Osteoporosis and Other Disorders of Skeletal Aging

  • Diane E. Meier


Skeletal pathology is a leading cause of serious morbidity and functional loss in old age. However, it is difficult to distinguish between disease and normal age changes in the clinical approach to bone disorders, and this has led to substantial controversy over the diagnosis and treatment of the most common metabolic bone disease, osteoporosis. For example, loss of skeletal calcium is a nearly universal concomitant of aging independent of body size, race, or gender, but the process does not become pathologic until it is of sufficient magnitude to lead to osteoporotic fracture, with associated adverse consequences such as pain, immobility, deformity, and (in the case of hip fracture) premature death.


Bone Loss Bone Mass Vertebral Fracture Endometrial Cancer Postmenopausal Osteoporosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Rodin A, Murby B, Smith MA, et al. Premenopausal bone loss in the lumbar spine and neck of femur: a study of 225 caucasian women. Bone. 1990; 11: 1–50.PubMedCrossRefGoogle Scholar
  2. 2.
    Falch JA, Sandvik L. Perimenopausal appendicular bone loss: a 10 year prospective study. Bone. 1990; 11: 425–428.PubMedCrossRefGoogle Scholar
  3. 3.
    Riggs BL, Melton LJ III. The prevention and treatment of osteoporosis. N Engl J Med. 1992; 327: 620–627.PubMedCrossRefGoogle Scholar
  4. 4.
    Riggs BL, Melton LJ III. Involutional osteoporosis. N Engl J Med. 1986; 314: 1676–1686.PubMedCrossRefGoogle Scholar
  5. 5.
    Gallagher JC, Riggs BL, Eisman J, et al. Intestinal calcium absorption and serum vitamin D metabolites in normal subjects and osteoporotic patients: effect of age and dietary calcium. J Clin Invest. 1979; 64: 729–734.PubMedCrossRefGoogle Scholar
  6. 6.
    Parfitt AM. Bone remodeling: relationship to the amount and structure of bone, and the pathogenesis and prevention of fractures. In: Riggs BL, Melton LJ III, eds. Osteoporosis: Etiology, Diagnosis and Management. New York: Raven Press; 1988: 45–93.Google Scholar
  7. 7.
    Osteoporosis. In: Berg RL, Cassells JS, eds. The Second Fifty Years: Promoting Health and Preventing Disability. Washington, DC: National Academy Press; 1990: 76–100.Google Scholar
  8. 8.
    Cummings SR, Kelsey JL, Nevitt MC, O’Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev. 1985; 7: 178–208.PubMedGoogle Scholar
  9. 9.
    Jensen GF, Christiansen C, Boesen J, et al. Epidemiology of postmenopausal spinal and long bone fractures: a unifying approach to postmenopausal osteoporosis. Clin Orthop. 1966; 45: 31–36.Google Scholar
  10. 10.
    Ryan PJ, Blake G, Herd R, Fogelman I. A clinical profile of back pain and disability in patients with osteoporosis. Bone. 1994; 15: 27–30.PubMedCrossRefGoogle Scholar
  11. 11.
    Owen RA, Melton LJ, Johnson KA, et al. Incidence of Colles’ fracture in a North American community. Am J Public Health. 1982; 72: 604–607.CrossRefGoogle Scholar
  12. 12.
    Kanis JA, Pitt FA. Epidemiology of osteoporosis. Bone. 1992; 13: S7 - S15.PubMedCrossRefGoogle Scholar
  13. 13.
    Gallagher JC, Melton LJ, Riggs BL. Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop. 1980; 150: 163–171.PubMedGoogle Scholar
  14. 14.
    Melton LJ, Ilstrup M, Riggs B, et al. Fifty year trend in hip fracture incidence. Clin Orthop. 1982; 62: 144–149.Google Scholar
  15. 15.
    Wallace W. The increasing incidence of fractures of the proximal femur: an orthopedic epidemic. Lancet. 1983; 2: 1413–1414.CrossRefGoogle Scholar
  16. 16.
    Heyse SP. Epidemiology of hip fractures in the elderly: a cross-national analysis of mortality rates for femoral neck fractures. Osteoporosis Int. 1993;(suppl 1):516–19.Google Scholar
  17. 17.
