Seven Secrets To Reverse Your Osteopenia
All women should be counseled about the risk factors for osteoporosis, especially smoking cessation and limiting alcohol. All women should be encouraged to participate in regular weight-bearing and exercise. B. Measurement of BMD is recommended for all women 65 years and older regardless of risk factors. BMD should also be measured in all women under the age of 65 years who have one or more risk factors for osteoporosis (in addition to menopause). The hip is the recommended site of measurement. C. All adults should be advised to consume at least 1,200 mg of calcium per day and 400 to 800 IU of vitamin D per day. A daily multivitamin (which provides 400 IU) is recommended. In patients with documented vitamin D deficiency, osteoporosis, or previous fracture, two multivitamins may be reasonable, particularly if dietary intake is inadequate and access to sunlight is poor.
Osteopenia is prevalent in diet-treated persons with PKU from early life. Reduced bone mineral density and or bone mass has been detected in up to approximately 50 of patients screened by various methods. These methods have included DEXA (dual energy X-ray absorptiometry), pQCT (peripheral quantitative computed tomography), and SPA (single photon absorptiometry). The defect seems to be characterized by a reduction in the speed of bone mineralization, especially after 8 years of age. Osteoporosis is an important cause of morbidity and mortality in older adults in the general population. Reduction in bone mass increases the risk of fracture. A reduction of one The pathogenesis of osteopenia in PKU is under study. Discrepant associations have been reported between osteopenia and blood phenylalanine levels, serum vitamin and mineral levels, protein, vitamin and mineral intakes, serum markers of bone formation and PTH, and ratio of urinary minerals, to creatinine. One theory is that...
In summary, several practices can be adopted to assist in the prevention of osteoporosis. From a nutritional standpoint an emphasis should be made on adequate intakes of calcium, vitamin D and a balanced diet that meets the requirements of other essential bone-related minerals and nutrients (detailed in Table 1). A healthy body weight should be achieved and maintained throughout the life cycle. Age-appropriate physical activity and exercise programs should be promoted to maintain fitness, muscle strength and weight bearing activities. Lifestyle habits that adversely impact bone health, including smoking and excessive alcohol intake, should be avoided. Individuals with risk factors known to increase the risk of low bone mass should discuss these concerns with their physician to identify the need for bone density screening. Appropriate screening will allow for the initiation of medical interventions to maintain or build existing bone mass and reduce the subsequent risk of fragility...
Normal bone density is defined as a bone mineral density (BMD) value within one standard deviation of the mean value in young adults of the same sex and race. B. Osteopenia is defined as a BMD between 1 and 2.5 standard deviations below the mean. C. Osteoporosis is defined as a value more than 2.5 standard deviations below the mean this level is the fracture threshold. These values are referred to as T-scores (number of standard deviations above or below the mean value). E. Biochemical markers of bone turnover. Urinary deoxypyridinoline (DPD) and urinary alpha-1 to alpha-2 N-telopeptide of collagen (NTX) are the most specific and clinically useful markers of bone resorption. Biochemical markers are not useful for the screening or diagnosis of osteoporosis because the values in normal and osteoporosis overlap substantially.
The World Health Organization (WHO) has established criteria for making the diagnosis of osteoporosis, as well as determining levels which predict higher chances of fractures. These criteria are based on comparing bone mineral density (BMD) in a particular patient with those of a 25-year-old female. BMD values which fall well below the average for the 25-year-old female (stated statistically as 2.5 standard deviations below the average) are diagnosed as 'osteo-porotic'. If a patient has a BMD value less than the normal 25-year-old female, but not 2.5 standard deviations below the average, the bone is said to be 'osteopaenic' (means decreased BMD, but not as severe as osteoporosis).
The arthrochalasis type of EDS (the former EDS type VIIA and B) is inherited as an autosomal dominant trait. The clinical hallmark of this type is congenital bilateral hip dislocation.1-18-1 There is also severe generalized joint hypermobility with recurrent dislocations of large and small joints and ligamentous tears. The skin is moderately involved, with skin hyperextensibility, a velvety touch, and poor wound healing with formation of atrophic scars. Other features include easy bruising, muscular hypotonia and delay in gross motor development, kyphoscoliosis and osteopenia with wormian bones and sometimes a history of fractures.
Corticosteroids have a role both in antirejection maintenance and during acute rejection episodes. Corticosteroids inhibit antigen-stimulated I-lymphocyte proliferation and inhibit lymphokine production. A major drawback of the use of steroids is their nonselectivity of immunosuppression, effecting both the cellular and humoral immunity and resulting in significantly increased risk of infection. Other deleterious effects of steroids include osteoporosis, hyperglycemia, hyperkalemia, and growth suppression in children.
Consumption of several servings of milk and other dairy products on a daily basis for all age groups. Despite this recommendation, fluid milk consumption globally has declined over the past decade. However, consumers have continued to ingest large amounts of dairy products including cheese and yogurt as an alternative supplement to the nutritional benefits of milk. Milk and dairy products are an important source of calcium to attain proper bone development and maintenance of bone mineral density. Likewise, milk and dairy products serve as a source of calcium for tooth development and mineralization (Wise et al., 2002).
Whatever the bone osteoporosis and the importance of deformity, the scarf osteotomy regularly provides good results in more than 80 years old patients. 1, 2. Whatever the bone osteoporosis and the importance of deformity, the scarf osteotomy regularly provides good results in more than 80 years old patients.
These agents (eg, leuprolide Lupron , goserelin Zoladex ) inhibit the secretion of gonadotropin. GnRH agonists are contraindicated in pregnancy and have hypoestrogenic side effects. They produce a mild degree of bone loss. Because of concerns about osteopenia, add-back therapy with low-dose estrogen has been recommended. The dosage of leuprolide is a single monthly 3.75-mg depot injection given intramuscularly. Goserelin, in a dosage of 3.6 mg, is administered subcutaneously every 28 days. A nasal spray (nafarelin Synarel ) may be used twice daily. The response rate is similar to that with danazol about 90 percent of patients experience pain relief.
Since the accretion rate of calcium in the fetus is normally 100 mgkg-1 day-1 (2.5 mmol kg-1 day-1), infants on prolonged parent-eral nutrition may develop osteopenia and fractures. The usual dose of magnesium is 0.3-0.5 mEq kg-1 day-1 (0.3-0.5 mmol kg-1 day-1).
BONE-PROTECTIVE EFFECTS OF THIAZIDE DIURETICS IN IDIOPATHIC HYPERCALCIURIA AND OSTEOPOROSIS It has become increasingly clear that many stone formers with idiopathic hypercalciuria have reduced bone density, particularly at the spine 10, 11 , The cause of the osteopenia is not yet established, but considerations include prolonged dietary Ca restriction, excessive production of or sensitivity to l,25-(OH)2D, and excessive production of bone resorptive cytokines by marrow cells, e.g., IL-1. Despite the widespread use of thiazide diuretics in the management of various forms of idiopathic hypercalciuria, there have been few longitudinal studies of the effect of these agents on markers of bone turnover or bone density. In one recent study, Rico et al. randomized 14 patients with idiopathic hypercalciuria to treatment with chlorthalidone 50 mg day and 10 such patients served as untreated controls over a 1-year period 32 , The treated patients had a significant decrease in 24-hr urine Ca and...
