期刊全称 | Bone Densitometry and Osteoporosis | 影响因子2023 | Harry K. Genant (Chief,Musculoskeletal Radiology, | 视频video | http://file.papertrans.cn/190/189655/189655.mp4 | 发行地址 | This is the firtst book on the diagnosis of osteoporosis * a collection of state-of-the-art articles of renowned authors | 图书封面 |  | 影响因子 | The diagnosis of osteoporosis and the determination of fracture risk has always been a challenge for radiologists, epidemiologists, and clinicians as well as oth er researchers and health care professionals working in the field. It is bone min eral density that is closely related to bone fragility, and the advent of techniques to quantitatively assess bone density has been welcomed. It has reduced the sub jectivity inherent to conventional radiologic assessment of osteoporosis. The on going technical process has made various techJ)iques to assess bone density wide ly available. However, these measurement techniques have also incurred some crit icism because bone densitometry has sometimes been applied without specific indications and without appropriate clinical ramifications. The purpose of this text is to provide a perspective on the current status of bone densitometry and ist relevance to osteoporosis diagnosis and management. Therefore, this book will give the reader an introduction to the nature of osteo porosis, its pathophysiology and epidemiology, and the clinical consequences of performing bone densitometry. Aside from standard bone densitometry, newer technologies | Pindex | Book 1998 |
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Front Matter |
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Abstract
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2 |
,Osteoporosis: The Clinical Problem, |
L. V. Avioli,M. Kleerekoper |
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Abstract
Osteoporosis is a disease characterized by low bone mass and the development of nontraumatic or atraumatic fractures as a direct result of the low bone mass. A nontraumatic fracture has been arbitrarily defined as one occurring from trauma equal to or less than that of a fall from a standing height. In the preclinical state the disease is characterized simply by low bone mass without fractures. This totally asymptomatic state is often termed “osteopenia.” Osteoporosis and osteopenia are the most common metabolic bone diseases in the developed countries of the world, whereas osteomalacia may be more prevalent in underdeveloped countries where nutrition is suboptimal and vitamin D deficiency common [1]. To be able to evaluate more fully the prevalence and incidence of osteoporosis worldwide, the World Health Organization (WHO) recently convened an expert panel to define osteoporosis on the basis of bone mass measurement [2].The diagnostic categories for women that were established by that panel are as follows [1]:.Osteoporotic fractures may affect any part of the skeleton except the skull. Most commonly, fractures occur in the distal forearm (Colles’ fracture), thoracic and lumbar ve
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3 |
,Epidemiology of Osteoporosis, |
P. D. Ross |
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Abstract
Fractures related to osteoporosis affect more than half of women and about one-third of men in the United States during their lifetimes, making it one of the most prevalent chronic health conditions among the elderly. Many persons currently have low bone density and are at risk but have not yet experienced fractures. This chapter reviews how common osteoporosis is, based on two criteria (low bone density and frequency of fractures), and also reviews the extent of health and economic impacts.
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,The Pysiology of Bone Turnover, |
R. Pacifici |
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Abstract
Bone is remodeled by a sequence of cellular events which occur in discrete locations known as bone remodeling units. This process begins with the activation of mature osteoclasts adhering to the bone surfaces usually covered by lining osteoblasts and with an expansion of the osteoclastic pool. Through the interaction of preexisting and newly formed osteoclasts with osteoblasts, resorption is initiated in discrete areas. This phase, which lasts 2–4 weeks, leads to the formation of focal areas of bone resorption which reach a depth of about 30 μm [1]. Toward the end of the resorption phase mononuclear cells, an important source of cytokines, are typically found at the bottom of the resorption cavity [1]. The transition from resorption to formation is called reversal. This phase is characterized by the accumulation of osteoblast precursors and of a thin layer of inorganic matrix, known as cement line, at the bottom of the resorption pit. The cement line is rich in osteopontin, a RGD-rich protein which may be involved in signaling the cessation of osteoclastic activity. This is followed by the replacement of the removed bone by osteoblasts which accumulate at the base of the resorption
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,Growth Factors and the Skeleton, |
E. Canalis |
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Abstract
Bone remodeling is a process regulated by systemic hormones and locally synthesized factors. Bone remodeling consists of bone resorption and bone formation. These two functions are coupled, and local factors are probably important in the coupling of the resorptive and forming phases of bone remodeling. Agents that regulate bone formation may act either by increasing or decreasing the number of cells available to form new bone or by modifying the differentiated function of the bone forming cell, the osteoblast. Similarly, bone resorption can be regulated by agents that alter the number of osteoclasts or modify the function of these cells. The number of mature osteoblasts or osteoclasts can be regulated by increasing or decreasing the replication of precursor cells or by altering their differentiation into mature cells.