    Eriksen EF, Colvard DS, Berg NJ, et al. Evidence of estrogen receptors in normal human osteoblast-like cells. Science. 1988; 241: 84–86.PubMedCrossRefGoogle Scholar
  18. 18.
    Komm BS, Terpening CM, Benz DJ, et al. Estrogen binding, receptor mRNA, and biologic response in osteoblastlike osteosarcoma cells. Science. 1988;241:84.Google Scholar
  19. 19.
    Cummings SR. Epidemiology of osteoporotic fractures: Selected topics. In: Roche AF, ed. Osteoporosis: Current Concepts. Report of the 7th Ross Conference on Medical Research. Columbus, OH: Ross Laboratories; 1987: 3–8.Google Scholar
  20. 20.
    Williams AR, Weiss NS, Ure CL, et al. Effect of weight, smoking, and estrogen use on the risk of hip and forearm fractures in post-menopausal women. Obstet Gynecol. 1982; 60: 695–699.PubMedGoogle Scholar
  21. 21.
    Heaney RP, Gallagher JC, Johnston CC, et al. Calcium nutrition and bone health in the elderly. Am J Clin Nutr. 1982; 36: 986–1013.PubMedGoogle Scholar
  22. 22.
    Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. N Engl J Med. 1995; 332: 767–773.PubMedCrossRefGoogle Scholar
  23. 23.
    Slemenda CW, Hui SL, Longcope C, Wellman H, Johnston CC. Predictors of bone mass in perimenopausal women. Ann Intern Med. 1990; 112: 96–101.PubMedGoogle Scholar
  24. 24.
    Hui SL, Slemenda CW, Johnston CC. Baseline measurement of bone mass predicts fracture in white women. Ann Intern Med. 1989; 111: 355–361.PubMedGoogle Scholar
  25. 25.
    Cummings SR, Black DM, Nevitt MC, et al. Appendicular bone mass and age predict hip fracture in women. JAMA. 1990; 263: 665–668.PubMedCrossRefGoogle Scholar
  26. 26.
    Wasnich RD, Ross PD, Heilbrun LK, Vogel JM. Prediction of postmenopausal fracture risk with use of bone mineral measurements. Am J Obstet Gynecol. 1985; 153: 745–751.PubMedGoogle Scholar
  27. 27.
    Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet. 1993; 341: 72–75.PubMedCrossRefGoogle Scholar
  28. 28.
    Faulkner KG, Cummings SR, Black D, Palermo L, Gluer GL, Genant HK. Simple measurement of femoral geometry predicts hip fracture: the study of osteoporotic fractures. J Bone Miner Res. 1993; 8: 1211–1217.PubMedCrossRefGoogle Scholar
  29. 29.
    Ross PD, Davis JW, Epstein R, Wasnich RD. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. 1991; 114: 919–923.PubMedGoogle Scholar
  30. 30.
    Wasnich R. Bone mass measurement: prediction of risk. Am J Med. 1993; 95 (suppl 5A): 6S - 10S.PubMedCrossRefGoogle Scholar
  31. 31.
    Nevitt MC, Cummings SR, and Study of Osteoporotic Fractures Research Group. Type of fall and risk of hip and wrist fractures. J Am Geriatr Soc. 1993; 41: 1226–1234.Google Scholar
  32. 32.
    Lyritis GP, Tsakalakos N, Magiasis B, Karachalios T, Yiatzides A, Tsekoura M. Analgesic effect of salmon calcitonin in osteoporotic fractures: a double blind placebo controlled study. Calcif Tissue Int. 1991; 49: 369–372.PubMedCrossRefGoogle Scholar
  33. 33.
    Merli GJ. Prophylaxis for deep vein thrombosis and pulmonary embolism in the geriatric patient undergoing surgery. Clin Geriatr Med. 1990; 6: 531–542.PubMedGoogle Scholar
  34. 34.
    Hull RD, Raskob GE, Hirsh J. Prophylaxis of venous thromboembolism: an overview. Chest. 1986; 89 (suppl): 374S - 383S.PubMedGoogle Scholar
  35. 35.