Oral refers to the mouth, and includes the teeth and gums (gingival) and their supporting tissues, the hard and soft palate, the mucosal lining of the mouth and throat, the lips, salivary glands, chewing muscles, and upper and lower jaw bones. Digestion begins in the oral cavity, and there are numerous supporting structures for the mouth including the nervous, vascular, and immune systems. Humans contract oral diseases for a number of reasons including genetics, poor hygiene, poor nutrition, alcohol and tobacco use, drug abuse (Shaner et al., 2006), and complications from other diseases such as diabetes (Sandberg et al., 2000, Twetman et al., 2002), cancer (Woo et al., 1993), obesity (Ritchie and Kinane, 2003), and osteoporosis (Norlen et al., 1993). Oral infections themselves may play a role in progressing pathogenesis of many systemic diseases in healthy individuals, ill patients, and those immunocompromised (Ridker et al., 1998). The theory is that oral infections, specifically...
Metabolic diseases may affect the skeleton. A condition of too little bone, osteoporosis, has three major causes (1) disuse atrophy (2) a decrease in anabolic hormones, especially in postmenopausal women, and (3) an increase in catabolic hormones, such as androgens or corticos-teroids. Affecting the weight-bearing vertebrae predominantly, the bones are thin, light, and weak, and pathologic fractures can occur, causing kyphosis (hunchback), or scoliosis (lateral curvature of the spine), and loss of stature.
It is evident that plant phenolic compounds constitute one of the most numerous and widely distributed groups of substances with more than 8000 phenolic structures currently known (28). In addition to stress linked phenolics coming only from the shikimate and phenylpropanoid pathways, a number of the phenolic compounds are found in plants, including the flavonoids that contribute to the characteristic flavor and fragrance of vegetables, fruits, tea, and wine. These compounds, which come from phenylpropanoid and polyketide (acetate-malonate) pathways, also have biological properties that are beneficial to human health. Flavonoids such as quercetin and catechin and isoflavonoids, genistein for example, are being investigated for properties which may reduce the incidence of cancer (22,23). Flavonoids and isoflavonoids are a class of phenolic compounds that have appeared sequentially during plant evolution and are simple aromatic compounds generated from both the phenypropanoid and...
Effects of antiepileptic drug therapy on bone mineral density in ambulatory epileptic children. Brain Dev. 1994 16 382-385. Sheth R, Wesolowski C, Jacob J, et al. Effect of carbamazepine and valproate on bone mineral density. J Pediatr. 1996 127 256-262. Valimaki M, Tiihonen M, Laitinen K, et al. Bone mineral density measured by dual-energy x-ray absorptiometry and novel markers of bone formation and resorption in patients on antiepileptic medications. J Bone Miner Res. 1994 9 631-637.
Breast-feeding also seems to provide benefits for the mother. Nursing an infant soon after birth speeds a woman's recovery from the stresses of childbirth. Breast and ovarian cancer rates and osteoporosis are lower among women who breast-fed their infants. Certainly one can argue that having a healthy infant is advantageous to a mother's health, as well.
Ninety percent of the body's lead eventually makes it way into the skeleton. Incorporation of a toxicant into bone occurs between the interface of the extracellular fluid and the surface of the bone. The surface of the bone is made of hydroxyapatite crystals. The crystal structures of hydroxyapatite create a large surface area for contact of the extracellular fluid. Some toxicants displace other compounds of similar size and charge, such as F- for OH- or strontium for calcium. Sometimes, such an exchange and the deposition of a toxicant into bone can be detrimental to bone health, e.g., fluoride deposition resulting in skeletal fluorosis. Other times, toxicant deposited in bone may eventually be released from the bone and such mobilization can cause toxic side effects.
As noted previously, some older people, especially postmenopausal women, seem to be at increased risk of developing marginal vitamin K deficiency, which manifests itself, for instance, by an increased percentage of undercarboxylated osteocalcin (ucOC) in the circulation. The sequelae of such marginal deficiency, and in particular its implications for bone health, are currently the subject of considerable research effort (Table 2). Several epidemiological cross-sectional studies have noted an association between higher vitamin K intakes and higher bone mineral density or lower fracture risk. One study reported that a subgroup of postmenopausal women who were 'fast losers' of calcium responded to vitamin K supplements by reduced calcium and hydroxyproline excretion. Although vitamins D and K have distinct functions in calcium absorption, and its distribution, deposition, and excretion, there is evidence that synergistic interactions can occur between them, and that both can affect the...
It usually affects the femur, radius, and spine, in order of decreasing frequency. Estrogen deficiency is not a major causative factor. Any patient with an eating disorder who has been amenorrheic and low in weight for more than a year should undergo bone-density studies. A femur fracture has been reported in a young anorexic who tripped on a rug.6
Today older women are warned repeatedly about heart disease, osteoporosis, memory loss, and Alzheimer's disease, and numerous other conditions for which they are said to be at increased risk due to their estrogen-deficient condition. Misleading interpretations of often poorly executed epidemiological research create confusion about estimates of risk for major disease in women who are past menopause. Even so, daily medication on a permanent basis with regular medical monitoring has been recommended by gynecological organizations in many countries for virtually all older women, although reversals of these blanket suggestions are now taking place in light of recent evidence from longitudinal research trials. Few commentators deny that drug company interests have contributed to this situation.
Elderly individuals prefer to stay indoors and many are actually 'shut-ins' who have little opportunity for direct sun exposure (UV-B does not penetrate glass windows in rooms or solaria). The shut-ins are most likely to be deficient in vitamin D and calcium and at increased risk for fractures of the hip, especially with increasing age. They need supplementation on a daily basis with a calcium salt ( 1000 mg of elemental calcium) plus vitamin D (400 IU or more) to counter not only hypovitamino-sis D but also secondary hyperparathyroidism and possibly osteoporosis. Two large prospective trials have demonstrated efficacy of such therapy in reducing hip and other nonverteabral fractures. Migration of dark-skinned people, especially Muslims, from the Middle East and other Asian nations to the UK and other Northern European nations has led to decreased skin production of vitamin D, especially in the winter months, and to reported cases of rickets and osteomalacia. Cultural practices, i.e.,...
Some nutritionists claim that people with high metabolic needs, like pregnant or lactating women and children, face significantly higher risks of nutritional deficiency if they exclude both meats and dairy products from their diets. They claim, for instance, that (1) it is difficult for vegan women to get enough iron because iron from nonmeat sources is less efficiently absorbed than the iron available in meat (iron deficiency is a problem for women because menstruation removes iron from their systems monthly), (2) vegans cannot get enough vitamin B12 (deficiencies of which cause severe neurological damage) because the vitamin is produced by microorganisms in the digestive tracts of animals, and (3) it is particularly difficult for women to get enough calcium from a dairy-free diet (osteoporosis, a condition characterized by brittle bones, is a serious problem for postmenopausal women).
Testosterone has long been known for its anabolic effects (Brodsky et al 1996). Muscle weakness, anaemia, lowered bone mass, and mood disturbances rapidly normalize in mid-adult hypogonadal men during T replacement therapy. Since the decrease in serum T concentrations occurs in parallel with the decrease in muscle mass, strength and bone mass, it has been suggested that these are causatively related. Several cross-sectional and longitudinal studies have demonstrated relationships in older men between serum T levels and muscle strength, changes in body composition and bone mineral density (Rudman & Shetty 1994, Murphy et al 1993, Ongphiphadhanakul et al 1995). In agreement, in a cross-sectional study of 403 elderly men, we found positive relationships between non-SHBG-bound T and muscle strength and bone mineral density, and an inverse relationship with fat mass. A cross-sectional study among 856 elderly men demonstrated that bioavailable T levels were significantly lower for the 25...
In a research we performed among 403 independently living elderly men (aged 73-94 years) from a blue-collar suburb of Rotterdam, The Netherlands, we have measured several physical characteristics. We assessed subjective and objective functional ability using the modified health assessment questionnaire and a physical performance test, respectively. Furthermore, we measured bone mineral density, body composition, muscle strength and cognition. Muscle strength was independently, positively related to lean body mass, bone mineral density and physical performance, and inversely related to the number of problems in activities of daily living. Muscle strength and functional ability can be considered the key characteristics of physical functional status in independently living elderly men. These findings confirm previous studies in which it was demonstrated that loss of muscle strength is a strong predictor of physical functional problems (Fiatarone et al 1994, Guralnik et al 1994). The...
