Osteoporosis and its management

Poole, Kenneth; Compston, Juliet

doi:10.1136/bmj.39050.597350.47

Cited by 210 publications

(177 citation statements)

References 28 publications

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“…O steoarthritis (OA) (1) and osteoporosis (2) are both associated with altered bone mass and a disordered balance between bone formation and bone resorption. Each disease is associated with increased activation of remodeling, which in OA can be localized.…”

Section: Introductionmentioning

confidence: 99%

Sclerostin and the regulation of bone formation: Effects in hip osteoarthritis and femoral neck fracture

Power

Poole

Bezooijen

et al. 2010

Journal of Bone and Mineral Research

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Remodeling imbalance in the elderly femoral neck can result in thin cortices and porosity predisposing to hip fracture. Hip osteoarthritis protects against intracapsular hip fracture. By secreting sclerostin, osteocytes may inhibit Wnt signaling and reduce bone formation by osteoblasts. We hypothesised that differences in osteocytic sclerostin expression might account for differences in osteonal boneformation activity between controls and subjects with hip fracture or hip osteoarthritis. Using specific antibody staining, we determined the osteocytic expression of sclerostin within osteons of the femoral neck cortex in bone removed from subjects undergoing surgery for hip osteoarthritis (hOA: 5 males, 5 females, 49 to 92 years of age) or hip fracture fixation (FNF: 5 males, 5 females, 73 to 87 years of age) and controls (C: 5 males, 6 females, 61 to 90 years of age). Sclerostin expression and distances of each osteocyte to the canal surface and cement line were assessed for all osteonal osteocytes in 636 unremodeled osteons chosen from fields ($0.5 mm in diameter) with at least one canal staining for alkaline phosphatase (ALP), a marker of bone formation. In adjacent sections, ALP staining was used to classify basic multicellular unit (BMUs) as quiescent or actively forming bone (ALP þ ). The areal densities of scl À and scl þ osteocytes (number of cells per unit area) in the BMU were inversely correlated and were strong determinants of ALP status in the BMU. In controls and hip fracture patients only, sclerostin-negative osteocytes were closer to osteonal surfaces than positively stained cells. Osteon maturity (progress to closure) was strongly associated with the proportion of osteonal osteocytes expressing sclerostin, and sclerostin expression was the chief determinant of ALP status. hOA patients had 18% fewer osteocytes per unit bone area than controls, fewer osteocytes expressed sclerostin on average than in controls, but wide variation was seen between subjects. Thus, in most hOA patients, there was increased osteonal ALP staining and reduced sclerostin staining of osteocytes. In FNF patients, newly forming osteons were similar in this respect to hOA osteons, but with closure, there was a much sharper reduction in ALP staining that was only partly accounted for by the increased proportions of osteonal osteocytes staining positive for sclerostin. There was no evidence for a greater effect on ALP expression by osteocytes near the osteonal canal. In line with data from blocking antibody experiments, osteonal sclerostin appears to be a strong determinant of whether osteoblasts actively produce bone. In hOA, reduced sclerostin expression likely mediates increased osteoblastic activity in the intracapsular cortex. In FNF, full osteonal closure is postponed, with increased porosity, in part because the proportion of osteocytes expressing sclerostin increases sharply with osteonal maturation. ß

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Section: Introductionmentioning

confidence: 99%

Sclerostin and the regulation of bone formation: Effects in hip osteoarthritis and femoral neck fracture

Power

Poole

Bezooijen

et al. 2010

Journal of Bone and Mineral Research

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“…Inclusion criteria were: acute distal radius fracture in patients with mature sceleton, age 18-65 years (this excludes the influence of the clinically relevant osteoporosis [12]), operative treatment indicated (regardless of the type of the fixation method used [13]). Exclusion criteria were: fracture in patients with unfused epiphyses, concomitant carpal or hand fractures on the initial radiographs (carpal fracture), neuro-vascular injury.…”

Section: Patientsmentioning

confidence: 99%

Analysis of the Arthroscopically Diagnosed Soft-Tissue Injuries Associated With the Distal Radius Fractures

