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  • 1
    Electronic Resource
    Electronic Resource
    Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Synopsis of a WHO report (1994)
    Springer
    Osteoporosis international 4 (1994), S. 368-381 
    Details
    ISSN: 1433-2965
    Keywords: Bone mineral measurement ; Fractures ; Osteoporosis ; Screening
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The criteria required for an effective screening strategy for osteoporosis are largely met in Caucasian women. The disease is common and readily diagnosed by the measurement of bone mineral with single- or dual-energy absorptiometry. Such measurements have high specificity but lower sensitivity, so that the value of the technique is greater for those identified as being at higher risk. Against this background there is little evidence that osteoporosis can usefully be tackled by a public health policy to influence risk factors such as smoking, exercise and nutrition. This suggests that it is appropriate to consider targetting of treatment with agents affecting bone metabolism to susceptible individuals. Since the main benefits of the use of hormone replacement therapy (HRT) are probably on cardiovascular morbidity, the major role for selective screening is to direct non-HRT interventions. An appropriate time to consider screening and intervention is at the menopause, but screening at later ages is also worthy of consideration. Since the cost of screening is low and that of bone-active drugs is high, the selective use of screening techniques will improve the cost-benefit ratio of intervention.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01622200
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  • 2
    Electronic Resource
    Electronic Resource
    Bone loss in the elderly (1994)
    Springer
    Osteoporosis international 4 (1994), S. S59 
    Details
    ISSN: 1433-2965
    Keywords: Bone loss ; Elderly ; Osteoporosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A large number of cross-sectional studies suggest that rates of bone loss decrease in the elderly, particularly at the spine and radius. For this reason it has been argued that bone mass measurements are unhelpful in assessing fracture risk in the elderly and that drugs affecting bone metabolism are less likely to be of benefit in reducing this risk. This paper reviews the assumptions on which these conclusions are based and argues that in many instances they are flawed. Indeed, studies examining rates of bone loss in the elderly either directly or by biochemical indices of bone turnover suggest that bone loss continues throughout life and may even accelerate after the age of 70 years. This conclusion supports the view that identification of patients at risk and subsequent treatment is of value in all age groups.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623438
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  • 3
    Electronic Resource
    Electronic Resource
    A precise method for the assessment of tibial ultrasound velocity (1996)
    Springer
    Osteoporosis international 6 (1996), S. 1-7 
    Details
    ISSN: 1433-2965
    Keywords: Osteoporosis ; Ultrasound velocity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We assessed a method for the measurement of ultrasound velocity in cortical bone of the human tibia using a probe designed to minimize the effects of surrounding soft tissues. Of four different measurement values, the maximum velocity (average of the five highest readings) gave the lowest errors of reproducibility in relation to the population variance (standardized coefficient of variation=1.8%). The maximum velocity varied according to the tibial site measured and for practical reasons the mid-tibial site was chosen for further study. The short-term intra- and inter-observer reproducibilities (coefficients of variation) were 0.35% (n=22) and 0.50% (n=27) respectively. Long-term reproducibility over 4 months in 31 subjects was 0.68%. There was no significant difference in maximum ultrasound velocity between the dominant and non-dominant tibia in 78 women (3764±209 vs 3763±199 m/s). Tibial ultrasound velocity was significantly higher in 73 premenopausal women (3999±102 m/s) than in 129 women referred for assessment of postmenopausal osteoporosis (3780±168 m/s), 26 women with steroid-induced osteoporosis (3790±188 m/s) and 4 women with hyperparathyroidism (3575±261 m/s). In premenopausal women, ultrasound velocity did not correlate significantly with age, height, weight or body mass index. In women with postmenopausal osteoporosis, ultrasound velocity decreased with age after the menopause (r=−0.47,p〈0.0001) and body weight exerted a weaker protective effect. The apparent annual decrease in velocity with age in postmenopausal osteoporosis (8.5 m/s) was comparable to the error of reproducibility. We conclude that the technique for measuring tibial ultrasound velocity is highly reproducible in relation to the distribution of values in the population and is sensitive to age- and osteoporosis-induced changes in bone. Further studies are required to examine its relationship to other indices of skeletal status to determine the biological and clinical relevance of the technique.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01626530
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  • 4
    Electronic Resource
    Electronic Resource
    Rationale for the use of alendronate in osteoporosis (1995)
    Springer
    Osteoporosis international 5 (1995), S. 1-13 
    Details
    ISSN: 1433-2965
    Keywords: Alendronate ; Osteoporosis ; Paget's disease ; Pharmacology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Bisphosphonates are being used in disorders associated with accelerated resorption of bone, particularly Paget's disease of bone and the bone disease of malignancy. Their undoubted biological efficacy and relatively low apparent toxicity make them attractive candidates for the management of osteoporosis. The bisphosphonate alendronate has many characteristics which suggest that it is suitable for use in osteoporosis. It is a potent inhibitor of osteoclast-mediated bone resorption with no adverse effect on the mineralization of bone. Earlier studies have shown it to be one of the most active bisphosphonates in Paget's disease and the hypercalcemia of malignancy. In common with other bisphosphonates tested thus far, alendronate appears to inhibit bone loss in a variety of experimental models of osteoporosis. Long-term studies are needed to determine its steady-state effects on bone mass in man. Most data indicate that alendronate is capable at least of decreasing the rate of bone loss, and might even induce increments in bone mass for many years. Since the experimental studies show that the increase in bone mass observed with alendronate is associated with an increase in bone strength, its use is likely to decrease the frequency of fractures. However, direct clinical evidence for this requires the outcome of well-designed long-term prospective studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623652
