Bone Densitometry and Osteoporosis

ISBN-13: 9783642804427 / Angielski / Miękka / 2011 / 602 str.

Harry K. Genant; Giuseppe Guglielmi; Michael Jergas

Opis

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 such as quantitative ultrasound techniques, magnetic resonance imaging and bone structure analysis are discussed in the context of diagnosing osteoporosis."

Spis treści

1 Osteoporosis: The Clinical Problem.- Epidemiology.- Pathogenesis.- Classifications of Osteoporosis.- Clinical Manifestations of Osteoporosis.- Diagnostic Studies in Osteoporosis.- Calcitropic Hormones and Biochemical Markers of Bone Remodeling.- Medical Therapy.- Selecting a Therapy and Monitoring the Response to Therapy.- References.- 2 Epidemiology of Osteoporosis.- Skeletal Development and Aging.- Skeletal Development.- Prevalence of Low Bone Density.- Fracture Incidence and Prevalence.- Vertebral Fractures.- Hip Fractures.- Other Fractures.- Secular Trends.- Lifetime Risk.- Mortality and Morbidity.- Mortality.- Economic Costs and Morbidity.- Summary.- References.- 3 The Physiology of Bone Turnover.- Cytokines and Bone Remodeling.- Role of the Bone Matrix in the Regulation of Bone Turnover.- Effect of Menopause and Estrogen Replacement on the Production of Bone Resorbing Cytokines.- Effect of Menopause on the Stromal Cell Responsiveness to Cytokines.- Conclusions.- References.- 4 Growth Factors and the Skeleton.- Platelet-Derived Growth Factors.- Fibroblast Growth Factors.- Transforming Growth Factors-b.- Insulin-Like Growth Factors I and II.- Growth Factors and Clinical Medicine.- References.- 5 Cellular Basis of Bone Resorption.- Osteoclast Morphology and Functions.- Coupling Between Osteoclast and Osteoblast Activity.- Systemic and Local Factors in Bone Remodeling.- References.- 6 Biochemical Markers of Bone Turnover.- Parameters of Bone Formation.- Serum Alkaline Phosphatase.- Serum Osteocalcin (Bone Gla Protein).- Serum Type I Procollagen Propeptide.- Parameters of Bone Resorption.- Urine Hydroxyproline.- Urine Hydroxylysine Glycosides.- Plasma Tartrate-Resistant Acid Phosphatase.- Urine Pyridinoline Cross-Links.- Clinical Applications.- Diagnostic Value in Osteoporosis.- Prediction of Bone Loss and Fracture Risk.- Selection of Treatment.- Monitoring Treatment Compliance and Efficacy.- Diagnostic Value in Other Metabolic Bone Diseases.- Future Directions.- References.- 7 Determinants of Bone Loss.- Genetic Factors.- Age.- Estrogen Deficiency.- Body Weight.- Smoking.- Alcohol.- Nutrition.- Calcium.- Vitamin D.- Protein and Phosphate.- Caffeine.- Sodium Intake.- Physical Exercise.- Conclusions.- References.- 8 Biomechanical Properties of Bone.- What Are Bones Made For?.- Why Be Stiff?.- How To Achieve Stiffness?.- Why Not Just Be Massive?.- What Is Necessary To Be Strong?.- Are Bone Strength and Bone “Quality” Equivalent Concepts?.- How Do Bones Acquire an Optimal Mechanical Quality?.- Are Bones No More Than “Mechanical Structures”?.- What Then Is a “Bone-Weakening” Disease?.- How Should a Bone-Weakening Condition Be Diagnosed and Controlled?.- How Can Bone Absorptiometry Assess Bone Quality?.- Bone Mass Measurements.- Bone Material Quality Determinations.- Bone Macroarchitecture Assessment.- Noninvasive Estimations of Whole-Bone Quality.- References.- 9 Risk Factors for Osteoporosis Fractures.- Risk Factors for Osteoporosis Fractures.- Anthropometric Measurements.- Height.- Body Weight.- Body Mass Index.- Previous Fractures.- Falling Tendency.- Physical Activity.- Risk Factors in Men.- Combination of Risk Factors for Prediction of Hip Fractures.- References.