2014

Maced J Med Sci

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Competing Interests: The authors have declared that no competing interests exist. Abstract AIM:The aim of this study was to analyze the frequencies of these soft-tissue injuries and to describe the arthroscopic technique used for their diagnosis. METHODS:The prospective study included 85 patients with operatively treated distal radius fracture. Wrist arthroscopy was used to identify the associated lesions of triangular fibrocartilage complex (TFCC), scapholunate ligament (SL) and lunitriquetral ligament (LT), extrinsic ligaments, and chondral lesions. RESULTS:Wrist arthroscopy identified TFCC injury in 72.9%, SL injury in 65.9%, LT injury in 17.7%, extrinsic ligaments in 49.4% and chondral lesion in 30.6% of the patients. 87.1% of the patients had at least one of the major structures injured (TFCC, SL or LT). The presence of the ulnar styloid fractures significantlly correlated with with the associated LT lesion, with the LT lesion type, and with the lesion of both SL and LT ligament. If the distal radius fracture was intraarticular there was no correlation with the finding of any associated soft-tissue lesion. CONCLUSIONS:The frequency of the associated soft-tissue lesions in distal radius fractures is high. Ulnar styloid fracture was identified as risk factor for associated LT lesion, as well as combined lesion of both scapholunate and luntriquetral ligament.

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“…Often, osteopaenia, which is a decrease in bone mineral density (BMD), is also considered osteoporosis [29], but osteoporosis consists not only of a reduction in bone mass but also of important changes in trabecular architecture, such as trabecular perforation and loss of connectivity [73]. The World Health Organization offers the following diagnostic criteria for osteopaenia and osteoporosis: Osteopaenia is present when BMD is greater than 1 standard deviation (SD) but less than or equal to 2.5 SD below normal values for young adults; osteoporosis is present when values are greater than 2.5 SD below normal peak bone mass [57,81].…”

Section: Introductionmentioning

confidence: 99%

Osteoporosis, falls and exercise

Meléndez-Ortega

2007

Eur Rev Aging Phys Act

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Osteoporosis, a manifestation of bone atrophy that leads to great susceptibility to fractures, is a very important public health problem today because of its great morbidity, mortality and important economic repercussions. It is a problem that will tend to become more serious with the increase in the number of elderly persons. Bone mass is gained during adolescence, reaches a plateau during the third decade and remains stable until approximately age 50, after which a progressively gradual loss is observed. There is no real cure for osteoporosis, but a series of strategies can be used to reduce bone loss and improve bone mass. Osteoporosis has been considered a disease that accompanies the process of ageing; however, this fatalistic attitude should be discarded, as it is possible to correct and decrease the risk factors. Intervention strategies are based on three pillars: nutrition, physical activity and pharmacological agents. Physical activities and exercise programmes are important because they not only can counter the loss of bone mass but also improve neuromuscular capacity, maintaining and increasing strength and muscle mass, which can help to avoid falls and reduce their impact and consequences. The general principles that apply to any exercise programme also apply to preventing bone mass loss. They also can be applied to persons with osteoporosis. However, to understand the peculiarities of these programmes, the propensity for suffering fractures of these former groups should be kept in mind. Special care should be taken to avoid falls and injuries. Weight-bearing exercise and resistance training are recommended for the prevention programmes. Other activities such as tai-chi, dancing, gymnastic or callisthenic exercises can help to improve balance, gait and muscle coordination and diminish the risk of falling. These programmes should be complemented with postural education and a series of safety precautions.

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Osteoporosis and its management

Cited by 210 publications

References 28 publications

Sclerostin and the regulation of bone formation: Effects in hip osteoarthritis and femoral neck fracture

Sclerostin and the regulation of bone formation: Effects in hip osteoarthritis and femoral neck fracture

Analysis of the Arthroscopically Diagnosed Soft-Tissue Injuries Associated With the Distal Radius Fractures

Osteoporosis, falls and exercise

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