The efficiency of calcium absorption is highest during infancy (approximately 60 ), and the amount absorbed from breast milk does not appear to be affected by calcium consumed in solid foods. During the growth spurt of adolescence, calcium retention and accretion increase to peak at approximately 200-300 mg per day in girls and boys, respectively. It involves the action of growth hormone, IGF-1, and sex steroids. The onset of menstruation in girls is associated with a rapid decline in bone formation and resorption. Intestinal calcium absorption is predictably more efficient during the growth spurt and also decreases subsequently. Importantly, it is thought that calcium intakes during the period of growth can affect the peak bone mass achieved and therefore influence the amount of bone mineral remaining when osteoporosis begins in later life. Bone mass may continue to accumulate up to approximately age 30 years, although the amount gained is relatively small after age 18 years. end of...
Ifugao farmers are almost equally male and female. Male farmers traditionally construct and maintain rice fields, plow rice fields (except in the Kiangan area), carry loads of harvested rice from fields to homes, raise and catch fish, hunt, trap, engage in carpentry work and forestry, care for domestic animals, and collect and chop wood. Some men carve wood to make crafts, and smith iron. Historically, men also engaged in pot-making, warfare, headhunting, revenge murder, and capturing and selling slaves. Men also serve as mediators, or go-betweens to aid in dispute settlements or transactions between families. Female farmers prepare rice seedlings, weed rice fields, plant and harvest rice, carry harvested rice to homes from fields, raise vegetables, sell food they have cultivated, collect fire wood, and weave. Women's agricultural work involves extensive stooping, probably playing a role in the severe bending of their spines with osteoporosis. Women also engage in weaving, sanding...
The location of the injury, the integrity of the overlying soft tissues, and fracture type are important considerations. High-energy patterns of injury will result in fracture comminution, damage to the soft tissue envelope, and possibly devascularization of bony fragments. Distal humeral fractures in particular are relatively common in the elderly, in whom a degree of osteoporosis is invariably present. Iatrogenic factors center on failure to achieve adequate stabilization of
Arthroplasty of the elbow represents a solution to the nonunion of the distal humeral fracture in a select group of patients (42). In the elderly, previous unsuccessful treatment may well have led to disuse osteopenia, complicating the preexisting osteoporosis that contributed to the original injury. Often the fracture fragments may be comminuted and very distal. In such circumstances, revision of previously attempted internal fixation is unlikely to yield satisfactory results, even if eventual union is achieved (Fig. 9). The elbow tolerates long periods of immobilization poorly, and this is especially true in the elderly. In the elderly, low-demand patient, excellent pain relief and restoration of function can be achieved by total elbow arthroplasty.
In older adults reduced cutaneous synthesis and enteric absorption of vitamin D increases the risk of vitamin D deficiency. Reduced renal responsiveness to parathormone is an added risk factor. At least 500IUday_1 of vitamin D are required to prevent significant osteoporosis in postmenopausal women. Institutionalized patients with reduced exposure to sunlight are at higher risk of vitamin D deficiency due to reduced cutaneous synthesis. The role of calcium supplementation in the prevention of osteoporosis is also well accepted. Additional evidence suggests that inadequate dietary calcium consumption may play a role in the genesis of colorectal cancer and hypertension.
Another neglected group is the elderly. Currently, there are 580 million people older than 60 years (61 in developing countries), and this number is projected to increase to 1 billion by 2020 (71 in developing countries). The majority are women because they live longer than men. Special problems associated with nutrition include osteoporosis and fractures, vulnerability to malnutrition, and degenerative diseases.
The more common manifestations of HPT include nephrolithiasis, osteoporosis, hypertension (HTN), and emotional disturbances. The widespread use of the multichannel autoanalyzer has led to more patients being diagnosed with asymptomatic hypercalcemia or with earlier symptoms, such as muscle weakness, polyuria, anorexia, and nausea. Differential diagnosis of hypercalcemia includes HPT, malignancy, granulomatous disease (e.g., sar-coidosis), immobility, hyperthyroidism, milk-alkali syndrome, and familial hypocalciuric hypercalcemia (FHH). Patients with hypercalcemia and suspected HPT should minimally have serum calcium, phosphate, creatinine, and PTH measured. The diagnosis of HPT is biochemical and requires demonstration of hypercalcemia (serum calcium greater than 10.5 mg dL) and an elevated PTH level. Hypercalcemia without an elevated PTH can be Parathyroidectomy is indicated for all patients with symptomatic HPT. Nephrolithiasis, bone disease, and neuromuscular symptoms are improved...
All of the immunosuppressants currently available carry potentially serious side-effects such as kidney damage (ciclosporin), bone marrow suppression (azathioprine), osteoporosis (systemic steroids) and skin cancer (photochemotherapy). These are described in more detail in the systematic review. It is difficult to make any statements about how useful these drugs are in comparison with one another because the impact of these adverse effects (for example azathioprine-induced bone marrow
In drugs developed for non-life-threatening diseases, a Phase II clinical trial is usually the first one to recruit patients with the disease under study. Patients for Phase II trials are recruited so that these patients may be most likely to benefit from the drug candidate and least likely to be exposed to potential toxicities. Endpoints used in Phase II studies include efficacy and safety endpoints. The efficacy endpoints may be clinical endpoints such as blood pressure, time to disease relapse, number of painful joints, visual acuity or surrogate markers such as white blood cell count, bone mineral density, among others.
These micronutrients are discussed elsewhere (see 00033 and 00051). Childhood is an important time for deposition of bone mineral and the development of peak bone mass (PBM). Seventy-five per cent of bone mineral is deposited in childhood. Low PBM in late adolescence is a significant precursor of later osteoporosis. Much of the population variation in PBM is genetically determined, but low calcium and vitamin D together with a relatively sedentary lifestyle seem factors likely to contribute to low PBM and risks of osteoporosis later in life. Data from The Gambia show that in preadolescent children adequate calcium deposition takes place despite very low intakes of calcium. In some studies where milk-derived calcium phosphate was fed to children there was accelerated growth and maturation in the supplemented children. The Gambian studies showed no change in growth in the supplemented children although there was increased bone mineralization.
A recent trend is toward the consumption of 'functional foods,' which are foods or dietary components designed to support health and reduce the risk of chronic, diet-related illnesses and conditions, including cardiac disease, osteoporosis, and cancer (Hasler, 1998). Most examples of functional foods are plant based, such as oats, soy, flaxseed, garlic, tomatoes, broccoli and other cruciferous vegetables, citrus fruits, grapes, olive oil, and cranberries. Fatty fish and eggs from chickens fed flaxseed are good sources of omega-3-fatty acids. Fernandez-Gines et al. (2005) reviewed meat products that are formulated with additional plant products and have reduced or modified lipid content as functional foods.
Immunosuppressive therapy during the 1960s and 1970s consisted of combinations of different agents intended to produce maximal suppression while keeping the side-effects as few as possible. The most common immunosuppressive protocol was the combination of azathioprine and corticosteroids, which significantly improved allograft survival but also created a variety of severe side-effects, especially long term, among which were overwhelming, sometimes fatal infections, direct organ toxicities, slow wound healing, anemia, leukopenia, diabetes, osteoporosis, stunted growth in children, and even malignancies. The average 1 year kidney survival rate from all transplantation centers reached about 50 using this protocol while in outstanding centers the figures reached 80 and higher. Under those conditions, liver transplantation remained an experimental procedure and heart transplantation, which had enjoyed a transient burst of activity in the late 1960s, was abandoned in all but three centers...
