective study. Osteoporosis Int 14:589–594
Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936
Kelly CM, Wilkins RM, Gitelis S, Hartjen C, Watson JT, Kim PT (2001) The use of a surgical grade calcium sulfate as a bone graft substitute: results of a multicenter trial. Clin Orthop 42–50
Kessenich CR (1998) Tai Chi as a method of fall prevention in the elderly. Orthop Nurs 17:27–29
Lane JM (1997) Osteoporosis. Medical prevention and treatment. Spine 22:32S-37S
Lane JM, Nydick M (1999) Osteoporosis: current modes of prevention and treatment. J Am Acad Orthop Surg 7:19–31
Lieberman JR, Le LQ, Wu L, et al (1998) Regional gene therapy with a BMP-2-producing murine stromal cell line induces heterotopic and orthotopic bone formation in rodents. J Orthop Res 16:330–339
Liberman UA, Weiss SR, Broll J, et al (1995) Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med 333:1437–1443
Lin JT, van der Meulen MCH, Myers ER, Lane JM (2003) Fracture evaluation and clinical complications. In: Favus MJ (ed) Primer on the metabolic bone diseases and disorders of mineral metabolism, 5th edn. (in press)
Lin JT, Backus S, Meyers E, Peterson M, Lane JM (2003) Six minute walk test: a new powerful predictor of functional dysfunction in osteoporotic patients with and without vertebral fractures (abstract). J Bone Min Res (in press)
Lindsay R, Hart DM, Forrest C, Baird C (1980) Prevention of spinal osteoporosis in oophorectomised women. Lancet 2:1151–1154
Lindsay R, Silverman SL, Cooper C, Hanley DA, et al (2002) Risk of new vertebral fracture in the year following fracture. JAMA 17:285:320–323
Liu G, Peacock M, Eilam O, Dorulla G, Braunstein E, Johnston CC (1997) Effect of osteoarthritis in the lumbar spine and hip on bone mineral density and diagnosis of osteoporosis in elderly men and women. Osteoporos Int 7:564–569
Lofman O, Larsson L, Toss G (2000) Bone mineral density in diagnosis of osteoporosis: reference population, definition of peak bone mass, and measured site determine prevalence. J Clin Densitom 3:177–186
Looker AC, Johnston CC Jr, Wahner HW, et al Prevalence of low femoral bone density in older US women from NHANES III (1995) J Bone Miner Res 10:796–802
Luckey MM, Gilchrist N, Bone HG, et al (2003) Therapeutic equivalence of alendronate 35 milligrams once weekly and 5 milligrams daily in the prevention of postmenopausal osteoporosis. Obstet Gynecol 101:711–721
Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259
Matthis C, Weber U, O’Neill TW, Raspe H (1998) Health impact associated with vertebral deformities: results from the European Vertebral Osteoporosis Study (EVOS). Osteoporos Int 8:364–372
Melton LJ 3rd, Chrischilles EA, Cooper C, Lane AW, Riggs BL (1992) Perspective. How many women have osteoporosis? J Bone Miner Res 7:1005–1010
Melton LJ 3rd, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221
Miller PD (2001) New possibilities for diagnosis and treatment of osteoporosis. Int J Fertil Womens Med 46:215–221
Moro M, Hecker AT, Bouxsein ML, Myers ER (1995) Failure load of thoracic vertebrae correlates with lumbar bone mineral density measured by DXA. Calcif Tissue Int 56:206–209
Nakajima A, Shimoji N, Shiomi K, et al (2002) Mechanisms for the enhancement of fracture healing in rats treated with intermittent low-dose human parathyroid hormone (1–34). J Bone Miner Res 17:2038–2047
Neer RM, Arnaud CD, Zanchetta JR, 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
Neuner JM, Zimmer JK, Hamel MB (2003) Diagnosis and treatment of osteoporosis in patients with vertebral compression fractures. J Am Geriatr Soc 51:483–491
Nordin BE, Morris HA (1989) The calcium deficiency model for osteoporosis. Nutr Rev 47:65–72
O’Gradaigh D, Debiram I, Love S, Richards HK, Compston JE (2003) A prospective study of discordance in diagnosis of osteoporosis using spine and proximal femur bone densitometry. Osteoporos Int 14:13–18
Okazaki K, Jingushi S, Ikenoue T, Urabe K, Sakai H, Iwamoto Y (2003) Expression of parathyroid hormone-related peptide and insulin-like growth factor I during rat fracture healing. J Orthop Res 21:511–520
Orwoll E, Ettinger M, Weiss S, et al (2000) Alendronate for the treatment of osteoporosis in men. N Engl J Med 343:604–610
Osteoporosis prevention, diagnosis, and therapy (2000) NIH Consensus Statement 17:1–45