    Riggs BL, Wahner HW. Bone densitometry and clinical decision-making in osteoporosis (editorial). Ann Intern Med. 1988; 108: 293–295.PubMedGoogle Scholar
  36. 36.
    Lindsay R. Osteoporosis. Clin Geriatr Med. 1988; 4: 41 1430.Google Scholar
  37. 37.
    Johnston CC Jr, Slemenda CW, Melton LJ III. Clinical use of bone densitometry. N Engl J Med. 1991; 324: 1105–1109.PubMedCrossRefGoogle Scholar
  38. 38.
    Mazess RB, Barden H, Ettinger M, Schultz E. Bone density of the radius, spine, and proximal femur in osteoporosis. J Bone Miner Res. 1988; 3: 13–18.PubMedCrossRefGoogle Scholar
  39. 39.
    Chestnut CH. The imaging and quantitation of bone by radiographic and scanning methodologies. In: Coe FL, Favus MJ, eds. Disorders of Bone and Mineral Metabolism. New York: Raven Press; 1992: 447–448.Google Scholar
  40. 40.
    Pacifici R, Rupich R, Griffin M, Chines A, Susman N, Avioli LV. Dual energy radiography vs. quantitative computer tomography for the diagnosis of osteoporosis. J Clin Endocrinol Metab. 1990; 70: 705–710.PubMedCrossRefGoogle Scholar
  41. 41.
    Ettinger B, Grady D. The waning effect of postmenopausal estrogen therapy on osteoporosis. N Engl J Med. 1993; 329: 1192–1193.PubMedCrossRefGoogle Scholar
  42. 42.
    Heaney RP. Nutritional factors in osteoporosis. Annu Rev Nutr. 1993; 13: 287–316.PubMedCrossRefGoogle Scholar
  43. 43.
    Dawson-Hughes B. Calcium supplementation and bone loss: a review of controlled clinical trials. Am J Clin Nutr. 1991; 54: 274S - 280S.PubMedGoogle Scholar
  44. 44.
    Cumming RG. Calcium intake and bone mass: a quantitative review of the evidence. Calcif Tissue Int. 1990; 47: 194201.Google Scholar
  45. 45.
    Johnston CC, Miller JZ, Slemenda CW, et al. Calcium supplementation and increases in bone mineral density in children. N Engl J Med. 1992; 327: 82–87.PubMedCrossRefGoogle Scholar
  46. 46.
    Reid IR, Ames RW, Evans MC, Gamble GD, Sharpe SJ. Effect of calcium supplementation on bone loss in postmenopausal women. N Engl J Med. 1993; 328: 460–464.PubMedCrossRefGoogle Scholar
  47. 47.
    Aloia JF, Vaswani A, Yeh JK, Ross PL, Flaster E, Dilmanian FA. Calcium supplementation with and without hormone replacement therapy to prevent postmenopausal bone loss. Ann Intern Med. 1994; 120: 97–103.PubMedGoogle Scholar
  48. 48.
    Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med. 1992; 327: 1637–1642.PubMedCrossRefGoogle Scholar
  49. 49.
    Mckenna MJ. Differences in vitamin D status between countries in young adults and elderly. Am J Med. 1992; 93: 69–77.CrossRefGoogle Scholar
  50. 50.
    Heaney RP, Rocker RR, Saville PD. Calcium balance and calcium requirement in middle aged women. Am J Clin Nutr. 1977; 30: 1603–1611.PubMedGoogle Scholar
  51. 51.
    Chestnut CH. Bone mass and exercise. Am J Med. 1993; 95 (5A): 34S - 36S.CrossRefGoogle Scholar
  52. 52.
    Dalsky GP, Stocke KS, Ehsani AA, et al. Weight bearing exercise training and lumbar bone mineral content in postmenopausal women. Ann Intern Med. 1988; 108: 824828.Google Scholar
  53. 53.
    Krall EA, Dawson-Hughes B. Walking is related to bone density and rate of bone loss. Am J Med. 1994; 96: 20–26.PubMedCrossRefGoogle Scholar
  54. 54.
    Drinkwater BD, Nilson KC, Chestnut CH. Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med. 1984; 311: 277–281.PubMedCrossRefGoogle Scholar
  55. 55.