Bone involvement is among the more variable and probably the most debilitating features, particularly the recurrent attacks of ''bone crises'' experienced primarily in childhood. The incidence of these episodes abates with age. The occurrence of pathological fractures, avascular necrosis of the heads of femur and humeri, and compression fractures of the spine are well-documented complications of severe skeletal involvement. Osteopenia and osteoporosis may be important findings even among young adults.
Drugs elevated glucose levels, hypertension, obesity, osteoporosis, and psychiatric disturbances). Thus, the ideal therapy for autoimmune disease should affect the pathogenic clone or clones specifically without suppressing the entire immune system it should be devoid of toxicity and it should be easily administered. Although considerable efforts have been made to improve the treatment of autoimmune disease, none of the current immunosuppressive therapies are satisfactory.
Major complications, such as hypertension, accelerated atherosclerosis and osteoporosis. The detrimental effects of muscle weakness are responsible for a substantial part of the initial functional disturbance, and rehabilitation programmes should include resistance and weight-bearing activities as well as aerobic exercise. Kobashigawa, et al. (1999) found that when initiated early after cardiac transplantation, exercise training increased capacity for physical work in transplant patients.
Children with meningomyelocele have multiple, complex medical problems due to impairment of nerves at or below the site of the lesion. There is variable impairment of sensory and motor nerves controlling voluntary and autonomic functioning. Associated medical concerns include neurogenic bowel and bladder function, contractures, scoliosis, club feet, hydrocephalus, Chiari II malformation, tethering of the spinal cord, spinal cord syrinx, vesicoureteral reflux, decubitus ulcers, constipation, encopresis, recurrent urinary tract infections, growth failure, latex allergy, gastroesophageal reflux, apnea stridor syndrome, seizures, partial agenesis of the corpus callosum, strabismus, visual acuity impairment, precocious puberty, and osteoporosis. Individuals also may have cognitive impairments. Mild forms of cognitive impairment may affect visual motor functioning. More severe cognitive impairment has been associated with sparing of verbal skills and a cocktail party syndrome, in which the...
Glucocorticoids act primarily by inhibiting T-cell and macrophage function. In addition to immune suppression, long-term use of glucocorticoids suppresses endogenous adrenal function, which may produce Cushing syndrome and cause hypertension, glucose intolerance, osteoporosis, avascular necrosis of the hip, cataracts, pancreatitis, peptic ulcer disease, delayed wound healing, behavioral disorders, and malignancies.
Fulfillment of diagnostic criteria and genetic testing confirm in individuals suspected with PWS. In 1993, age-stratified diagnostic criteria were published by Holm et al. PWS is very likely in children 3 years of age with 8 points (4 from major criteria). Major diagnostic criteria for PWS (1 point for each) include infantile central hypotonia, feeding difficulties in infancy, accelerated weight gain in early childhood, hypgonadism, developmental delay and typical facial features (narrow bifrontal diameter, almond palpebral fissures, narrow nasal bridge, down-turned mouth). Current minor diagnostic criteria for PWS (1 2 point each) include decreased fetal movement, sleep apnea, short stature, hypopigmenta-tion, small hands feet, narrow hands with straight ulnar border, esotropia myopia, thick saliva, skin picking and speech problems. Other commonly reported features of individuals with PWS include high pain threshold, decreased vomiting, temperature instability, premature adrenarche...
Some beneficial effects following dietary intervention with soy isoflavones have been observed on bone health, and the mechanism is likely to be via an oestrogenic action, particularly because ERfl is highly expressed in bone, although this requires further investigation. Consumption by postmeno-pausal women (6-month parallel group design) of soy protein (40g day providing either 56 mg isofla-vones day or 90 mg isoflavones day) compared to caesin and nonfat dry milk (40 g day) produced significant increases in bone mineral content (BMC) and bone mineral density (BMD) in the lumbar spine (but not in any other parts of the body) only in the higher isoflavone (90 mg day) group compared to the control group. In a long-term study, consumption by postmenopausal women (2-year parallel group design) of isoflavone-rich soy milk (500 ml day providing 76 mg isoflavones day) compared to isoflavone-poor soy milk control (providing 1 mg isoflavones day) resulted in no decline in BMC and BMD in the...
Primary neoplasms occur in the spine and are similar to those occurring in bones elsewhere in the body such as osteogenic sarcoma, osteoclastoma, chondroma and chron-drosarcoma. In children, Ewing's sarcoma may occur in the vertebrae and neuroblastoma within the extradural space. In patients with osteoporosis, particularly in post-menopausal women, collapse fractures can occur spontaneously or with minimal trauma (pathological fractures). Such fractures may be single or multiple. Osteomalacia can also lead to pathological fractures (see Chapter 20).
Nonunion following primary surgical treatment can be caused by inadequate stabilization, distraction or lack of contact of the bone ends, osteopenia, infection, lack of blood supply, or soft tissue inadequacy. Like nonoperative nonunions, comorbidities can significantly retard bone healing. Operative treatment choices may be more complex because of bone loss, soft tissue defects, or the presence of infection. In both operative and nonoperative nonunions, adjunctive bone graft is desirable in specific subsets of patients but is not required in all (9,11).
Abstract Present knowledge on the effects of growth hormone (GH) insulin-like growth hormone (IGF)1 deficiency on ageing and lifespan are reviewed. Evidence is presented that isolated GH deficiency (IGHD), multiple pituitary hormone deficiencies (MPHD) including GH, as well as primary IGF1 deficiency (GH resistance, Laron syndrome) present signs of early ageing such as thin and wrinkled skin, obesity, hyperglycemia and osteoporosis. These changes do not seem to affect the lifespan, as patients reach old age. Animal models of genetic MPHD (Ames and Snell mice) and GH receptor knockout mice (primary IGF1 deficiency) also have a statistically significant higher longevity compared to normal controls. On the contrary, mice transgenic for GH and acromegalic patients secreting large amounts of GH have premature death. In conclusion longstanding GH IGF1 deficiency affects several parameters of the ageing process without impairing lifespan, and as shown in animal models prolongs longevity. In...
The antioxidant defence system has a particularly important role in Down's syndrome, and parents and caregivers can be advised on providing a diet rich in antioxidants. Dietary intakes need to be considered for the sulfur amino acids (which are needed for glutathione synthesis) fat-soluble vitamins A, C, and E water-soluble vitamins B6, B12, and folic acid and the minerals selenium and zinc. In latitudes where no vitamin D is synthesized in the winter months, it is particularly important to ensure exposure to sunlight during summer months to maintain adequate stores of the vitamin throughout the year because studies indicate an increase in the incidence of osteoporosis in Down's syndrome.
Because the trials have failed to show benefit for secondary prevention, and there are no published trial data for primary prevention, in both instances decisions about hormone therapy should be based on established non-cardiovascular risks and benefits.64 The major proven benefits of estrogen are relief of the symptoms accompanying the menopause, urogenital atrophy, and prevention of osteoporosis. Known risks include endometrial cancer, venous thromboembolism, pancreatitis (in women with high blood triglycerides), and gallbladder disease. At the average age of menopause, the risk for cardiovascular and non-cardiovascular disease conditions is low, and therefore, the short-term use of estrogens to manage the menopause is not at issue.65 However, until these clinical trial data are known, it may be wise to consider alternatives to hormone therapy even for proven indications such as prevention of osteoporosis.65 For osteoporosis prevention, exercise, diet, calcium, and vitamin D may be...
Frequent consumption of milk and other dairy foods has been associated with better bone health in some studies, and a strict lactose-free diet may not contain adequate amounts of calcium and vitamin D. Table 2 provides a list of some commercially available lactose-free calcium supplements.
