Epidemiology and clinical features of osteoporosis in young individuals

Khosla, Sundeep; Lufkin, Edward G.; Hodgson, Stephen F.; Fitzpatrick, L.A.; Melton, L. Joseph

doi:10.1016/8756-3282(94)90280-1

Cited by 163 publications

(70 citation statements)

References 14 publications

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“…This effect is partially compensated by an increase in cortical diameter (4), thus increasing torsional stiffness while reducing buckling resistance (5). Recent data suggest that weakened cortical bone may primarily be responsible for hip intracapsular hip fracture (6), thus emphasizing the importance for quantitatively assessing and monitoring cortical structure.…”

Section: Introductionmentioning

confidence: 99%

Method for Cortical Bone Structural Analysis From Magnetic Resonance Images1

Gomberg¹,

Saha²,

Wehrli³

2005

Academic Radiology

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Rationale-Quantitative evaluation of cortical bone architecture as a means to assess bone strength is typically accomplished on the basis of images obtained by dual-energy X-ray absorptiometry (DXA) or computed tomography (CT). Magnetic resonance imaging (MRI) has potential advantages for this task in that it allows imaging in arbitrary scan planes at high spatial resolution. However, several hurdles have to be overcome in order to make this approach practical, including resolution of issues related to nonlinear receive coil sensitivity, variations in marrow composition and the presence periosteal isointense tissues which all complicate segmentation. Objectives-To develop MR acquisition and analysis methods optimized for detection of cortical boundaries in complex geometries such as the femoral neck.Materials and Methods-Cortical boundary detection is achieved by radially tracing intensity profiles that intersect the bone's periosteal and endosteal boundary. The profiles are subsequently normalized to the intensity of the marrow signal, processed with morphologic image operators and binarized. The resulting boundaries are then mapped back onto the spatial image and erroneous boundary points removed. From the detected cortical boundaries cortical cross-sectional area and thickness are computed. The method was evaluated on cortical bone specimens and human volunteers on the basis of high-resolution images acquired at 1.5 Tesla field strength. To assess whether the method is sensitive to detect the expected dependencies of cortical parameters in weight-bearing bone on overall habitus, ten women ages 46-73 years (mean 56 years) underwent the cortical imaging protocol in the proximal femur and the results were compared with DXA BMD parameters of the hip and spine.Results-Reproducibility was on the order of 2%. Double oblique images of the femoral neck in the ten women studied showed cortical cross-sectional area to correlate strongly with height (r = 0.88, p = 0.0008) while cortical diameter versus age approached significance (r = 0.61, p = 0.06). Measurements in specimens of some cortical parameters indicated a resolution dependence. It is to be noted, however, that parameter rank remained constant across all specimens studied. Conclusion-The data suggest the new method to be robust and applicable on standard clinical MR scanners at arbitrary anatomic locations to yield clinically meaningful quantitative results.

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Section: Introductionmentioning

confidence: 99%

Method for Cortical Bone Structural Analysis From Magnetic Resonance Images1

Gomberg¹,

Saha²,

Wehrli³

2005

Academic Radiology

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“…A secondary cause of osteoporosis can be found in a substantial proportion of premenopausal women with low BMD or fractures [24,25,27], and identification of a contributing condition often helps to guide management of the affected individual.…”

Section: Discussionmentioning

confidence: 99%

“…The same "secondary causes" may be associated with bone loss in older women. In a population study from Olmstead County, MN, 90% of men and women aged 20 to 44 years with established osteoporosis (ie, fractures) were found to have a secondary cause [24]. In contrast, several other case series records of young women with osteoporosis evaluated in tertiary referral centers have found that only 44% to 56% had secondary causes [25][26][27].…”