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,Cellular Basis of Bone Resorption, |
A. Zambonin Zallone,G. Zambonin |
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Abstract
Bone remodeling is a finely tuned process that lasts throughout one’s life. Old bone is removed, and new bone is formed according to the mechanical and metabolic needs of the body. Osteoblasts and osteoclasts are the cell types that take part in this complex task. The osteoblasts are very possibly, together with the osteocytes, responsible for selecting the area that is to be removed, while the osteoclasts are the cells that actually carry out the resorption. Newly formed osteoblasts are immediately thereafter recruited to repair and/or reorganize the tissue. This chapter describes principally the origin of the osteoclasts, the molecular mechanisms of bone resorption, and the current hypothesis about the coupling mechanism that joins osteoclast and osteoblast activity.
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,Biochemical Markers of Bone Turnover, |
K. Ziambaras,R. Civitelli |
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Abstract
The bone turnover (remodeling) cycle is characterized by two opposite but finely coupled processes, bone formation and resorption. In adult normal bone these two processes represent not only the physiological response of the skeleton to injuries, but they also provide the mechanism for renewal of aging bone and remodeling of the skeletal architecture to maximize its flexibility to stress and resistance to load. Most metabolic bone diseases, including osteoporosis, are the consequence of an unbalanced bone turnover.
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,Determinants of Bone Loss, |
S. Adami,V. Braga |
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Abstract
The loss of bone mass and of its microarchitectural integrity is a slow process which remains asymptomatic until the appearance of the typical low trauma fracture. In order to effectively prevent the osteoporotic fractures methods of identifying individuals at risk earlier in the disease are needed. There are several different categories of risk factors for osteoporotic fractures. They may be related to the determinants of bone mineral density (BMD), to propensity for falling, and to skeletal fragility independently of BMD. The risk factors for the latter are relatively uncommon and poorly understood mainly because bone “quality” cannot be properly assessed in vivo. In some cases the risk factors can be generally defined as independent of BMD. This is the case for previous fractures, which are associated with an approximate doubling of fracture risk after correction for BMD (Ross et al. 1991), for the length of the head of the femur or for the thickness of the fat tissue overlying the hip (Reid et al.1994b;Cummings1995). In other cases the risk for fractures are linked to a greater liability to falls (poor visual acuity, neuromuscular impairment, inadequate lighting, use of benzodi
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,Biomechanical Properties of Bone, |
J. L. Ferretti |
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Abstract
There is no scientific answer to this teleological question. Bones may be either regarded as “serving” to protect bone marrow from cosmic radiation and to store quantities of electrolytes that are essential for life, or merely to act as columns or levers to support the body and allow locomotion and work, and so on.
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10 |
,Risk Factors for Osteoporosis Fractures, |
O. Johnell |
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Abstract
The major risk factor for osteoporosis fractures is low bone mass, which is a subject discussed in other chapters of this volume. Also, risks may be indicated by biochemical markers. In the literature there are several studies on risk factors and osteoporosis. In a Medline search the osteoporosis field has increased substantially from 1980 to 1995 as has the number of papers on bone mineral density (BMD). However, the increase in studies on other risk factors has increased 112 times (Table 9-1). I discuss some of the risk factors identified in the literature and their possible clinical usefulness.