- 10 Bone Biopsy in Metabolic Bone Disease.- The Bone Biopsy.- The Microscopic Structure of Bone.- Bone Remodeling.- Bone Biopsy in Metabolic Bone Diseases.- Conclusions.- References.- 11 Radiology of Osteoporosis.- Principal Radiographic Findings in Osteopenia and Osteoporosis.- Diseases Characterized by Generalized Osteopenia.- Involutional Osteoporosis.- Osteopenia and Osteoporosis of the Axial Skeleton.- Vertebral Fractures and Their Diagnosis.- Osteopenia and Osteoporosis at Other Skeletal Sites.- Other Causes of Generalized Osteoporosis.- Endocrine Disorders Associated with Osteoporosis.- Medication-Induced Osteoporosis.- Miscellaneous Causes of Generalized Osteoporosis.- Regional Osteoporosis.- References.- 12 Assessment of Vertebral Fracture.- Standardized Visual Assessment of Vertebral Fractures.- Quantitative Morphometric Assessment of Vertebral Fractures.- Defining Vertebral Deformity Using Quantitative Morphometry.- Applying Standardized Visual and Quantitative Morphometric Diagnosis of Vertebral Fracture.- Summary and Conclusion.- References.- 13 Basic Considerations and Definitions in Bone Densitometry.- Acronyms in Bone Densitometry.- Bone Mineral Density Is Not Bone Mineral Density Is Not Bone Mineral Density.- Quantity Versus Quality: Diagnosing Osteoporosis with Quantitative Ultrasound Techniques.- Being in Conformity to Fact: Accuracy.- Being Within Specified Limits: Precision and Its Impact on Serial Bone Mass Measurements.- Which Site To Measure?.- Interpretation of Bone Densitometry for Diagnosing Osteoporosis and Predicting Future Fractures.- Radiation Exposure in Bone Densitometry.- Quality Control in Bone Densitometry.- Summary and Conclusion.- References.- 14 Radiogrammetry and Radiographic Absorptiometry.- History.- Radiogrammetry.- Radiographic Absorptiometry.- Outline of Present Techniques.- Radiogrammetry.- Radiographic Absorptiometry.- Applications.- Radiogrammetry.- Radiographic Absorptiometry.- Future Developments.- References.- 15 Single- and Dual-Energy: X-Ray Absorptiometry.- Past Radionuclide Methods.- Single-Photon Absorptiometry.- Dual-Photon Absorptiometry.- Present Photon Absorptiometric Methods.- Single-Energy X-Ray Absorptiometry.- Dual-Energy X-Ray Absorptiometry.- Indications for DXA Bone Densitometry.- Interpretation of DXA Bone Densitometry and Reference Ranges.- Conclusions.- References.- 16 Quantitative Computed Tomography at the Axial Skeleton.- Spinal QCT.- Measurement of BMD Using Volumetric CT Images of the Spine and Hip.- High-Resolution Imaging of Trabecular Microarchitecture Using CT.- Conclusion.- References.- 17 Peripheral Quantitative Computed Tomography.- Development of the pQCT Technology.- Technical Aspects of pQCT.- Precision.- Clinical Evaluation of the pQCT Technology.- Animal Models Assessed by pQCT.- Noninvasive Estimation of Bone Stability.- Future Prospects.- References.- 18 Comparison of Quantitative Computed Tomography and Dual X-Ray Absorptiometry at the Lumbar Spine in the Diagnosis of Osteoporosis.- Quantitative Computed Tomography.- Dual X-Ray Absorptiometry.- Comparison of QCT and DXA.- Age-Related Changes and Response to Treatment.- Influence of Degenerative Joint Disease on BMD Assessed by DXA and QCT.- Fracture Association.- Estimates of Volumetric Bone Density from DXA.- Conclusions.- References.- 19 Quantitative Ultrasound for Assessing Bone Properties.- Quantitative Ultrasound Parameters.- Attenuation and Broadband Ultrasound Attenuation.- Velocity of Ultrasound.- Composite Parameter.- Quantitative Ultrasound Equipment.- Calcaneus.- Tibia.- Finger Phalanges.- Other Skeletal Sites.- Quality Control of QUS Systems.