Most Effective Osteoporosis Home Treatments

The Osteoporosis Reversing Breakthrough

eres just a few things youll learn about how to get back into health. and conquer Osteoporosis. Those not-so innocent yet everyday substances that are currently attacking your body, perpetuating and aggravating your Osteoporosis. What to do and what Not to do to overcome your Osteoporosis effectively and permanently. How to create the energy you need to be able to work full time and feel confident you will be able to take care of your loved ones. How the pharmaceutical and food industry are conspiring to poison you and make you sick (Hint: American medical system is now the leading cause of death in the US). Which food industries use advertising to encourage doctors to tell you that their food is good for you just like those cigarette ads in the 1950s! The single most effective fruits and vegetables in cleaning up excess acidic waste and how to cleanse your inner terrain completely from systemic acidosis. Why, what your Doctor has told you is wrong, and why many medications actually increase the side effects and complications of Osteoporosis (primarily by depleting vital vitamins, minerals and nutrients from your body). Which supplements every patient must take to stop the symptoms and boost your body's ability to reverse Osteoporosis. How to naturally reduce your cravings for toxic foods. Lifestyle and food choices to reverse your Osteoporosis fast, naturally, and for good. Why treating the symptoms of disease is like using an umbrella inside your house instead of fixing the roof. The most powerful creator of health (Hint: its not a food or vitamin!) The best way to simplify the task of making a health-conscious lifestyle adjustment. A miraculous scientific discovery that jump-starts your body to do its natural work, which is to heal itself and restore your Health.

The Osteoporosis Reversing Breakthrough Overview

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What is osteoporosis and what does it look like

Osteoporosis is a disease in which bones become less dense, lose strength, and are more likely to break (fracture). Some people describe bones with osteoporosis as Swiss cheese. Even the word, osteoporosis, is derived from the Greek osteo, meaning bones, and porosis, with holes. Osteoporosis happens mainly to women at midlife and later, but also can happen to men and children. In children, new bone forms more quickly than it breaks down so that bone is actually growing all the time. In adults, bone goes through a constant and normal process where new bone is formed and old bone is broken down simultaneously and at relatively even rates. When more bone is lost than is being formed, osteopenia and osteoporosis develop. Figure 1 compares normal bone with osteoporotic bone.

Why is it important to know about osteoporosis

First, osteoporosis is the most common bone disease. While osteoporosis is painless, it is still important for you to understand how it can affect your personal health, Figure 1 Comparison of normal bone with osteoporosis. A, normal bone. B, osteoporotic bone. Courtesy of the National Association of Nurse Practitioners in Women's Health (NPWH). From Dempster DW et al. J Bone Miner Res 1986 1 15-21. Figure 1 Comparison of normal bone with osteoporosis. A, normal bone. B, osteoporotic bone. Courtesy of the National Association of Nurse Practitioners in Women's Health (NPWH). From Dempster DW et al. J Bone Miner Res 1986 1 15-21. family, finances, and lifestyle. A recent report from the U.S. Surgeon General says that by 2020, half of all Americans over the age of 50 will be at risk for fractures as a result of osteoporosis. Current estimates indicate that osteoporosis is an expensive health care problem, costing Americans 18 billion per year. Osteoporosis is costly not only in dollars...

Thought osteopenia was also bone loss What is the difference between osteoporosis and osteopenia

Although the words sound somewhat alike, osteoporosis and osteopenia are a little different from one another. Both relate to bone loss, but the difference is in how much bone is lost. Osteopenia, like osteoporosis, means that the process of bone development has become unbalanced and the rate of bone loss exceeds the rate of new bone growth. With osteopenia, some bone has been lost but not as much as with osteoporosis. Although osteope-nia slightly increases your risk of breaking a bone, the Osteopenia In Greek, literally meaning bone (osteo) that is lacking (penia) the process of bone development has become unbalanced and the rate of bone loss exceeds the rate of new bone growth. With osteopenia, some bone has been lost but not as much as with osteoporosis. Poor Bone Health is Common and Costly Poor Bone Health is Common and Costly Fractures from osteoporosis 1.5 million Fractures from osteoporosis 1.5 million Figure 2 Impact of osteoporosis. Courtesy of the U.S. Department of Health...