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  • 5
    Electronic Resource
    Electronic Resource
    Quality of life as outcome in the treatment of osteoporosis: The development of a questionnaire for quality of life by the European foundation for osteoporosis (1997)
    Springer
    Osteoporosis international 7 (1997), S. 36-38 
    Details
    ISSN: 1433-2965
    Keywords: Quality of life ; Osteoporosis ; Vertebral fractures
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The morbidity of osteoporosis is caused by fractures. Vertebral fractures lead to pain and disability and a decrease in quality of life. A Working Party of the European Foundation for Osteoporosis has developed a specific questionnaire for patients with established vertebral osteoporosis. This questionnaire is intended for use in clinical trials. The questionnaire consists of questions and visual analogue scales in the following domains: pain, activities of daily living, jobs around the house, mobility, leisure and social activities, general health perception and mood. The questionnaire has been translated from English into French, German, Italian, Hebrew, Swedish and Dutch. The questionnaire is currently being validated in a multicentre study involving patients with stable osteoporosis and control subjects. Preliminary results indicate that the reproducibility is sufficient and that the questionnaire is able to discriminate between patients with vertebral osteoporosis and control subjects.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623457
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  • 6
    Electronic Resource
    Electronic Resource
    The hospital burden of vertebral fracture in Europe: A study of national register sources (1997)
    Springer
    Osteoporosis international 7 (1997), S. 138-141 
    Details
    ISSN: 1433-2965
    Keywords: Hip fracture ; Osteoporosis ; Vertebral fracture
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aims of this study were to quantify the hospital burden of vertebral fracture in Europe and to compare this with that of hip fracture. Information on hospital discharges was sought by age and sex from Ministries of Health in Europe. Discharge rates for vertebral fracture, available from 12 countries, varied by more than 4-fold between countries, which was greater than the differences between sexes. Where the discharge rate was high for vertebral fracture the incidence of hip fracture was also high. Since nearly all cases of hip fracture are hospitalized, this suggests a relationship between hip and vertebral fracture risk that is not explained by different admission policies for vertebral fracture in different European countries.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623689
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  • 7
    Electronic Resource
    Electronic Resource
    Rationale for the use of clodronate in osteoporosis (1993)
    Springer
    Osteoporosis international 3 (1993), S. 23-28 
    Details
    ISSN: 1433-2965
    Keywords: Clodronate ; Osteoporosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Bisphosphonates are widely used in disorders associated with increased resorption of bone, particularly in Paget's disease of bone and in the hypercalcemia of malignancy. Because of their undoubted efficacy and relatively low toxicity, bisphosphonates are attractive candidates for the management of osteoporosis. Clodronate, one of the many bisphosphonates being tested in osteoporosis, may be given intravenously or by mouth. In contrast to etidronate, even high doses of clodronate do not impair the mineralization of bone, making it suitable for long-term use in osteoporosis. As do all the bisphosphonates tested thus far, clodronate appears to delay the rate of bone loss in osteoporosis. Long-term studies are relatively few, so that its steady-state effects on bone mass are not yet known. Most data suggest clodronate is capable at least of delaying the rate of bone loss, but several pilot studies with this agent suggest that increments of bone mass might be sustainable for several years. Clodronate is likely to decrease the frequency of osteoporotic fractures, but there is no evidence for this at present. Well-controlled, long-term prospective studies are needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623223
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    Paper (German National Licenses)
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  • 8
    Electronic Resource
    Electronic Resource
    Acute effects of deflazacort and prednisone on rates of mineralization and bone formation (1995)
    Springer
    Calcified tissue international 56 (1995), S. 109-112 
    Details
    ISSN: 1432-0827
    Keywords: Glucocorticoid ; Histomorphometry ; Bone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine , Physics
    Notes: Abstract The aims of this study were to determine (1) whether acute suppression of bone formation could be evaluated after the administration of corticosteroids in man by quantitative bone histomorphometry; and (2) whether there were significant differences between the effects of prednisone and its analog deflazacort. Thirteen patients who needed high-dose corticosteroid therapy were randomly allocated to two groups of treatment (prednisone or deflazacort). Quantitative bone histomorphometry, using the technique of triple labeling, and biochemical measurements of bone turnover were studied. There were no differences in biochemical indices of bone turnover between prednisone and deflazacort at the beginning and end of the 15 days of treatment course. During corticosteroid treatment, there were no significant changes in biochemical indices of bone turnover but a significant decline in total alkaline phosphatase (P〈0.01). Histomorphometric indices, as revealed by measurements of tetracycline interval and extent of labeling, showed no significant differences in either mineral apposition rate or bone formation rate in the two groups. We conclude that the acute glucocorticoid suppression of bone turnover by glucocorticoids is not detectable within the first 2 weeks of treatment by histomorphometric techniques. No differences in bone effects of prednisone and deflazacort were detected in this short-term study.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00296340
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