Osteoporosis is now widely recognized as a problem for both men and, more especially, women, and an increased bone mineral content is one of the benefits of participation in an exercise program. Regular exercise results in increased mineralization of those bones subjected to stress and an increased peak bone mass may delay the onset of osteoporotic fractures exercise may also delay the rate of bone loss. Estrogen plays an important role in the maintenance of bone mass in women, and prolonged strenuous activity may result in low estrogen levels, causing bone loss. Many very active women also have a low body fat content and may also have low energy (and calcium) intakes in spite of their high activity levels. All of these factors are a threat to bone health. The loss of bone in these women may result in an increased predisposition to stress fractures and other skeletal injury and must also raise concerns about bone health in later life. It should be emphasized, however, that this...
Biliary atresia This disorder is the prototypic biliary tract disorder in infancy, accounting for 50 of all liver transplants in the pediatric age group and 10 of all liver transplants. It presents with cho-lestasis in early infancy there is a palliative surgical procedure called the Kasai hepatic portoenterostomy that, if performed before 60 days of age, may at least delay disease progression. In 20-25 of infants in whom the procedure is done in a timely fashion, liver transplantation may never be necessary. Severe steatorrhea and malnutrition are common and malabsorption of the fat-soluble vitamins is profound, sometimes requiring parenteral administration (particularly of vitamin K) to achieve sufficiency. Nutritional deficiency disorders such as osteoporosis are common. cholestatic disorders in patients with Crohn's disease of the small bowel, aggressive administration of an elemental diet rich in medium-chain triglycerides may be beneficial. It is accepted, however, that...
Fat-soluble vitamins Deficiencies of fat-soluble vitamins are common in liver disease associated with steatorrhea due to the concomitant malabsorption of fat. Vitamin A deficiency can result in anorexia, growth failure, decreased resistance to infections, and night blindness. Vitamin D deficiency results in osteopenia or osteoporosis as well as rickets. The prevalence of fractures is increased in women being treated for alcohol abuse and also following sobriety deficiencies of vitamin D as well as calcium, phosphorus, and fluoride may play a role. The deficiency of vitamin E results in neur-axonal dystrophy, clinically manifesting as peripheral neuropathy and cerebellar disturbances. Vitamin K deficiency results in hemorrhage because of reduced synthesis of clotting factors.
Decade, there is a steady decline in bone calcium. This is especially marked after menopause in women, when estrogen declines, and often leads to bone loss (osteopenia) to below a threshold that predisposes women in particular to fractures (osteoporosis). Osteoporosis is not just a disease of the elderly, and may occur in much younger patients, especially athletic young women, those with anorexia nervosa, those on steroids and other medications, and in anyone on prolonged bed rest, including astronauts experiencing long periods of weightlessness. Thus, attention has focused on whether supplementation or fortification with calcium, especially during adolescence, will ensure achievement of peak bone mass. Calcium supplementation in adolescent females has shown short-term increases in bone mineral density, but this may be because it increases mineralization in a limited amount of tra-becular bone, and it remains to be seen whether this leads to long-term improvement or protection against...
The most common cause of calcium levels within 1 mg dl above the upper limit of normal is primary hyperparathyroidism. If the normal range of serum Ca concentration is 8.5-10.5 mg dl, most patients with primary hyperparathyroidism will show Ca levels between 10.6 and 11.5 mg dl. Even with mild hypercalcemia, if such a patient suffers from any of the adverse consequences of hyperparathyroidism such as kidney stones, recurrent ulcers, or fractures, or if underlying physiologic derangements are present such as hypercalciuria or markedly reduced bone mineral density, the appropriate recommendation would be parathyroid surgery. However, approximately 50 of patients with primary hyperparathyroidism will not demonstrate any of these complications and, thus, will not be clear surgical candidates.
The authors concluded that significant potential benefits in life expectancy in coronary artery disease reduction, combined with the osteoporosis prevention in symptom relief, would point to greater emphasis on postmenopausal estrogen use in appropriate patients. Since the report by Zubialde et al22 hormone replacement therapy has undergone additional study. A growing body of literature suggests that its predicted effects have not been fully realized,23'24 and the results of a recent polymorphism study have further complicated matters.25 It bears repeating here that the reliability of a decision analysis is related directly to the quality of the data on which the analysis is based. The Zubialde analysis was based on the best data of its time, but superior data from clinical trials have since called the findings into question.
See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Folic Acid Physiology, Dietary Sources, and Requirements. Iron Physiology, Dietary Sources, and Requirements. Obesity Definition, Aetiology, and Assessment. Osteoporosis Nutritional Factors. Zinc Physiology. See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Folic Acid Physiology, Dietary Sources, and Requirements. Iron Physiology, Dietary Sources, and Requirements. Obesity Definition, Aetiology, and Assessment. Osteoporosis Nutritional Factors Zinc Physiology. Assessment. Osteoporosis Nutritional Factors.
Soybean isoflavonoids may also have potential in natural chemoprevention therapies against long term health problems associated with menopause, particularly for osteoporosis (44-47). After menopause, the ovaries stop producing estrogen. Because estrogen positively affects the metabolism of calcium, lack of sufficient estrogen can lead to bone loss and osteoporosis (48). Hormone replacement therapy (HRT) can reduce bone loss and the risk of osteoporosis in postmenopausal women, but unfortunately appears to also increase the risk for certain estrogen linked cancers (49-51). Current osteoporosis prevention research is focused on the development of estrogenlike compounds (selective estrogen receptor modulators, or SERMs) that can selectively act against bone loss without causing negative estrogenic action against the uterus (52). The soybean isoflavonoid genistein has shown SERM activity in ovariectomized mice (53). When provided at optimal dosages, soybean isoflavonoids (especially...
See also Anemia Iron-Deficiency Anemia. Appetite Physiological and Neurobiological Aspects. Bone. Carbohydrates Chemistry and Classification Regulation of Metabolism Requirements and Dietary Importance. Electrolytes Water-Electrolyte Balance. Energy Balance. Exercise Beneficial Effects. Fats and Oils. Osteoporosis. Protein Synthesis and Turnover Requirements and Role in Diet. Sports Nutrition. Supplementation Dietary Supplements Role of Micronutrient Supplementation Developing Countries Developed Countries.
Bone mineral content declines with age this aging process is known as 'osteopenia.' (It should be distinguished from the related pathological process in which bone architecture is altered, producing 'osteoporosis.') From the peak in the third and fourth decades, a 30 average decline in bone mineral density occurs through the ninth decade. In women, there is well-characterized acceleration of the rate of bone mineral loss immediately following the menopause. Decreasing levels of anabolic hormones may be associated with musculoskeletal atrophy and decrease in function that is observed in older women. This change in skeletal mineralization with aging is not associated with any apparent change in vitamin D nutriture as reflected in circulating levels of the vitamin.
Other lifestyle choices, such as smoking, alcohol abuse, and physical activity, also impact overall bone health. Excessive alcohol intake is a risk factor for low bone mass. This finding may be a consequence of poor dietary quality in chronic alcoholics and may also be related to adverse effects of excessive alcohol intake on osteoblast function. Cigarette smoking also adversely impacts bone health. Smokers may be leaner, and female smokers may experience an earlier menopause and have lower postmenopausal estrogen levels. Smoking may also have adverse effects on bone cells either directly or indirectly through an increase in oxidative stress.
Accelerated aging syndromes No distinct pheno-copy exists for normal aging, but there are several genetic diseases syndromes that display some features of accelerated aging, including Hutchinson-Gilford syndrome (classic early onset Progeria), Werner's syndrome, and Down's syndrome. Patients with these syndromes suffer from many signs of premature aging including hair loss, early greying, and skin atrophy, and also suffer from premature age-related diseases such as atherosclerosis, osteoporosis, and glucose intolerance. The defined genetics involved in these syndromes provide strong evidence for the genetic basis of aging.