Which bones are affected by osteoporosis

Although the hipbones and the vertebrae (bones of the spine) provide the best measurements of bone loss, osteoporosis occurs in all bones. The osteoblasts and osteoclasts are most active in the bones of the body's central region, that is, bones of the hip and vertebrae, and the long bones of the arms and legs. The skull bone is very rarely affected by osteoporosis. Fractures of the hip and vertebrae are also the most common fractures. Because all bones can be affected by osteoporosis, clinicians usually recommend that individuals with weakened bones, like those caused by osteoporosis and osteopenia, avoid playing certain sports or engaging in certain activities that will increase the likelihood of falls, which, of course, increases the risk of fractures of any bones, but particularly the hip (see Question 45). Individual bones of the spine. Fractures of these bones are the most common fractures in people with osteoporosis. In primary osteoporosis, women lose 5 to 10 of cortical bone...

Who gets osteoporosis

Both men and women can develop osteoporosis. Although more people with osteoporosis are women, particularly those who are postmenopausal, about two million men in the United States currently have osteoporosis, and one out of four will experience a fracture related to osteoporosis in his lifetime. Primary osteoporosis, which occurs in both men and women, is a result of aging. It occurs most frequently in postmenopausal women due to the rapid loss in bone associated with the normal drop in estrogen around menopause. The average age of menopause in the United States is 51. The World Health Organization reports that 35 of postmenopausal white women have osteoporosis. Primary osteoporosis or age-related osteoporosis tends to develop toward the end of life in men. The American Academy of Orthopedic Surgeons reports that almost 14 of men over the age of 85 have osteoporosis, while only 2 of men between the ages of 65 and 74 have osteoporosis. Secondary osteoporosis, which occurs as a result...

What are the risk factors for osteoporosis

Unless you break a bone, osteoporosis is painless. It's therefore important to know if you are at risk for developing it. While men and women have many of the same risk factors for osteoporosis and osteopenia, a few are gender-specific. The following factors put you at risk for osteopenia and osteoporosis Age. Bone mass decreases as you age. So as you get older, you are more likely to develop osteoporosis. While osteoporosis can affect women and men at any age, it most commonly affects postmenopausal women and older men. The National Osteoporosis Foundation reports that 75 of all cases of osteoporosis are diagnosed in white women over the age of 50. As men age, they too can develop osteoporosis, but it's much more likely to occur in men who are well into late life. Gender. Eighty percent of those with osteoporosis are women. Although men account for approximately 20 of cases, they develop osteoporosis much later if they get primary osteoporosis. Men can develop secondary osteoporosis...

Could I be taking any medications that affect bone health

There are several types of medications that can put you at greater risk for developing osteopenia and osteoporosis. These types of medications are believed to decrease bone mass either by accelerating bone breakdown or by interfering with new bone formation. Some drugs may also interfere with the body's use of Vitamin D and parathyroid hormone. However, certain medications cause bone loss and we just don't know why. Glucocorticosteroids (prednisone, prednisolone, cortisone, glucocorticoids, steroids, adrenocorticotropic hormone ACTH , Orapred , Pediapred , Prelone ) are the main group of medications associated with secondary osteoporosis. They cause more osteoporosis than any other medication. The glucocorticosteroids, also called corticosteroids or more commonly, steroids, can be taken orally, inhaled, injected, or used topically (through the skin) or intravenously. The oral, intravenous, and injected forms of steroids are the most damaging to bones. The long-term effects of inhaled...

Are there any illnesses or medical conditions that are associated with osteoporosis

If you have certain illnesses, you are definitely more at risk for developing osteoporosis either because of the illness itself or the medications used to treat the underlying illness interfere with bone development (see Question 16). Some illnesses, such as hyperthyroidism and Cushing's syndrome, increase the speed with which bone is broken down. Other illnesses, such as cystic fibrosis and celiac disease, interfere with bone formation by impeding the body's absorption or production of the nutrients needed for bone development. In fact, 3 to 4 of those with osteoporosis have gluten intolerance, the allergy to wheat that occurs in celiac disease. People with gluten intolerance cannot absorb the correct amount of calcium and Vitamin D from their intestines. One of the problems is that many people have minor symptoms and do not even know they have an allergy to wheat. Gluten intolerance can also occur later in life. Table 1 lists illnesses and medical conditions that can interfere with...

How will I know if I have osteoporosis Are there any signs or symptoms

Because osteoporosis and osteopenia are not painful conditions, you will not know that you have either one unless you break a bone or you have bone mineral density testing. A fracture of the body of a vertebra (spine bone) that collapses it and makes it thinner and weaker. Usually results from osteoporosis but can also result from complications of cancer or some injuries. It was only a little fall I couldn't have broken a bone. While not common, it is important to discuss such injuries with your clinician. Back pain that comes on suddenly in the spine can mean that you have one or more vertebral fractures resulting from osteoporosis. This is different from the back pain associated with a muscle spasm. Even if you have just bent forward to reach for something or slipped in the bathtub, you can still get a fracture in your spine if you have osteoporosis. One physical sign indicating that you have osteoporosis is loss of height. So, if you shrink in height as measured in your annual...