Section: Pathological Processes (Secondary Causes) Of Low Bmd In Premmentioning

confidence: 99%

Treatment of premenopausal women with low bone mineral density

Cohen

Shane²

2008

Curr Osteoporos Rep

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Interpretation of bone mineral density (BMD) results in premenopausal women is particularly challenging, because the relationship between BMD and fracture risk is not the same as for postmenopausal women. Z scores rather than T scores should be used to define "low BMD" in premenopausal women. The finding of low BMD in a premenopausal woman should prompt an evaluation for secondary causes of bone loss. If a secondary cause is found, management should focus on treatment of this condition. In some cases in which the secondary cause cannot be addressed, such as glucocorticoid therapy or cancer chemotherapy, treatment with a bone-active agent to prevent bone loss should be considered. In women with no fractures and no known secondary cause, low BMD may not signify compromised bone strength. BMD is likely to remain stable in these women, and pharmacologic therapy is rarely justified. Assessment of markers of bone turnover and follow-up bone density measurements can help to identify those with an ongoing process of bone loss that may indicate a higher risk for fracture, and possible need for pharmacologic intervention.

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“…Hypogonadism, corticosteroid use and alcohol abuse constitute the majority of secondary causes (21). Additionally, evaluation for hypercalciuria (≥ 4 mg/kg/day) is also worthy of consideration, as this condition may be present in up to 15% of osteoporotic men (35,36).…”

Section: Pathophysiologymentioning

confidence: 99%

Osteoporosis in men

Binkley¹

2006

Arq Bras Endocrinol Metab

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Osteoporosis is defined as "a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture". Approximately 40-50% of women sustain osteoporotic fractures in their lifetime; as such, it is appropriate that studies initially focused upon females. Despite an increased recognition of osteoporotic fractures in men, there continues to be neglect of this disease in males. This ongoing neglect is inappropriate as 25-33% of men in some populations will sustain osteoporotic fractures in their lifetime. Testosterone plays an important role in male skeletal health. However, recent data suggest that estrogen may in fact be the dominant hormone regulating skeletal status in both men and women. BMD measurement may be utilized for osteoporosis diagnosis and to assist with fracture risk prediction in men prior to their sustaining a fracture. Recognizing this need, the International Society for Clinical Densitometry (ISCD) recommended and recently reaffirmed use of a BMD T-score of -2.5 or below be utilized to diagnose osteoporosis in men. Androgen therapy of hypogonadal men may be considered with the caveat that data do not exist to document that this treatment reduces fracture risk. At this time, the data is inadequate to support use of androgen treatment in eugonadal men with osteoporosis. Parathyroid hormone treatment does increase BMD; existing studies have not been of adequate size or duration to document fracture reduction efficacy. Bisphosphonate therapy increases BMD, reduces vertebral fracture risk and is considered the standard of care for osteoporotic men at this point in time. RESUMO Osteoporose em Homens.A osteoporose é definida como "uma doença esquelética sistêmica caracterizada por baixa massa óssea e deterioração da microarquitetura do tecido ósseo com conseqüente aumento da susceptibilidade a fraturas". Aproximadamente 40-50% das mulheres apresentarão uma fratura osteoporótica durante suas vidas, e por isso os estudos iniciais focalizaram o sexo feminino. A despeito do reconhecimento cada vez mais freqüente da ocorrência de fraturas osteoporóticas em homens, a doença continua sendo negligenciada no sexo masculino. Isto não é apropriado na medida em que 25-33% dos homens em algumas populações apresentarão fraturas osteoporóticas durante suas vidas. A testosterona exerce um importante papel na integridade esquelética masculina, contudo dados recentes sugerem que os estrógenos são de fato os hormônios dominantes na regulação esquelética em ambos os sexos. A medida da densidade mineral óssea pode ser utilizada no diagnóstico e para avaliar o risco de fraturas, e a ISCD recomenda que o escore T de -2.5 ou menos seja usado como critério diagnóstico no homem. A terapia androgênica no hipogonadismo masculino deve ser original articleOsteoporosis in Men

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Epidemiology and clinical features of osteoporosis in young individuals

Cited by 163 publications

References 14 publications

Method for Cortical Bone Structural Analysis From Magnetic Resonance Images1

Method for Cortical Bone Structural Analysis From Magnetic Resonance Images1

Treatment of premenopausal women with low bone mineral density

Osteoporosis in men

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