As individuals with CP age, they experience the normal sequala of the aging process in addition to already existing impairments in movement. Weak muscles may exhibit a decrease in strength, and joints may become less flexible. Therefore, greater effort may be required to perform activities of daily living. Community recreation may assist the individual in retarding this process by providing physical activities that promote muscle strengthening, endurance, and joint flexibility. Finally, involvement in community recreation and fitness can provide a social outlet, improve cardiovascular fitness, assist with weight control, and assist in the prevention of osteoporosis.
Factors other than age and sex that are associated with low bone mass include low body weight, smoking, alcohol consumption, reduced physical activity, low calcium absorption, and secondary risk factors such as the use of steroids. Although there is still uncertainty about the quantitative role of nutritional factors in the pathogenesis of osteoporosis, preventive measures include adequate calcium intakes (probably even in old age) and exposure to sunlight to ensure vitamin D adequacy and or dietary supplementation with vitamin D. Restricted sunlight exposure, reduced capacity of the skin to produce vitamin D, and low vitamin D intake make elderly people prone to vitamin D deficiency.
Vitamin D deficiency has been defined in terms of bone health, and there is still debate about the levels below which there is deficiency and insufficiency.1214 At levels below 50 nmol L preosteomalacic changes are seen on bone biopsy.15 Recent studies have attempted to define sub-clinical deficiency in adults and children in terms of the basal level of 25(OH)D3 above which l,25(OH)2D3 did not rise and or PTH did not fall with supplementation.12,13 Surprisingly, this level was in the range 50-75 nmol L in adults and 50 nmol L in children. No study to date has determined optimal levels of vitamin D in pregnant women in terms of health and development of their offspring. However, there is no doubt that many pregnant women have low vitamin D levels and some groups are deficient. Dark-skinned women who migrate to higher latitudes or women who cover up are at high risk of vitamin D deficiency.5'16
A therapeutic dilemma suppressive doses of thyrox-ine significantly red measurements in both premenopausal and postmenopausal women with thyroid cancer. J Clin Endocrinol Metab 1991 72(6) 1184-8. Bone mineral density (BMD) studies in women on thyroxine which demonstrated signifi-cantlydecreased BMD in both pre- and postmenopausal women as compared to normals. Suggestive of osteoporosis risk although there have not been any studies demonstrating increased fracture rates in these women.
In developing countries, these are mainly under-nutrition, labeled as protein energy malnutrition, and specific deficiency conditions, most commonly vitamin A, anemia, and goiter. Although the so-called 'diseases of affluence' often affect the richer urban sections of the population, they have not been policy priorities, but they have recently become so in some Asian and Latin American and other developing countries. However, countries such as China that are in nutritional transition between the predominance of diseases of poverty and of affluence have to consider how to reduce remaining nutritional deficiencies but avoid the nutrition-related problems afflicting developed countries. In developed countries, chronic diseases related to poor nutrition, such as obesity, coronary heart disease, diabetes, and osteoporosis (sometimes referred to as 'overnutrition'), are the main problems addressed because most micronutrient deficiencies have been contained, although anemia remains...
It is now nearly two decades since these landmark observations and concepts first appeared. It is apparent that those original findings have had far-reaching implications regarding human health and lifestyle choices, not only explaining the rapid societal rise in diabetes and obesity, but also covering areas as diverse as osteoporosis, depression and sedentary behaviour. With the wisdom of hindsight, we can see that some of the reluctance to accept the FOAD concept arose precisely from the problem which FOAD addressed namely that the underlying causes of the common chronic diseases of adulthood (heart disease, diabetes, stroke) could not be explained purely in terms of genetic inheritance or lifestyle factors, such as diet or exercise. That instead, gene-environment interactions would hold the clues. Some of the earliest concepts of the programming' of human disease have focused on the processes of mutation, genetic drift and selection, which may have created genotypes that were...
Although endocrine factors appear to be the major cause of age-related bone loss, there are important non-endocrine factors that also contribute. The level of bone mass present prior to the onset of age-related bone loss is clearly important those persons who have high levels are relatively protected against osteoporosis whereas those with low levels are clearly at a greater risk. As has been long recognized, there are a number of episodic factors that increase bone loss in some, but not other, members of the ageing population. These include use of certain drugs such as corticosteroids, diseases such as malabsorption, anorexia nervosa and renal hypercalciuria, and behavioural factors such as smoking, alcohol abuse and inactivity to enumerate but a few. These may make major contributions to fractures in about 40 of men and 20 of women (Riggs et al 1986).
The next period, from 1900 to 1970, began with the Smithsonian appointment of Ales Hrdlicka. Describing lesions that he called symmetrical osteoporosis, he noted that they were probably representative of a systemic disorder. He built one of the world's great collections and contributed to the training of many anthropologists. Flinders Petrie examined prehistoric Egyptian bones by X-ray in 1897, but the technique was little used until the work of Roy Moodie in the 1930s, and is only now beginning to be fully utilized.
The increase in low serum 25(OH)D3 found in so-called ordinary adults in a hospital survey of surgical patients in Massachusetts opened the eyes of health authorities who did not expect to find such low blood concentrations, which indicate future osteomalacia and also osteoporosis. This evidence suggests that many adults in the US are not consuming adequate amounts of vitamin D and calcium in their usual patterns of food selection and that supplementation of these two nutrients is probably inadequate among adults. Low intakes among the elderly result from the same type of eating pattern, but typically with even lower caloric consumption (see below).
Both glucocorticoids and cyclosporine can exacerbate glucose intolerance, worsen osteoporosis, and cause myopathy and systemic hypertension. Commonly, chronic cyclosporine use at the levels employed in lung transplant immunosuppression results in renal insufficiency by decreasing renal blood flow and by a direct effect on the renal tubules, causing in hyperkalemia and hypomagnesemia. Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided, since these will act synergistically with cyclosporine to further reduce glomerular filtration. The major side effect of azathioprine is bone marrow suppression. Neutropenia may often result from either azathioprine or CMV infection.
Perturbations in the action and or metabolism of vitamin D may also occur in Mg deficit. Because Mg plays a key role in skeletal metabolism, Mg deficit may be a possible risk factor for osteoporosis. However, epidemiologic studies relating Mg intake to bone mass or rate of bone loss have been conflicting, and further investigation is necessary to clarify the role of Mg in bone metabolism and osteoporosis.
Major health reasons given for taking supplements include a sense of well-being and 'feeling better' (especially multivitamins minerals), preventing colds and flu (especially vitamin C), preventing chronic disease (especially vitamin E and calcium), increasing 'energy,' coping with stress, and improving the immune system. Many vitamin E users believe that the vitamin helps prevent heart disease, and most calcium users know that calcium use helps prevent osteoporosis. Using micronutrient supplements is one way by which people who may be at high risk for certain diseases try to gain some degree of personal control over their health outcomes. Ironically, many individuals who take supplements regularly report that they do not discuss the supplement use with their physicians because they believe that physicians are biased against supplements and are not knowledgeable about the products.
Plain x-rays of the lumbar spine are recommended for ruling out fractures in patients with acute low back problems when any of these red flags are present recent significant trauma (any age), recent mild trauma (patient age over 50), history of prolonged steroid use, osteoporosis, or patient age over 70. Oblique views are not necessary.14 Laboratory tests such as erythrocyte sedimentation rate (ESR), complete blood count (CBC), and urinalysis (UA) can be useful to screen for nonspecific medical diseases (especially infection and tumor) of the low back.15 Plain x-rays in combination with CBC and ESR may be useful for ruling out tumor or infection in patients with acute low back problems when any of these red flags are present prior cancer or recent infection, fever over 100 F, IV drug abuse, prolonged steroid use, low back pain worse with rest, or unexplained weight loss. If tumor or infection is suspected, CT or MRI may be considered in the presence of red flags, even if plain films...