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,Bone Biopsy in Metabolic Bone Disease, |
E. Bonucci |
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Abstract
The morphological study of bone tissue is a necessary complement to clinical investigations that aim to diagnose metabolic bone disease. A number of reviews have stressed the important diagnostic role of histological, histochemical, ultrastructural, and biophysical studies that can be carried out on bone specimens (Faugere and Malluche 1983; Girasole and Passeri 1994; Jowsey 1977; Weinstein 1992). In the past these studies were limited to skeletal segments taken at the autopsy or after surgery. The discovery that specimens suitable for microscopic investigations can be obtained by safe and relatively painless needle biopsies of the iliac crest (Bordier et al.1964; Ellis et al.1964) has provided a new tool for the diagnosis of metabolic bone disease, and for the monitoring of its evolution during and after therapeutic treatments.
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,Radiology of Osteoporosis, |
M. Jergas |
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Abstract
The term osteoporosis is widely used clinically to mean generalized loss of bone, or osteopenia, accompanied by relatively atraumatic fractures of the spine, wrist, hips, or ribs. Because of uncertainties of specific radiological interpretation, the term osteopenia (“poverty of bone”) has been used as a generic designation for radiographic signs of decreased bone density. Radiographic findings suggestive of osteopenia and osteoporosis are frequently encountered in daily medical practice and can result from a wide spectrum of diseases ranging from highly prevalent causes such as postmenopausal and involutional osteoporosis to very rare endocrinological and hereditary or acquired disorders. The value of conventional radiographs for detecting and quantifying osteopenia and osteoporosis has raised scientific interest for many years.
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,Assessment of Vertebral Fracture, |
M. Jergas,D. Felsenberg |
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Abstract
In everyday clinical practice radiologists visually analyze radiographs of the thoracolumbar spine in the lateral projection to identify vertebral fractures in patients whose clinical indications suggest trauma, osteoporosis, malignancy, or acute back pain. While diagnosing the vertebral fracture in question, the interpreter also considers the potential differential diagnoses of this deformity. The radiologist’s decision can be aided by additional radiographic projections such as anteroposterior or oblique views and by complementary examinations such as bone scintigraphy, computed tomography, and magnetic resonance imaging. Thus in a clinical environment the detection of vertebral fractures seldom poses great difficulties.
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14 |
,Basic Considerations and Definitions in Bone Densitometry, |
M. Jergas,M. Uffmann |
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Abstract
Bone densitometry has become an established tool for diagnosing and following up patients with disorders affecting the bone mineralization. The development of bone densitometry has certainly been driven by the need to overcome the inherent shortcomings of plain radiography for assessing bone density [17, 79]. Several studies show that the agreement between radiologists for the assessment of the bone mineral status based on radiographs of the spine is only moderate [30, 66]. This maybe even more a problem when one tries to assess changes in bone density based on conventional radiography. Semiquantitative methods such as Saville’s, Singh’s, or Jhamaria’s osteoporosis indices are of limited value, and some quantitative scores such as the Barnett-Nordin index at the spine do not really demonstrate a good correlation with bone density [6, 67, 68,112,114]. Therefore a number of methods for quantitatively assessing a person’s bone status to overcome the imperfections of plain radiography have been developed. With these methods a completely new terminology has evolved including various acronyms and definitions that are in part specific to some methods, or that are used for diagnostic purpo
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,Radiogrammetry and Radiographic Absorptiometry, |
C. van Kuijk,H. K. Genant |
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Abstract
This chapter addresses the methods of radiogrammetry (translated freely as “measuring dimensions on radiographs”) and radiographic absorptiometry (“measuring the X-ray absorption on radiographs”). Both techniques have been used widely in the past, and especially the latter continues to be used in the present as a straightforward, relatively simple and inexpensive technique for the assessment of skeletal status. Its use is primarily in osteoporosis, which is defined as loss of bone leading to fractures. Radiographic absorptiometry also has strong roots and applications in dental research, as is discussed below.