    Drinkwater BL. Exercise in the prevention of osteoporosis. Osteoporosis Int. 1993; 1: S169–171.CrossRefGoogle Scholar
  56. 56.
    Heaney RP, Recker RR, Saville PD. Menopausal changes in bone remodeling. J Lab Clin Med. 1978; 92: 964–970.PubMedGoogle Scholar
  57. 57.
    Nachtigall LE, Nachtigall RH, Nachtigall RD. Estrogen replacement therapy I: a 10 year prospective study in the relationship of osteoporosis. Obstet Gynecol. 1979; 53: 277284.Google Scholar
  58. 58.
    Lindsay R, Hart DM, MacLean A, et al. Bone response to termination of estrogen treatment. Lancet. 1978; 1: 1325 1327.Google Scholar
  59. 59.
    Horowitz MC. Cytokines and estrogen in bone: antiosteoporotic effects. Science. 1993; 206: 626–627.CrossRefGoogle Scholar
  60. 60.
    Marcus R, Cann C, Madvig P, et al. Menstrual function and bone mass in elite women distance runners. Ann Intern Med. 1985; 102: 158–163.PubMedGoogle Scholar
  61. 61.
    Ettinger B, Genant HK, Cann CE. Long term estrogen therapy prevents bone loss and fracture. Ann Intern Med. 1985; 102: 319–324.PubMedGoogle Scholar
  62. 62.
    Hutchinson TA, Polansky JM, Feinstein AR. Postmenopausal oestrogens protect against fracture of the hip and distal radius. Lancet. 1979; 2: 705–709.PubMedCrossRefGoogle Scholar
  63. 63.
    Kreiger N, Kelsey JL, Holford TR. An epidemiological study of hip fracture in postmenopausal women. Am J Epidemiol. 1982; 116: 141–148.PubMedGoogle Scholar
  64. 64.
    Smith DM, Khairi MRA, Johnston CC. The loss of bone mineral with aging and its relationship to risk of fracture. J Clin Invest. 1975; 56: 311–318.PubMedCrossRefGoogle Scholar
  65. 65.
    Weiss NS, Ure CL, Ballard JH, Williams AR, Daling JR. Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen. N Engl J Med. 1980; 303: 1195–1198.PubMedCrossRefGoogle Scholar
  66. 66.
    Lindsay R, Tohme JF. Estrogen treatment of patients with established osteoporosis. Obstet Gynecol. 1990; 76: 290295.Google Scholar
  67. 67.
    Lufkin EG, Wahner HW, O’Fallon WM, et al. Treatment of postmenopausal osteoporosis with transdermal estrogen. Ann Intern Med. 1992; 117: 1–9.PubMedGoogle Scholar
  68. 68.
    Lobo RA. Cardiovascular implications of estrogen replacement therapy. Obstet Gynecol. 1990;75(suppl):18S255.Google Scholar
  69. 69.
    Barrett-Connor E, Bush TL. Estrogen and coronary heart disease in women. JAMA. 1991; 265: 1861–1867.PubMedCrossRefGoogle Scholar
  70. 70.
    Stampfer MJ, Colditz GA, Willett WC, et al. Postmenopausal estrogen therapy and cardiovascular disease-ten year follow-up from the Nurses’ Health Study. N Engl J Med. 1991; 325: 756–762.PubMedCrossRefGoogle Scholar
  71. 71.
    Williams JK, Adams MR, Klopfenstein HS. Estrogen modulates responses of atherosclerotic coronary arteries. Circulation. 1990; 81: 1680–1687.PubMedCrossRefGoogle Scholar
  72. 72.
    Colditz GA, Hankinson SE, Hunter DJ, et al. The use of estrogens and progestins and the risk of breast cancer in postmenopausal women. N Engl J Med. 1995; 332: 1589 1593.Google Scholar
  73. 73.
    Shapiro S, Kelley JP, Rosenberg L. Risk of localized and widespread endometrial cancer in relation to recent and discontinued use of conjugated estrogens. N Engl J Med. 1985; 313: 969–972.PubMedCrossRefGoogle Scholar
  74. 74.