If osteoporosis doesnt hurt what impact does it have on my health

Osteoporosis can affect your health in many ways, directly and indirectly You become more much more susceptible to fractures. Fractures, depending on which bone you break, can cause physical immobility and impairment of your general health, as well as financial problems and social isolation. Fractures can lead to death. If you are 50 or older with osteoporosis, you have a 1 in 2 chance of having an osteoporosis-related fracture during the remainder of your lifetime. Vertebral fractures caused by osteoporosis can severely affect the quality of your life in many areas, such as social functioning, overall health, emotional health, bodily pain, and vitality. The acute back pain associated with vertebral fractures and the healing process can be very debilitating. Being unable to do activities of daily living without pain can cause you to stop moving physically and mentally physically because of pain or physical impairment, and mentally because of fears of further injury and resulting...

When should I be tested for osteoporosis Will my tests be covered by insurance

The National Osteoporosis Foundation recommends bone mineral density (BMD) testing on the following individuals If you are a women aged 65 or older, you should be tested for osteoporosis even if you have no other risk factors. low trauma Family history of osteoporosis Genetic factors Sedentary lifestyle Nutritional deficiencies Excessive alcohol intake Cigarette smoking You will note that few of the above recommendations refer specifically to men. Male patients and their clinicians should discuss their risk factors for osteoporosis, just as women should. Insurance coverage for testing are estrogen deficient (postmenopausal) women with a clinical risk for osteoporosis are being monitored for effects of or response to approved osteoporosis treatments (see Part Three).

If my clinician does not discuss screeningfor osteoporosis at what age should I make sure that I am screened

You and your clinician should discuss your bone health during every annual exam, regardless of your age. Your calcium and Vitamin D intake, your level of physical activity, and your lifestyle factors such as smoking and drinking alcohol can affect bone health at any age. If you believe that you have one or more risk factors for developing osteoporosis, it is important to discuss being screened with your clinician (see Question 13). The Surgeon General, in his 2004 report on bone health, advises that the following red flags at any age should warrant further assessment for osteoporosis or other bone diseases If you believe that you have one or more risk factors for developing osteoporosis, it is important to discuss being screened with your clinician Presence of disease that is associated with secondary osteoporosis (see Question 17)

Can my clinician tell if I have osteoporosis during my annual checkup

It is very important that your clinician take a good history during your annual check-up. The history is particularly important because osteoporosis is not painful unless you break a bone. Your clinician should ask you about the following Family history of osteoporosis Medications that can cause secondary osteoporosis (see Question 16) History of illnesses that are associated with secondary osteoporosis (see Question 17) After taking a thorough history, your clinician will examine you. For the purposes of detecting osteoporosis or for conditions that put you at increased risk of developing osteoporosis, your clinician should pay particular attention to the following Even after collecting all of this information, your clinician cannot determine if you have osteoporosis. They use this information to determine your risk for osteoporosis and then will order testing if needed (see Question 24). Since age 65, I have had a complete yearly physical, blood work, urinalysis, and so forth. When...

How is osteoporosis diagnosed

Conventional x-rays are not used to diagnose osteoporosis however, osteoporosis can sometimes be seen on x-rays. The x-rays used to diagnose a fracture can show osteoporosis, but only if you have a significant amount of bone loss, that is, 30 to 40 . There are, however, other tests that can be used specifically to evaluate your bone health. All bone mineral density (BMD) tests are safe, painless, and noninva-sive. Most of the tests subject you to no more radiation than that received from the atmosphere during a crosscountry airplane trip. One of the BMD tests uses ultrasound technology. The gold standard (best test) for diagnosing osteoporosis or identifying osteopenia is dual-energy x-ray absorptiometry (DXA). Because your hip, spine, or whole body may be evaluated using DXA, you will need to lie down on an x-ray type of table while a machine takes measurements of your bone density. The measurements and images of your bones are sent to a computer nearby, usually in the same room....

Are there other tests that are used to diagnose osteoporosis

While other tests can be used to diagnose osteoporosis, the World Health Organization (WHO) has established the guidelines for diagnosis based only on the results of DXA testing. So most other methods for identifying osteoporosis or osteopenia are used for screening, and then if the screening test suggests reduced bone density, a DXA is ordered to make a diagnosis. The following are the other tests that are available but less widely used Type of radiograph where the bone mineral density test is done on the wrist or heel while the body part is submerged in water. In addition to BMD tests, there are also biochemical markers that are measured in blood and urine to determine if specific therapies for osteoporosis are working. Biochemical marker measurements are not used for the purpose of diagnosing osteoporosis but sometimes for monitoring the progress of treatments (see Questions 40 and 69).