Optimal nutrition is needed to supply the necessary substrates for bone however, other parameters also influence the impact of a given nutrient on bone health. A substantial amount of bone mineral acquisition (up to 80 ) is genetically determined. An individual's ability to utilize a given nutrient intake is influenced by his or her genetic makeup. Many candidate genes have been associated or linked with the risk of osteoporosis or fracture, including genes coding for hormones (PTH), receptors (including PTH, vitamin D, estrogen,
Many of the systemic hormones directly or indirectly have an impact on calcium balance. Obviously, special demands are imposed on overall calcium balance during growth, pregnancy, and lactation. All of the hormones that govern growth, namely, growth hormone, the insulin-like growth factors, and thyroidal and gonadal hormones (see Chapter 44), directly or indirectly influence the activity of bone cells and calcium balance. The gonadal hormones, particularly estrogens, play a critical role in maintaining bone mass, which decreases in their absence, leading to osteoporosis. This condition is common in postmenopausal women. Osteoblastic cells express receptors for estrogens, which stimulate proliferation of osteoblast progenitors and inhibit production of cytokines such as interleukin-6 that activate osteo-clasts. Consequently in their absence osteoclastic activity is increased and osteoblastic activity is decreased, and net loss of bone results.
A different attenuation of low- and high-energy X-rays by fat and nonfat or bone tissues is the basic principle for the measurement of body composition by dual energy X-ray absorptiometry (DXA). The fat and lean (nonfat) content is determined for each pixel of a scan that does not overlie bone and is reported to be virtually independent of tissue thickness. In addition to whole-body or regional composition values of fat and lean content (Fig. 1), DXA provides estimates for bone mineral content, bone mineral density, and total mass of soft tissues. DXA has been used with poultry, 3 swine, 4 and recently with calves. 5
Phosphate balance in adults is almost always zero, in contrast to calcium balance, which is usually negative, because of the effective action of PTH on renal tubules to block Pi reabsorption. In late life, however, intestinal phosphate absorption decreases and the serum phosphate concentration declines. These physiological decrements may contribute to disease, especially to increased bone loss and osteo-penia or more severe osteoporosis. Typically, these changes in Pi balance are also accompanied by similar changes in calcium balance. Too little dietary phosphorus and too little dietary calcium may be determinants of low bone mass and density and, hence, increased bone fragility. The usual scenario invoked to explain osteoporosis in old age, however, is that too little dietary calcium in the presence of adequate dietary phosphorus stimulates PTH release and bone loss (Figure 1).
Sclerae, joint laxity, dentinogenesis imperfecta, easy bruising, and hearing loss. OI represents extreme variation in severity from lethal perinatal to barely detectable. These clinical features, along with radiological and genetic criteria, were used to separate four major clinical types of OI. 1 The patients affected with the mildest (type I) OI have blue sclerae, osteopenia, slight growth retardation or normal height, and premature deafness dentinogenesis imperfecta is less common. Fractures are not commonly observed at birth, but begin with am-bulation and decrease following puberty. Type II is the lethal perinatal form infants exhibit multiple intra-uterine fractures of the ribs and long bones. They have a relatively large and soft cranium, short limbs, and a narrow thoracic cavity death usually results from pulmonary insufficiency. Type III is the progressively deforming form with multiple fractures, short stature, and severe dentinogenesis imperfecta. Children with type III may...
Some promising or developing targets include bone and cardiovascular health and mental state performance. Thus, numerous biomarkers related mostly to disease have been exhaustively listed in previous publications (Crews et al., 2001 Saris et al., 2002). The reader is particularly referred to two recent supplements of the European Journal of Nutrition (Asp et al., 2003, 2004). In these supplements, biomarkers presently available for assessing the effects of food components on cardiovascular disease bone health and osteoporosis physical performance and fitness body weight regulation, insulin sensitivity and diabetes risk diet-related cancers mental state and performance gut health and immunity are thoroughly described and discussed.
All patients with follicular carcinoma require lifelong treatment with exogenous thyroid hormone to suppress TSH synthesis, the production of which can stimulate the growth of differentiated thyroid cancer. Thyroid-stimulating hormone suppression lowers the recurrence rate of follicular carcinoma by diminishing the stimulation of TSH receptors which are present on the surface of differentiated thyroid tumors.9 Ideally, TSH levels should be suppressed to undetectable levels with the lowest possible dose of thyroid hormone, especially since replacement therapy can cause side effects such as osteoporosis and thyrotoxicosis.4
Middle-aged adults must care for their elderly parents. Many older women and men must work, or choose to work, as long as they are physically capable of doing so, regardless of their social class position. Many elderly women suffer from severe osteoporosis, which results in their being bent almost horizontally. Yet, even many of these women continue to engage in agricultural labor (Hewner, 2001). Older women, more so than older men, care for their grandchildren while the children's parents are working. For poor widows, middle and old age can entail greater respect, but also a period of increased poverty, since women generally earn lower wages than men.
Chronic or acute narrowing of the spinal canal by more than 50 compromise of the free antero-pos-terior diameter entails the risk of compressing the cord (Scarff 1960). The acute compression caused by impact (Fig. 10.8a, b) results in an acute neurological deficit of the involved motor and or sensory axons in the cord. Chronic lesions of the cord may be caused by survival after impact-induced compression (Fig. 10.8c, d), as well as by congenital diseases of the vertebral column (achondroplasia), by neoplastic proliferation (Schwannoma, meningioma, carcinoma), by osteogenic degeneration (spondylosis, osteoporosis), by cartilaginous degeneration (protrusion of the intervertebral disc), by inflammatory diseases (spondylitis), or by iatrogenic events (myelograph-
The term 'physical activity' refers to bodily movement produced by skeletal muscle that results in energy expenditure it thus includes activities of daily living, as well as leisure activity from sport and exercise. The term 'exercise' refers to planned or structured bodily movements, usually undertaken in leisure time in order to improve fitness (e.g., aerobics), while 'sport' is physical activity usually in structured competitive situations (e.g., football). Physical activity at recommended levels (moderate intensity for 30 min for 5 days each week) is associated with many health benefits these include lower all-cause mortality rates, fewer cardiovascular events such as myocardial infarction and stroke, and a lower incidence of metabolic disorders including non-insulin-dependent diabetes mellitus and osteoporosis. Levels of activity have been falling in Westernized societies largely because of a decrease in physical activity at work (from increasing mechanization) and increasingly...
The mainstay of treatment is open reduction with rigid internal fixation. However, there is some role for total elbow arthroplasty in the elderly with severe osteopenia. Until the early 1970s, most surgeons believed that the treatment of choice was nonoperative, because of unpredictable results with operative inter-
Tolerance to the diuretic action of caffeine was demonstrated more than 50 years ago and was shown to develop on chronic caffeine intake so that the clinical significance of hypokalemia and calciuria is difficult to evaluate. Although controversial, some epidemiological studies have implicated caffeine in the increased risk for poor calcium retention. For calcium intakes lower than 750 mg per day, increased rate of bone loss and lower bone density were reported. However, it has been suggested that the effect on bone of high caffeine intake requires a genetic predisposition toward osteoporosis. In individuals who ingest calcium recommended daily allowances, there is no evidence of any effect of caffeine on bone status and calcium economy.