    Horowitz RI, Feinstein AR. Alternative analytic methods for case control studies of estrogens and endometrial cancer. N Engl J Med. 1978; 299: 1088–1094.CrossRefGoogle Scholar
  75. 75.
    Chu J, Schweed AI, Weiss NS. Survival among women with endometrial cancer: a comparison of estrogen users and nonusers. Am J Obstet Gynecol. 1982; 143: 569573.Google Scholar
  76. 76.
    Voight LF, Weiss NS, Chu J, Daling JR, McKnight B, Van Belle G. Progestogen supplementation of exogenous oestrogens and risk of endometrial cancer. Lancet. 1991; 338: 274–277.CrossRefGoogle Scholar
  77. 77.
    Gambrell RD, Massey FM, Castaneda TA, et al. Reduced incidence of endometrial cancer among postmenopausal women treated with progestogens. J Am Geriatr Soc. 1979; 27: 389–394.PubMedGoogle Scholar
  78. 78.
    Grady D, Rubin SM, Petitti DB, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. 1992; 117: 1016–1037.PubMedGoogle Scholar
  79. 79.
    Steinberg KK, Thacker SB, Smith SJ, et al. A meta-analysis of the effect of estrogen replacement therapy on the risk of breast cancer. JAMA. 1991; 265: 1985–1990.PubMedCrossRefGoogle Scholar
  80. 80.
    Colditz GA, Stampfer MJ, Willett WC, et al. Postmenopausal hormone use and the risk of breast cancer: 12 year follow-up of the Nurses’ Health Study. In: Mann RD, ed. Hormone Replacement Therapy and Breast Cancer Risk. Carnforth, England: Parthenon; 1992: 63–77.Google Scholar
  81. 81.
    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.PubMedCrossRefGoogle Scholar
  82. 82.
    Ettinger B, Genant HK, Cann CE. Long term estrogen therapy prevents bone loss and fracture. Ann Intern Med. 1985; 102: 319–324.PubMedGoogle Scholar
  83. 83.
    Ott SM. Estrogen therapy for osteoporosis-even in the elderly. Ann Intern Med. 1992; 117: 85–86.PubMedGoogle Scholar
  84. 84.
    Marx CW, Daily GE, Cheney C, Vint VC, Muchmore DB. Do estrogens improve bone mineral density in osteoporotic women over age 65? J Bone Miner Res. 1992; 7: 1275–1279.PubMedCrossRefGoogle Scholar
  85. 85.
    Felson DT, Zhang Y, Hannan MT, et al. Effect of postmenopausal estrogen therapy on bone density in elderly women. N Engl J Med. 1993; 329: 1141–1146.PubMedCrossRefGoogle Scholar
  86. 86.
    Kiel DP, Felson DT, Anderson JJ, Wilson PWF, Moskowitz MA. Hip fracture and the use of estrogen in postmenopausal women: the Framingham Study. N Engl J Med. 1987; 317: 1169–1174.PubMedCrossRefGoogle Scholar
  87. 87.
    Cauley JA, Seeley DG, Ensrud K, et al. Estrogen replacement therapy and fractures in older women. Ann Intern Med. 1995; 122: 9–16.PubMedGoogle Scholar
  88. 88.
    McDermott MT, Kidd GS. The role of calcitonin in the development and treatment of osteoporosis. Endocr Rev. 1987; 8: 377–390.PubMedCrossRefGoogle Scholar
  89. 89.
    Gruber HE, Ivey JL, Baylink DL, et al. Long term calcitonin therapy in postmenopausal osteoporosis. Metabolism. 1984; 33: 295–303.PubMedCrossRefGoogle Scholar
  90. 90.
    Mazzuoli GF, Passeri M, Gennari C, et al. Effects of salmon calcitonin in postmenopausal osteoporosis: a controlled double-blind clinical study. Calcif Tissue Int. 1986; 38: 3–8.PubMedCrossRefGoogle Scholar
  91. 91.
    Reginster JY. Calcitonin for prevention and treatment of osteoporosis. Am J Med. 1993; 95 (suppl 5A): 44S - 47S.PubMedCrossRefGoogle Scholar
  92. 92.