How will my clinician use my test results to determine whether I have osteoporosis

A T-score, expressed in standard deviations, will be reported to your clinician, and your score will most likely be evaluated using the WHO guidelines. Most machines are calibrated with special software to determine your scores. Based on the guidelines (see Question 32), your results will indicate normal bone density, low bone mass (osteopenia), or osteoporosis. If you have osteoporosis with a fragility fracture, you will have a diagnosis of severe osteoporosis. Because the T-score not only reflects bone density but also your risk of fracturing a bone, your clinician should discuss specific ways of not only increasing your bone mass but also lowering your fracture risk (see Question 79). A Z-score is usually not helpful in making the diagnosis of osteoporosis. However, if it is particularly low (lower than -1.5), it is important for your clinician to evaluate you for conditions and illnesses that may be causing your bone loss associated with secondary osteoporosis. Such causes of...

Animal Models of Osteoporosis or Increased Bone Formation

Studies by Hamrick et al. reveal that the bone phenotype of the ob ob mouse is more complex than has previously been appreciated. It is characterized by short femora with reduced cortical thickness and reduced trabecular bone volume. In the spine, however, although cortical thickness is still reduced, vertebral length, bone mineral density, and trabecular bone volume are all increased. These results indicate that the effects of altered leptin signaling on bone differ significantly between axial and appendicular regions. Few adipocytes are observed in BM from lumbar vertebrae, whereas in the femur the number of marrow adipocytes per unit area is increased 235-fold. Leptin treatment induces loss of BM adipocytes and increases bone formation in these leptin-deficient ob ob mice (153).

After Im diagnosed with osteoporosis or told that I have osteopenia what happens next

Once you have been sent for BMD testing, it's a good idea to investigate management options for osteopenia and osteoporosis. If your results are abnormal, you and your clinician can select the regimen that you both feel is best suited for your individual case. If your testing results come back in the normal range, you will still need to discuss prevention of osteoporosis to keep your bones healthy. If your T-score shows that you have osteopenia or osteoporosis, secondary causes of osteoporosis should be ruled out before treatments are suggested. It is very difficult to fully reverse osteoporosis once it is present. You might think that after you are told you have osteopenia or diagnosed with osteoporosis, your only goal should be to get rid of it. That is not the case. It is very difficult to fully reverse osteoporosis once it is present. But there are several important goals that you will want to work with your clinician to achieve It is important to remember that your goals toward...

What if Im told I that have osteopenia but not osteoporosis

If you have osteopenia, then your T-score is 1 to 2.5 standard deviations below the bone density of the average healthy young adult. Given a score in that range, your bone mass is somewhere between 10 and 30 below normal for a young adult. And your risk of fracture, based on your T-score alone, is as much as 2 to 5 times that of a healthy young adult with normal bone density. Therefore, it's still important to prevent falls. Although your T-score may indicate that you have osteopenia, it is best to assume that your bone loss will continue if you do not embrace the goals and behaviors intended to improve your bone health. Sometimes clinicians don't use the term osteopenia. Instead, they prefer to tell patients that they have low bone mass. Some clinicians may suggest prescription medications specifically intended to prevent further bone loss or to increase bone density. However, management options for osteopenia are controversial, and some clinicians think prescription medications for...

What are isoflavones Are they effective for treating osteoporosis

Because isoflavones have been found to act like estrogen in the body, isoflavones are being studied not only for their effects on the hot flashes associated with menopause, but also for their effects on bone health. Several small studies have shown some promise in reducing bone loss and increasing bone mineral density without some of the side effects of estrogen observed in other scientific studies. For example, isoflavones don't seem to increase breast density, increase endometrial thickness, or exert the same negative effects on your heart health. Further study is needed to confirm the bone findings reported when isoflavone supplements are taken. Isoflavones are considered safe when taken with other medications, such as the prescription medications described in Questions 56 to 67.

What types of medication are usually prescribed for osteoporosis

If you are told you have osteopenia or are diagnosed with osteoporosis, calcium and Vitamin D supplementation with appropriate exercise may not be enough to decrease bone loss or build bone. You may need a prescription medication. Some medications are only prescribed for women and others are prescribed for both women and men. The North American Menopause Society (NAMS) advises that the following women receive prescription medication as part of their treatment for osteoporosis Postmenopausal women who sustain a fracture of a vertebra as a result of osteoporosis. trying to break down old bone. Estrogen therapy (ET) is one of these types of medications and for post-menopausal women has been found to be very effective in the prevention of osteoporosis. ET is appropriate for preventing osteoporosis in postmenopausal women who are experiencing significant menopausal symptoms (see Questions 64-66). Other medications that fall into the group of drugs intended to prevent further loss by...