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16 |
,Single- and Dual-Energy: X-Ray Absorptiometry, |
J. E. Adams |
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Abstract
Osteoporosis is the most common of the metabolic disorders of bone. The condition is characterised by reduced bone mass and easy (fragility) fracture. Such fractures can occur in any site but are most frequent in the wrist, spine (vertebral body) and hip — areas of the skeleton rich in trabecular bone. Such fractures, and particularly those in the hip, result in considerable morbidity (pain, deformity, loss of height with vertebral fractures) and even mortality, with enormous socio-economic consequences. Treatment of established osteoporosis is difficult and often unsatisfactory, although in recent years diphosphonates (etidronate, alendronate) have been introduced which show encouraging results in increasing bone mass and reducing fracture incidence [1, 2]. Previously treatment strategies favoured prevention of osteoporosis by maximising peak bone mass, minimising age related and postmenopausal bone loss (hormone replacement therapy), avoiding risk factors, and ensuring adequate dietary intake of calcium and appropriate exercise. There is a growing demand from patients, general medical practitioners and specialists (obstetricians, orthopaedic surgeons, rheumatologists and endocrin
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,Quantitative Computed Tomography at the Axial Skeleton, |
G. Guglielmi,T. F. Lang,M. Cammisa,H. K. Genant |
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Abstract
Quantitative computed tomography (QCT) is an established technique for measuring bone mineral density (BMD) in the axial spine and appendicular skeleton [1–3]. Because it provides cross-sectional images, QCT is uniquely able to provide separate measurements of trabecular and cortical bone BMD as well as a true volumetric mineral density in grams per cubic centimeter. In this application QCT has been used for assessment of vertebral fracture risk [4, 5], measurement of age-related bone loss [6–8], and follow-up of osteoporosis and other metabolic bone diseases [9]. This chapter assesses the current capabilities of QCT at different skeletal sites, and reviews recent technical developments such as fast three-dimensional data acquisition and high-resolution image acquisition and processing techniques, in which novel information about bone strength may be obtained through analysis of trabecular microarchitecture.
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18 |
,Peripheral Quantitative Computed Tomography, |
P. Schneider,C. Reiners |
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Abstract
Access to measurement of bone density by absorptiometry has been limited to planar information due to its ability to deliver only projections of the bones that are investigated. Some researchers realized this lack of capability of the available techniques and tried to develop systems offering three-dimensional information. The aim was to provide a view inside the bone into the spongiosa compartment, which is known to have a high turnover. It was expected to see changes in bone mass occurring earlier in this compartment than in compact bone or in a projected mixture of trabecular and compact bone.
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,Comparison of Quantitative Computed Tomography and Dual X-Ray Absorptiometry at the Lumbar Spine in |
T. Fuerst,G. Guglielmi,M. Cammisa,H. K. Genant |
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Abstract
The noninvasive measurement of bone mass is an essential tool in the clinical diagnosis of osteoporosis. Bone mineral density (BMD) is an established, important predictor of risk of osteoporotic fracture. Various methods to quantify spinal BMD are currently in use to obtain an early diagnosis of osteoporosis and to follow its development or, alternatively, to evaluate the success of a particular therapy. The two methods of noninvasive spinal BMD assessment most widely used are quantitative computed tomography (QCT) and dual X-ray absorptiometry (DXA). Both methods offer specific inherent qualities.
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,Quantitative Ultrasound for Assessing Bone Properties, |
D. Hans,T. Fuerst,G. Guglielmi,H. K. Genant |
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Abstract
Osteoporosis is a systemic skeletal disease characterized by low bone mass and structural deterioration of bone tissue, with a consequent decrease in the mechanical competence of bone and thus an increase in the susceptibility to fracture [1]. It most commonly presents as vertebral fractures. Colle’s fractures of the forearm and low-trauma fractures at other sites are also associated with this disease. However, the most severe complications of osteoporosis are hip fractures. Today the lifetime risk of hip fracture for a 50-year old woman is about 18% [2], and the continuing rise in life expectancy is expected to cause a threefold rise in worldwide fracture incidence over the next 60 years [2]. It is clear that osteoporosis represents a major worldwide public health problem that will grow in importance in the coming decades as the population ages. The associated increase in the financial burden to the public health system is an additional concern. In the United States alone the combined public health costs from osteoporosis were 10 billion dollars in 1989 [3–5]. Such forecasts have lead to the search for new, cost-effective methods for early detection, prevention, and treatment.
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