    Overgaard K, Hansen MA, Jensen SB, Christiansen C. Effect of salcalcitonin given intranasally on bone mass and fracture rates in established osteoporosis: a dose response study. Br Med J. 1992; 305: 56–61.CrossRefGoogle Scholar
  93. 93.
    Kanis JA, Johnell O, Gullberg B, et al. Evidence for efficacy of drugs affecting bone metabolism in preventing hip fracture. Br Med J. 1992; 305: 1124–1128.CrossRefGoogle Scholar
  94. 94.
    Rico H, Hernandez ER, Revilla M, Gomez-Castresana F. Salmon calcitonin reduces vertebral fracture rate in postmenopausal crush fracture syndrome. Bone Miner. 1992; 16: 131–138.PubMedCrossRefGoogle Scholar
  95. 95.
    Wimalawansa SJ. Long and short term side effects and safety of calcitonin in man. Calcif Tissue Int. 1993; 52: 90–93.PubMedCrossRefGoogle Scholar
  96. 96.
    Muff R, Dambacher MA, Fischer JA. Formation of neutralizing antibodies during intranasal synthetic salmon calcitonin treatment of postmenopausal osteoporosis. Osteoporosis Int. 1991; 1: 72–75.CrossRefGoogle Scholar
  97. 97.
    Riggs BL, Hodgson SF, O’Fallon WM, et al. Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med. 1990; 322: 80 2809.Google Scholar
  98. 98.
    Kleerekoper M, Peterson EL, Nelson DA, et al. A randomized trial of sodium fluoride as a treatment for postmenopausal osteoporosis. Osteoporosis Int. 1991; 1: 155–161.CrossRefGoogle Scholar
  99. 99.
    Pak CYC, Sakhaee K, Adams-Huet B, et al. Treatment of postmenopausal osteoporosis with slow-release sodium fluoride: final report of a randomized controlled trial. Ann Intern Med. 1995; 123: 401–408.PubMedGoogle Scholar
  100. 100.
    O’Duffy JD, Wahner HW, O’Fallon WM, et al. Mechanism of acute lower extremity pain syndrome in fluoridetreated osteoporotic patients. Am J Med. 1986; 80: 561–566.PubMedCrossRefGoogle Scholar
  101. 101.
    Baylink DJ, Ivey JL. Sodium fluoride for osteoporosis-some unanswered questions. JAMA. 1980; 245: 463–464.CrossRefGoogle Scholar
  102. 102.
    Wasnich RD, Benfante RJ, Yano K, et al. Thiazide effect on the mineral content of bone. N Engl J Med. 1983; 309: 344–347.PubMedCrossRefGoogle Scholar
  103. 103.
    Wasnich RD, Ross PD, Heilbrun LK, et al. Differential effects of thiazide and estrogen upon bone mineral content and fracture prevalence. Obstet Gynecol. 1986; 67: 457–462.PubMedGoogle Scholar
  104. 104.
    Wasnich R, Davis J, Ross P, Vogel J. Effect of thiazide on rates of bone mineral loss: a longitudinal study. Br Med J. 1990; 301: 1303–1305.CrossRefGoogle Scholar
  105. 105.
    Cauley JA, Cummings SR, Seeley DG, et al. Effects of thiazide diuretic therapy on bone mass, fractures and falls. Ann Intern Med. 1993; 118: 666–673.PubMedGoogle Scholar
  106. 106.
    LaCroix AZ, Weinpahl J, White LR, et al. Thiazide diuretic agents and the incidence of hip fracture. N Engl J Med. 1990; 322: 286–290.PubMedCrossRefGoogle Scholar
  107. 107.
    Felson DT, Sloutskis D, Anderson JJ, et al. Thiazide diuretics and the risk of hip fracture. Results from the Framingham Study. JAMA. 1991; 265: 370–373.PubMedCrossRefGoogle Scholar
  108. 108.
    Ray WA, Griffin MR, Downey W. Long term-use of thiazide diuretics and risk of hip fracture. Lancet. 1989; 1: 687–690.PubMedCrossRefGoogle Scholar
  109. 109.
    Heidrich FE, Stergachis A, Gross KM. Diuretic drug use and the risk for hip fracture. Ann Intern Med. 1991; 115: 1–6.PubMedGoogle Scholar
  110. 110.