Owens JM, Fuller K, Chambers TJ (1997) Osteoclast activation: potent inhibition by the bisphosphonate alendronate through a nonresorptive mechanism. J Cell Physiol 172:79–86
Paganini-Hill A, Chao A, Ross RK, Henderson BE (1991) Exercise and other factors in the prevention of hip fracture: the Leisure World study. Epidemiology 2:16–25
Park J, Ries J, Gelse K, et al (2003) Bone regeneration in critical size defects by cell-mediated BMP-2 gene transfer: a comparison of adenoviral vectors and liposomes. Gene Ther 10:1089–1098
Pasquini GM, Davey RA, Ho PW, et al (2002) Local secretion of parathyroid hormone-related protein by an osteoblastic osteosarcoma (UMR 106–01) cell line results in growth inhibition. Bone 31:598–605
Peter CP, Cook WO, Nunamaker DM, Provost MT, Seedor JG, Rodan GA (1996) Effect of alendronate on fracture healing and bone remodeling in dogs. J Orthop Res 14:74–79
Rea JA, Chen MB, Li J, et al (2000) Morphometric X-ray absorptiometry and morphometric radiography of the spine: a comparison of prevalent vertebral deformity identification. J Bone Miner Res 15:564–574
Rea JA, Chen MB, Li J, et al (2001) Vertebral morphometry: a comparison of long-term precision of morphometric X-ray absorptiometry and morphometric radiography in normal and osteoporotic subjects. Osteoporos Int 12:158–166
Recker RR, Hinders S, Davies KM, et al (1996) Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res 11:1961–1966
Riew KD, Wright NM, Cheng S, Avioli LV, Lou J (1998) Induction of bone formation using a recombinant adenoviral vector carrying the human BMP-2 gene in a rabbit spinal fusion model. Calcif Tissue Int 63:357–360
Ross PD (1996) Osteoporosis. Frequency, consequences, and risk factors. Arch Intern Med 156:1399–1411
Saag KG, Emkey R, Schnitzer TJ, et al (1998) Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. Glucocorticoid-Induced Osteoporosis Intervention Study Group. N Engl J Med 339:292–299
Sahota O(2000) Osteoporosis and the role of vitamin D and calcium-vitamin D deficiency, vitamin D insufficiency, and vitamin D sufficiency. Age Ageing 29:301–304
Sarkar S, Mitlak BH, Wong M, Stock JL, Black DM, Harper KD (2002) Relationships between bone mineral density and incident vertebral fracture risk with raloxifene therapy. J Bone Miner Res 17:1–10
Schousboe JT, DeBold CR, Bowles C, Glickstein S, Rubino RK (2002) Prevalence of vertebral compression fracture deformity by X-ray absorptiometry of lateral thoracic and lumbar spines in a population referred for bone densitometry. J Clin Densitom 5:239–246
Shields AT, Chesnut CH 3rd (2001) Diagnosis of postmenopausal osteoporosis: reviews in endocrine and metabolic disorders. Rev Endocr Metab Disord 2:23–33
Simkin A, Ayalon J, Leichter I (1987) Increased trabecular bone density due to bone-loading exercises in postmenopausal osteoporotic women. Calcif Tissue Int 40:59–63
Stephenson J (2003) FDA orders estrogen safety warnings: agency offers guidance for HRT use. JAMA 289:537–538
Strocchi R, Orsini G, Iezzi G, et al (2002) Bone regeneration with calcium sulfate: evidence for increased angiogenesis in rabbits. J Oral Implantol 28:273–278
Tinetti ME, Baker DI, Garrett PA, Gottschalk M, Koch ML, Horwitz RI (1993) Yale FICSIT: risk factor abatement strategy for fall prevention. J Am Geriatr Soc 41:315–320
Varady P, Li JZ, Alden TD, Kallmes DF, Williams MB, Helm GA (2002) CT and radionuclide study of BMP-2 gene therapy-induced bone formation. Acad Radiol 9:632–637
Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T (1996) Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and injuries: cooperative studies of intervention techniques. J Am Geriatr Soc 44:489–497
Wu G (2002) Evaluation of the effectiveness of Tai Chi for improving balance and preventing falls in the older population — a review. J Am Geriatr Soc 50:746–754
Zerath E, Holy X, Noel B, Malouvier A, Hott M, Marie PJ (1998) Effects of BMP-2 on osteoblastic cells and on skeletal growth and bone formation in unloaded rats. Growth Horm IGF Res 8:141–149
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Lane, J.M., Gardner, M.J., Lin, J.T. et al. The aging spine: new technologies and therapeutics for the osteoporotic spine. Eur Spine J 12 (Suppl 2), S147–S154 (2003). https://doi.org/10.1007/s00586-003-0636-6
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DOI: https://doi.org/10.1007/s00586-003-0636-6