Its hard not to think about my bones being weak How do I keep osteoporosis from interfering with my life

Being told you have low bone mass or diagnosed with osteoporosis can represent an opportunity for change. Rather than letting the news interfere with your life, think of it as an opportunity to make positive changes. Rather than feeling deprived or feeling old, let osteoporosis be a life-changing moment. Because osteoporosis is a silent disease, you probably did not know you had it. But some of the changes you make now can positively affect the rest of your life. Get organized. If you are on many medications and you are taking medication to prevent or treat osteoporosis, get yourself a pill-minder to make sure that you are taking your medication in the appropriate amount, on the correct day, and at the right time. Even if you only take a couple of medications, it's worth it to your peace of mind to get organized and use a pill-minder so that by lunchtime, you don't have to worry about whether you took your morning dose of osteoporosis or blood pressure medication. Resolve to get...

Are there any medications that I should adjust or stop taking while Im being treated for osteoporosis

Presumably, you are taking prescription medications that are important to the treatment of your medical conditions. However, it's very important for you to be taking the smallest dosage that gives you the maximum benefit of any medication. Sometimes a medicine is prescribed by one clinician who is unaware of medication that you are taking that was prescribed by a different clinician. So, you need to be certain that all of your clinicians know about all of the medications you are taking. In addition, there are some over-the-counter medications such as non-steroidal anti-inflammatory drugs (NSAIDS), like ibuprofen, aspirin, and naproxen, and antacids that can increase side effects or interfere with your new medications for osteoporosis. In Question 16, there were certain medications mentioned that are good for bone health. There are other medications, however, that have a direct and negative impact on your bones (also see Question 16). If you are diagnosed with osteoporosis or placed on...

Im 60years old Is it really worth it to start exercising now Will exercise at my age help prevent osteoporosis

Absolutely Exercising will help you no matter how old you are. Although exercise has been encouraged for many years as part of a healthy lifestyle, we are just beginning to quantify its positive effects on heart disease, obesity, diabetes, menopausal symptoms, and of course osteoporosis. It is never too late to incorporate regular exercise into your lifestyle. It's easy for us to say that we're too old to begin exercising at our age, but that is not true. If you don't already have osteoporosis or osteopenia, exercise is still important even though exercise alone doesn't prevent bone loss. When you are well past the first 4 to 8 years after menopause, during which the greatest amount of bone loss occurs, and if you don't have osteoporosis, you are less likely to develop osteoporosis. If you are only a few years into post-menopause, you may still lose enough bone to be diagnosed with osteoporosis later. Regardless of how many years you are past menopause, get moving And if you're a man,...

Whats the likelihood that I will die from osteoporosis

Osteoporosis itself will not be the direct cause of your death, but it can certainly contribute to an earlier-than-expected death. Your risk of dying following a hip fracture is up to 4 times more likely than peers in your age group who have not fractured a hip. In fact, 65,000 women die every year following a hip fracture. Women outnumber men when it comes to hip fractures, but men are more likely to die as a result of a hip fracture. In addition, if you do sustain a fracture, which is the most devastating result of osteoporosis, your quality of life can be markedly decreased. Many people who With life expectancy increasing, the federal government is making recommendations in an effort to help you live out your years in a more healthful manner. By 2010, it is expected that 12 million men and women over the age of 50 will have osteoporosis, and a remarkable 40 million will have osteopenia. Preserving your bone health can help prevent osteoporosis and the fractures that can cause early...

Association Between Obesity and Bony Properties 221 Bone Mineral Density and Content and BMI

The literature examining the association between obesity and bony properties has predominantly focused on bone mineral density (BMD) and bone mineral content (BMC). Compared with normal-weight people, overweight individuals (BMI > 26) have higher BMD and BMC at both weight-bearing (e.g., femur) and non-weight-bearing (e.g., radius) sites (30). Nevertheless, the association between obesity, defined as an increased BMI, and BMD BMC is not this simplistic and is dependent on several other factors, including body composition. Abdominal obesity, body weight, and muscle strength have emerged as strong correlates of BMD in older persons (31). outcome of postmenopausal obesity is its protective role against the onset and progression of osteoporosis, which is characterized by reduced BMD. Although the association between an increased BMI and BMD BMC is important in the pathogenesis of osteoporosis, it is likely that other properties of bone are associated with OA. Osteophytosis in the...