    Multiple Risk Factor Intervention Trial Research Group. Multiple risk factor intervention trial: risk factor changes and mortality results. JAMA. 1982; 248: 1465–1477.CrossRefGoogle Scholar
  111. 111.
    Thapa PB, Ray WA. Can thiazide diuretics be recommended routinely to reduce hip fracture risk? Drugs Aging 1993; 3: 99–105.PubMedCrossRefGoogle Scholar
  112. 112.
    Papapoulos SE. The role of bisphosphonates in the prevention and treatment of osteoporosis. Am J Med. 1993; 95 (suppl 5A): 48S - 52S.PubMedCrossRefGoogle Scholar
  113. 113.
    Harris ST, Watts NB, Jackson RD, et al. Four-year study of intermittent cyclic etidronate treatment of postmenopausal osteoporosis: three years of blinded therapy followed by one year of open therapy. Am J Med. 1993; 95: 557–567.PubMedCrossRefGoogle Scholar
  114. 114.
    Storm T, Thamsborg G, Steiniche T, et al. Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. N Engl J Med. 1990; 332: 1265–1271.CrossRefGoogle Scholar
  115. 115.
    Liberman UA, Weiss SR, et al. Effect of treatment with oral alendronate on bone mineral density and fracture incidence in postmenopausal osteoporosis. N Engl J Med. 1995; 333; 1437–1443.PubMedCrossRefGoogle Scholar
  116. 116.
    Struys A. Snelder AA, Mulder H. Cyclical etidronate reverses bone loss of the spine and proximal femur in patients with established corticosteroid-induced osteoporosis. Am J Med. 1995; 99: 235–242.CrossRefGoogle Scholar
  117. 117.
    Riggs BL. Formation stimulating regimens other than sodium fluoride. Am J Med. 1993; 95 (suppl 5A): 62S - 68S.PubMedCrossRefGoogle Scholar
  118. 118.
    Slovik DM, Adams JS, Neer RM, et al. Deficient production of 1,25 dihydroxy vitamin D in elderly osteoporotic patients. N Engl J Med. 1981; 305: 37 2374.Google Scholar
  119. 119.
    Brandi ML. New treatment strategies: ipriflavone, strontium, vitamin D metabolites and analogs. Am J Med. 1993; 95 (suppl 5A): 69S - 74S.PubMedCrossRefGoogle Scholar
  120. 120.
    Heikinheimo RJ, Inkovaara JA, Hurju EJ, et al. Annual injection of vitamin D and fractures of aged bones. Calcif Tissue Int. 1992; 51: 105–110.PubMedCrossRefGoogle Scholar
  121. 121.
    Sambrook P, Birmingham J, Kelly P. Prevention of corticosteroid osteoporosis: a comparison of calcium, calcitriol and calcitonin. N Engl J Med. 1993; 328: 1747–1752.PubMedCrossRefGoogle Scholar
  122. 122.
    Reid IR. Steroid osteoporosis. Osteoporosis Int. 1993; (suppl 1):S 144–146.Google Scholar
  123. 123.
    Diamond T, McGuigan L, Barbagello S, Bryant C. Cyclical etidronate plus ergocalciferol prevents glucocorticoidinduced bone loss in postmenopausal women. Am J Med. 1995; 98: 459–463.PubMedCrossRefGoogle Scholar
  124. 124.
    Seeman E, Melton LJ, O’Fallon WM, et al. Risk factors for spinal osteoporosis in men. Am J Med. 1983; 75: 977983.Google Scholar
  125. 125.
    Kelepouris N, Harper KD, Gannon F, et al. Severe osteoporosis in men. Ann Intern Med. 1995; 123: 45 2460.Google Scholar
  126. 126.
    Orwoll ES, Oviatt SK, McClung MR, et al. The rate of bone mineral loss in normal men and the effects of calcium and cholecalciferol supplementation. Ann Intern Med. 1990; 112: 29–34.PubMedGoogle Scholar
  127. 127.
    Seeman E. Osteoporosis in men: epidemiology, pathophysiology, and treatment possibilities. Am J Med. 1993; 95 (suppl 5A): 25S - 28S.CrossRefGoogle Scholar
  128. 128.