Primary hyperparathyroidism may present in a variety of ways. Patients may be asymptomatic and the disease may be recognized through routine screening laboratory tests. Other patients may present with severe renal or bone disease. Because calcium affects nearly every organ system, calcium dysregulation may present clinically with a multitude of signs and symptoms. The most common symptoms include fatigue, weakness, depression, arthralgia and constipation. Conditions associated with hyperparathyroidism include kidney stones, chondrocalcinosis, osteitis fibrosa cystica, osteoporosis, hypertension, gout, peptic ulcer disease and pancreatitis. Patients with excess PTH production may experience progressive loss of bone mineralization. This is manifested as subperiosteal resorption, osteoporosis and pathologic fractures. Skeletal involvement is most readily demonstrated by radiographic films.
In general, total elbow arthroplasty in the setting of acute trauma is reserved for the elderly patient with a severely comminuted fracture (Figs. 20 to 22). The osteopenia in these patients makes open reduction with internal fixation very difficult. There is little in the literature about this option. The largest series, that of Cobb and Morrey, had 20 patients and 21 elbows treated acutely with total elbow replacements for comminuted distal humeral fractures (34). Using the Mayo elbow performance score, 15 patients in the study had excellent results and 5 good results. The mean age of patients in the study was 72 at the time of
Genetic and environmental factors are partners in the development of bone density and bone health over a lifetime (6). At present, the knowledge about genetic factors that are important in this process, and thus about the risk of osteoporosis, is meager at best. Genes, gene products, and nutrient-gene interactions are currently an evolving science (24,25). Ongoing research to understand the human genome, as well as many studies targeted at the environmental aspects of osteoporosis, will in time improve our knowledge. It is known now that hundreds of genes are involved in the growth, development, and maintenance of the skeletal system (6,26). A complete understanding of these genetic factors will help to clarify the underlying mechanisms of osteoporosis.
Respond do so within the first six months of therapy. Presence of cardiac disease and osteoporosis in elderly patients pose an additional hazard to suppressive thyroxine therapy. Unfortunately cessation of therapy is often followed by recurrence of the goiter. If one accepts that the sporadic goiter is a form of non-neoplastic hyperpla-sia, then one can explain the failure of suppressive therapy based on autonomicity. Recent data have suggested that once stimulated for a long time, autonomous growth occurs, and the hyperplasia is no longer a fully reversible process.
The parathyroid hormone (PTH) PTH-related protein (PTHrP) receptor (PPR) is a 593 amino acid, class 2 G proteincoupled receptor that mediates the actions of PTH, the major regulator of blood ionized calcium levels, and PTHrP, a key developmental protein. The PPR is abundantly expressed in bone osteoblasts and in renal tubule cells, the target cells of PTH, and in mesenchymal cells of developing tissues (e.g., skeleton, heart, teeth, and mammary glands), smooth muscle cells, and neurons, the target cells of PTHrP. The PPR binds PTH and PTHrP ligands via a bipartite mechanism involving binding interactions to the amino-terminal extracellular domain of the receptor and signaling interactions to the extracellular loops and seven transmembrane helices. The PPR couples strongly to the adenylyl cyclase (AC) 3',5'-cyclic-adenosine monophosphate (cAMP) protein kinase (PK)A signaling cascade, and can also activate the phospholipase (PL)C inositol triphosphate (IP3) intracellular calcium (iCa2+)...
The thoracic viscera are protected to a certain extent by the ribs and sternum. Consequently, any significant blunt injury to the chest involves fractures of these bones. The ribs are flexible and resist bending to a variable extent without fracturing. This ability is more marked in infancy and early childhood. Consequently, compressive forces applied to the chest in younger individuals may not result in rib fractures. However, this does not necessarily mean that there will be no consequent injury to the thoracic or abdominal viscera. This relative immunity from rib fractures in children is reflected in the observation that their presence indicates that severe trauma has been sustained and that they are associated with a disproportionately high mortality compared to adults. In one pediatric series, 70 of rib fractures resulted from road traffic accidents and another 21 from nonaccidental injury.6 In infants younger than 3 years, 63 of cases were the result of nonaccidental injury....
It is remarkable that all of these conditions are also associated with deficits of omega-3 essential fatty acids, suggesting that omega-3 deficits might contribute both to the depression and to the medical disorders (Horrobin et al., 1999a).
Raloxifene (Evista) (5 mg daily or a once-a-week preparation) is a selective estrogen receptor modulator (sErM) for prevention and treatment of osteoporosis. It increases bone mineral density and reduces serum total and low-density-lipoprotein (LDL) cholesterol. It also appears to reduce the incidence of vertebral fractures and is one of the first-line drugs for prevention of osteoporosis. 2. Raloxifene is somewhat less effective than the bisphosphonates for the prevention and treatment of osteoporosis. Venous thromboembolism is a risk.
Bone mineral content and bone mineral density of specific body sites (e.g., radius, hip, lumbar spine) are most commonly measured using DXA. Bone mass and microarchitecture are important determinants of bone strength, with microarchitectural deterioration being one of the specific changes associated with osteoporosis. Using high-resolution microcomputed tomography (micro-CT) and computer software, detailed analysis of three-dimensional (3D) architecture is feasible and allows microstructural 3D bone information to be collected.
If the patient does not require surgery, the nodule may either be observed or suppressed with Levothyroxine. The goal of thyroid hormone administration is to eliminate TSH stimulation by total exogenous replacement of the body's need for thyroid hormone. This should either reduce the size of the nodule or prevent its further growth. While this was a more commonly used approach for diagnosis and treatment in the past, it is being used less often. This is probably due in part to the increased diagnostic potential of FNAB, as well as several studies that have failed to demonstrate the efficacy of thyroxine therapy for solitary nodules.6 Because thyro-toxicosis is a risk factor for osteoporosis, there has also been some concern that the use of thyroxine, especially in postmenopausal women, may lead to osteoporosis.7 In a patient on thyroxine therapy, nodule growth during this period is suspicious for malignancy, and should be a strong indication for surgery.
Osteoporosis, which is common in adults with celiac disease, affects both men and women, and the exact mechanisms are not clear. The prevalence of osteoporosis is even higher in refractory sprue compared to gluten-free-diet-responsive patients. Diagnosis depends on bone mineral density testing with a T-score less than 2.5 SD below mean peak value in young adults. The primary treatment for the osteoporosis in a celiac is the strict gluten-free diet with adequate calcium (1500mgday_1 and vitamin D). Other measures directed at preserving or building bone density may be necessary if the boss mineral loss has been substantial or does not recover with a gluten-free diet.
Skeletal complications are responsible for significant morbidity and, because of increased survival times, are becoming more prevalent. Osteopenia and osteonecrosis can occur due to immobility, poor nutritional status, decreased muscle mass, steroid use, and immunosuppressive drugs. The first 3 to 6 months posttransplant are accompanied by accelerated bone loss (mostly trabecular). Fractures are common in the first year postoperatively, particularly at sites of trabecular bone (vertebrae and ribs), although long bone and pelvic fractures are also seen. The incidence of vertebral compression fracture may be as high as 38 percent. Patients may develop avascular necrosis of the femoral head from steroid use. Fractures should be treated in the standard fashion.
The female hypothalamus needs to 'sense' the presence of approximately 14-18 kg of body fat in order to allow fertility and menstrual cycles. With lesser amounts of fat, there is a progressive regression to the prepubertal state (low, nonspiking serum gonadotrophin levels). The signal from the fat stores to the gonadal hypothalamus seems to be the level of serum leptin. Very low levels of serum leptin, secondary to the decreased fat mass, seem to result in a decrease in luteinizing hormone-releasing hormone (LHRH) secretion. The hypothalamic, hypogonadal state of anorexia nervosa is due to the combined effects of malnutrition and the psychological disturbances on the hypothalamus. Secretion of LHRH and gonadotrophins improves as weight is regained and leptin levels increase however, in up to one-third of these patients menses do not return immediately after nutritional rescue and weight restoration are accomplished. The decreased estrogen secretion from the ovaries causes a...