Strontium Ranelate Osteoporosis [8890

Strontium ranelate, a divalent strontium salt of ranelic acid, has been developed and launched for the treatment of osteoporosis. As early as 1910, investigations suggested that strontium stimulates the formation of osteoid tissues while simultaneously repressing the resorptive process in bones. Specifically, strontium enhances pre-osteoblastic cell replication, inhibits pre-osteoclast differentiation, and suppresses the bone-resorbng activity of osteoclasts. From the evaluation of 26 strontium salts, ranelic acid was selected as the ideal strontium carrier due to its physicochemical and pharmacokinetic properties. The thiophene core of ranelic acid is constructed by the condensation of dialkyl 3-oxoglutarate, malononitrile, and sulfur in a suitable alcohol in the presence of morpholine or diethylamine. The resultant diester of acid is subsequently dialkylated with an alkyl bromoacetate to provide the tetraester precursor to strontium ranelate. Strontium ranelate is supplied in a 2g...

What should I tell my family about osteoporosis Will it curtail activities with them

If you have been diagnosed with osteoporosis, you should definitely discuss the diagnosis with your partner. First, your partner should know if you are on any new medications, so he or she can help support you in following the new regimen and watch for reactions. Second, you and your partner should discuss how your lives might be affected by osteoporosis. If your clinician has restricted your activity, discuss these restrictions with your partner or spouse. It is unlikely that you will be restricted from specific activities unless they are new to you (e.g., ice skating, skiing, skydiving). If you don't exercise regularly, this is a good time to discuss a new routine of exercising with your partner. Osteoporosis should not limit your activities or your thinking. Consider taking a class together for dancing, yoga, or tai chi. A diagnosis such as osteoporosis also gives you the opportunity to discuss other lifestyle changes that may be helpful to both you and your partner's bone health...

What about the new lowdose hormone patch Menostar estradiol that is used to prevent osteoporosis

Menostar (estradiol) was FDA-approved in 2004 for the prevention of postmenopausal osteoporosis. It is a dime-sized transdermal patch that delivers about 14 micrograms of estrogen per day. A new patch is applied every week. Because your body absorbs the estrogen from the patch through the skin, you can avoid the liver first-pass effect, meaning that the hormone is not metabolized through your liver. Instead, it can go directly into the bloodstream. If you are postmenopausal and want to prevent osteoporosis, or if you have osteopenia and you want to prevent further bone loss, Menostar may be appropriate for you. Menostar is not FDA-approved for osteoporosis treatment. Other treatment options are used instead. Menostar Osteoporosis Has half of the estrogen used in other transdermal patches is successful in the prevention of osteoporosis but does not prevent vasomotor symptoms Significantly increases bone mineral density after two years Although MHT can prevent postmenopausal...

What is Evista raloxifene What is a SERM and why is it effective in the treatment of osteoporosis

Evista (raloxifene) is the only FDA-approved selective estrogen receptor modulator (SERM) for the prevention and treatment of osteoporosis in postmenopausal women. You may be more familiar with tamoxifen, a SERM used in the treatment of breast cancer. A SERM binds with some estrogen receptor sites around the body. Although raloxifene is not a hormone, it has an estrogen-like effect in some body tissues such as bone and has an estrogen-blocking effect on other tissues such as breast and uterus. Evista increases bone mineral density, decreases the risk of fractures, and is FDA-approved for the prevention and treatment of osteoporosis in post-menopausal women. The dosage of Evista for both osteoporosis treatment and prevention is 60 mg per day taken as one tablet. Evista, unlike the bisphos-phonates, may be taken with or without food. In addition to Evista's positive effects on bone, it also decreases low-density lipoprotein (LDL) cholesterol (the bad cholesterol) as well as total...

Didronel etidronate is usually prescribed for Pagets disease Is it ever prescribed for osteoporosis

Didronel (etidronate) is another bisphosphonate. It is FDA-approved for Paget's disease, high calcium levels related to cancer, and rare bone conditions related to hip replacement surgery, but not for osteoporosis. Outside of the United States, Didronel is used for osteoporosis. It works a little differently from other bisphosphonates in that it kills off the osteoclasts (the cells that break down bone). Nonetheless, Didronel has been very effective in reducing osteoporosis-related fractures, particularly spinal ones, and safety has been established for 7 years or more use in postmenopausal women. Additionally, like other bisphos-phonates, some protective effects of Didronel on bone density have been shown to persist even after stopping the medication. Didronel is not FDA-approved for treatment or prevention of osteoporosis in the United States. Although Paget's disease is also a bone disease, it is totally unrelated to osteoporosis. One person can have both conditions. Paget's...