- Investigation of Quantitative Ultrasound In Vitro.- Investigation of Quantitative Ultrasound In Vivo.- Precision and Sensitivity.- QUS and Bone Mineral Density.- Age-Related Change.- Quantitative Ultrasound and Osteoporotic Fracture Risk.- QUS and Type of Hip Fracture.- Combining QUS and DXA to Improve Fracture Prediction.- QUS and Longitudinal Monitoring During Intervention.- Conclusions.- References.- 20 Applications of Magnetic Resonance Imaging in the Study of Osteoporosis.- Effect of Trabecular Bone on MR Relaxation Time T2*.- High-Resolution Magnetic Resonance Imaging of Trabecular Bone Structure.- Specimen Studies.- In Vivo Studies.- Conclusion.- References.- 21 Beyond Bone Densitometry: Assessment of Bone Architecture by X-Ray Computed Tomography at Various Levels of Resolution.- Assessment of Bone Macrostructure.- In Vivo Assessment of Bone Microstructure.- Ultrahigh-Resolution In Vitro Assessment of Bone Microstructure and In Vivo Examinations of Small Animals.- A Digital Bone Model as a Standard to Investigate Segmentation and Analysis Techniques.- Conclusions and Outlook.- References.- 22 Which Site, Which Method? Dilemmas in Bone Densitometry.- Dilemmas in Bone Densitometry.- Correlations Between Techniques for Measuring BMD.- Correlation Between the Techniques in Monitoring Age- and Menopause-Related BMD Loss.- Discrimination of Osteoporotic Women.- Considerations in Choosing Measurement Sites and Methods.- Conclusions.- References.- 23 Quality Assurance in Bone Densitometry.- Review of Techniques for Bone Mass Measurement.- Monitoring Densitometer Performance.- Standards for Quality Control.- Lunar Spine Phantom.- Norland Spine Phantom.- Hologic Spine Phantom.- European Spine Phantom.- Daily Quality Control Procedures of the DXA Manufacturers.- Analysis of Longitudinal Quality Control Data.- Replacing Old Densitometers with New Equipment.- Quality Control of the DXA Examination.- References.- 24 Clinical Application of Bone Densitometry.- References.- 25 Bone Densitometry in Children.- Dual-Energy X-Ray Absorptiometry.- Quantitative Computed Tomography.- Ultrasound.- References.- 26 Bone Mass and Bone Loss in Secondary Osteoporosis.- Glucocorticoids.- Heparin.- Hyperthyroidism.- Diabetes Mellitus.- Gastrointestinal Disorders and Alcohol Abuse.- Immobilization.- Anorexia Nervosa.- Pregnancy and Lactation.- References.- 27 Assessing the Response to Treatment for Osteoporosis.- References.- 28 Periprosthetic Bone Mineral Density and Other Orthopedic Applications.- Assessment of Bone Reaction to Metal Implants.- Total Hip Arthroplasty.- Total Knee Arthroplasty.- Other Implants.- Assessment of Bone Healing and Bone Regeneration.- Bone Healing After Fracture and New Bone Formation During Limb Lengthening.- Post-traumatic Osteopenia.- References.- 29 Osteoporosis and Oral Bone Loss: Mandibular Bone Density and Its Relationship to Systemic Osteoporosis in Edentulous Women.- Materials and Methods.- Subjects.- Bone Densitometry.- Patient Positioning.- Results.- Discussion.- References.

Blurb

The purpose of this book is to provide a perspective on the current status of bone densitometry and its relevance to osteoporosis diagnosis and management. Therefore, this book will give the reader an introduction to the nature of osteoporosis, its pathophysiology and epidemiology, and the clinical consequences of performing bone densitometry. Aside from standard bone densitometry, newer technologies such as quantitative ultrasound techniques, magnetic resonance imaging and bone structure analysis are discussed in the context of diagnosing osteoporosis.