    Frame B, Parfitt AM. Osteomalacia: current concepts. Ann Intern Med. 1978; 89: 976–982.Google Scholar
  129. 129.
    Holick MF. Vitamin D requirements for the elderly. Clin Nutr. 1986; 5: 121–129.Google Scholar
  130. 130.
    Bingham CT, Fitzpatrick LA. Noninvasive testing in the diagnosis of osteomalacia. Am J Med. 1993; 95: 519523.Google Scholar
  131. 131.
    Heath H, Hodgson SF, Kennedy MA. Primary hyperparathyroidism. Incidence, morbidity and potential economic impact in a community. N Engl J Med. 1980; 302: 189–193.PubMedCrossRefGoogle Scholar
  132. 132.
    Solomon BL, Schaaf M, Smallridge RC. Psychologie symptoms before and after parathyroid surgery. Am J Med. 1994; 96: 101–106.PubMedCrossRefGoogle Scholar
  133. 133.
    Mallette LE. Primary hyperparathyroidism: clinical and biochemical features. Medicine. 1974; 53: 127–146.PubMedCrossRefGoogle Scholar
  134. 134.
    Karpati G, Frame B. Neuropsychiatrie disorders in primary hyperparathyroidism. Arch Neurol. 1964; 10: 387–397.PubMedCrossRefGoogle Scholar
  135. 135.
    Clarke OH, Wilkes W, Siperstein AE, Duh QY. Diagnosis and management of asymptomatic hyperparathyroidism: safety, efficacy, and deficiencies in our knowledge. J Bone Miner Res. 1991; 6: 135–142.CrossRefGoogle Scholar
  136. 136.
    Consensus Development Conference Panel 1991. Diagnosis and management of asymptomatic primary hyperparathyroidism: Consensus development conference statement. Ann Intern Med. 1991; 114: 593–597.Google Scholar
  137. 137.
    Marcus R, Madvig P, Crim M, et al. Conjugated estrogens in the treatment of postmenopausal women with hyperparathyroidism. Ann Intern Med. 1984; 100: 633–640.PubMedGoogle Scholar
  138. 138.
    Selby PL, Peacock M. Ethinyl estradiol and norethindrone in the treatment of primary hyperparathyroidism in postmenopausal women. N Engl J Med. 1986; 314: 1481–1485.PubMedCrossRefGoogle Scholar
  139. 139.
    McDermott MT, Perloff JJ, Kidd GS. Effect of mild asymptomatic primary hyperparathyroidism on bone mass in women with and without estrogen replacement therapy. J Bone Miner Res. 1994; 9: 509–514.PubMedCrossRefGoogle Scholar
  140. 140.
    Cosman F, Shen V, Xie F, Seibel M, Ratcliffe A, Lindsay R. Estrogen protection against bone resorbing effects of parathyroid hormone infusion. Ann Intern Med. 1993; 118: 337–343.PubMedGoogle Scholar
  141. 141.
    Scholz DA, Purnell DC. Asymptomatic primary hyperparathyroidism-10 year prospective study. Mayo Clin Proc. 1981; 56: 473–478.PubMedGoogle Scholar
  142. 142.
    Singer FR, Wallach S. Paget’s Disease of Bone. New York: Elsevier; 1991.Google Scholar
  143. 143.
    Singer FR, Fredericks RS, Minkin C. Salmon calcitonin therapy for Paget’s disease of bone. The problem of acquired clinical resistance. Arthritis Rheum. 1980; 23: 1143 1154.Google Scholar
  144. 144.
    Hosking DJ. Advances in the management of Paget’s disease of bone. Drugs. 1990; 40: 829–840.PubMedCrossRefGoogle Scholar
  145. 145.
    Patel S, Stone MD, Coupland C, Hosking DJ. Determinants of remission of Paget’s disease of bone. J Bone Miner Res. 1993; 8: 1467–1473.PubMedCrossRefGoogle Scholar
  146. 146.
    Reginster JY, Treves R, Renier JC, et al. Efficacy and tolerability of a new formulation of oral tiludronate in the treatment of Paget’s disease of bone. J Bone Miner Res. 1994; 9: 615–619.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Diane E. Meier

There are no affiliations available

Personalised recommendations