How long will I be treated for osteoporosis How will I know if the treatments are working

Osteoporosis is beginning to get the scrutiny and concern that it deserves. Up to now, osteoporosis has received little attention, possibly because it causes no pain unless you break a bone or because many people associate it with normal aging. Few therapies for osteoporosis have been tested for use for longer than 10 years, except estrogen, which was approved for the prevention of postmenopausal osteoporosis in 1972. Despite this, treatment for primary osteoporosis is usually ongoing unless some contraindications to treatment arise. In the case of secondary osteoporosis, treatment continues until the secondary cause of osteoporosis is remedied or the medication causing osteoporosis is discontinued and bone density testing reveals stable bone mass over time. The American Association of Clinical Endocrinologists (AACE) recommends the following monitoring schedule In those with normal results (a T score > -1.0), further BMD testing is not needed for 3 to 5 years. In those who are...

What does menopause have to do with osteoporosis Are there different kinds of osteoporosis

There are actually two types of osteoporosis primary osteoporosis and secondary osteoporosis. Either type can affect men, women, and children. Primary osteoporosis is age-related and affects women more severely and earlier in life than men. Secondary osteoporosis is caused by other disease processes or medications used to treat various diseases or problems. Secondary osteoporosis is also more common in women because the illnesses that cause bone loss or the problems that require medications that affect bone remodeling more often affect women. Primary osteoporosis, although occurring in both men and women, is age-related and tends to occur mostly in women and about 10 years earlier than in men. This is because the rate of bone loss is different in women than men. Women rapidly lose bone in the four to eight years after menopause, and then continue with the slower rate of bone loss like men, who also experience bone loss over many years. Bone loss from primary osteoporosis is most...

How does osteoporosis occur

Osteoporosis, or bone loss, occurs when the process of bone breakdown and bone formation gets out of balance. The cells that cause bone breakdown (osteoclasts) start to make canals and holes in the bone faster than the cells that cause bone formation (osteoblasts) can make new bone to fill in the holes. The bone becomes When bone has to give up some of its calcium to ensure that blood levels of calcium stay normal, bone is weakened by the loss of calcium. The weakening of bone by its loss of calcium also leads to osteopenia and osteoporosis. Taking in extra calcium and vitamin D alone will not prevent osteoporosis. Because of the way bone develops, the mechanical stress on bone caused by exercise is also important for preventing osteoporosis. The less you exercise, the less the osteoblasts work to make new bone. You need both weight-bearing and resistive exercise to promote strong bones (see Questions 43 and 44). is also termed osteoporosis or osteopenia, depending on how frail the...

Thought I heard that it is better to live in a warmer climate to prevent osteoporosis Is that true

Warm weather would not prevent osteoporosis. There would be no mechanism for it to do that. In fact, the rates of hip fractures are higher among southern states in the United States, probably due to the higher percentage of older individuals living in those areas. However, there are some advantages to warmer climates when it comes to preventing and treating osteoporosis.

Im worried that my daughter who is 40 will get osteoporosis How can she prevent this from happening to her

If you have already been diagnosed with osteoporosis, you are right to be concerned. Family history is certainly a risk factor for osteoporosis. But what you have learned from your own diagnosis can truly help your daughter. Women beginning midlife should make themselves aware of all the risk factors for developing osteoporosis. First, at the age of 40, unless she is one of the 1 who experience premature menopause (natural and total cessation of menstrual periods before the age of 40), she is likely to still be making the necessary estrogen to protect her bones. She should continue to take adequate calcium and Vitamin D for her age, which means 1,000 to 1,200 mg of elemental calcium and 400 IU of Vitamin D per day. This may mean assessing her diet and supplementing it if she does not get enough calcium through dairy products and other foods (see Table 4 in Question 48). If she smokes, she should stop. If she drinks excessive alcohol, she should stop that, too. Equally important, she...

Osteoporosis

Statins have been shown to influence bone formation in animal models and in vitro. Osteoblasts promote bone formation and osteoclasts cause bone resorption and both aspects of bone metabolism may be influenced by statins. Of particular interest is the action of statins on osteoblasts, as therapeutic agents targeted at this cell type, promote bone formation and are likely to have a profound influence on osteoporosis. Bone Morphogenic Proteins (BMPs) are a family of differentiation factors that have bone-forming activity and account for the osteo-inductive activity found in bone extracts. An increase in BMP activity would therefore promote bone formation. In a screening programme to identify small molecules that enhance BMP-2 transcription, a collection of 30,000 natural products or drugs were screened. Lovastatin was identified as a potent and specific stimulator of the BMP-2 transcription 111 . Lovastatin and simvastatin were subsequently shown to induce BMP-2 expression in...

Ivy M Alexander PhD Canp Karl a A Knight RN MSN

100 Questions & Answers About Osteoporosis and Osteopenia 100 questions and answers about osteoporosis and osteopenia by Ivy M. Alexander and Karla A. Knight. p. cm. 1. Osteoporosis Prevention. 2. Osteopenia--Popular works. I. Title One hundred questions and answers about osteoporosis and osteopenia. II. Knight, Karla A. III. Title. RC931.073A42 2006 616.7'16--dc22 Part 1. An Overview of Osteoporosis and Bone Development 1 Questions 1-11 describe the physiology of bone development and how osteoporosis and osteopenia occur, including What is osteoporosis, and what does it look like Why is it important to know about osteoporosis What does menopause have to do with osteoporosis Are there different types of osteoporosis Questions 12-40 address the risk factors associated with osteoporosis, who should be tested, and how osteoporosis is diagnosed, including Who gets osteoporosis Could I be taking any medications that affect bone health Can my clinician tell if I have osteoporosis during...

Are there other vitamins and minerals that contribute to bone development

In addition to Vitamin D, the following vitamins play a role in bone health Vitamin B6 indirectly helps with bone development by lowering levels of homocysteine, a body substance associated with fractures due to osteoporosis. High homocysteine levels may also increase your risk of heart disease. Vitamin K can also help prevent bone from being broken down and calcium from being excreted in urine. Research is currently under way studying the long-term effects of Vitamin K on bones. Getting insufficient amounts of Vitamin K may lead to an increase in the risk of hip fracture. Folate, or folic acid, is a vitamin known to prevent spinal defects in developing fetuses, and like Vitamin B6 is also important in reducing homocys-teine levels, which have been associated with an increase in osteoporosis-related fractures. Calcium is probably the most well known mineral associated with bone health. However, magnesium and phosphorus play important roles as well. Magnesium and phosphorus contribute...

Can I change any of my risk factors

You cannot change your age, gender, sex, race, fracture history, family history, menstrual history, time of menopause, genetic factors, and most medical conditions. You can, however, change some risk factors because most of them are related to lifestyle. Here's what you can do to lower your risk of developing osteoporosis or low bone mass If you drink alcohol, use moderation. More than two drinks per day increases your risk of osteoporosis as well as your risk of falling and breaking a bone. If you have any medical conditions that put you at greater risk for bone loss, discuss with your clinician how your condition could be managed to reduce the risk of jeopardizing your bone health. For example, if you have an eating disorder, discuss getting the help you need to resume eating a healthy diet. Or if your BMI is less than 18 (meaning you are underweight), get the help you need to gain enough weight to have a healthier BMI. Although having a BMI of < 22 increases your risk for...

What is the difference between a DXA and a pDXA

The pDXA testing is only done for screening purposes. A diagnosis of osteoporosis can only be made using DXA. So if your pDXA shows some bone loss, your clinician would likely recommend a DXA to evaluate your hip and spine. pDXA testing is not considered appropriate for monitoring bone density in patients undergoing treatments for osteoporosis because response to treatments is not as evident in the bones of your hands, arms, and feet. pDXA testing on your forearm, usually your nondominant arm (for example, your left forearm if you are right handed), is not recommended if your forearm has been previously fractured, if it has a dialysis graft site, if it has been subject to prolonged immobilization, or if there is severe weakness or paralysis of that arm.

How do I know which type of test should be ordered

Tests for osteoporosis are either done to screen an individual to detect the presence of bone loss or done to monitor the progress of previously diagnosed bone loss. You may recall from Question 24 that the only tests used to diagnose osteoporosis are those that test the bone density of your spine or hip. Tests that are performed on peripheral limbs (hands, forearms, wrists, lower leg, and feet) are primarily used for screening. However, if you are obese, peripheral bone mineral density testing at the forearm is often used for diagnosis because most DXA machines are inaccurate for and cannot accommodate individuals who weigh more than 250 pounds. Peripheral bone mineral density testing Bone mineral density tests of the non-central bones, usually heel, wrist, forearm, or fingers. If you attend a health fair where you are screened for bone loss using a portable machine, there is not likely to be a choice of tests. And if the portable testing shows bone loss, your clinician may advise...

What if I live in a rural area and I cant get to a place with a DXA machine Are there further tests that I would need

DXA machines are the most widely available of all machines used for testing bone mineral density. However, some areas of the United States do not have access to DXA machines. Because it is important to have your bone density evaluated, particularly if you have risk factors for osteoporosis, you should still be evaluated using one of the screening tests that may be available in your area. While it is preferable to have a test of your spine or hip to confirm a diagnosis of osteoporosis or determine if you have osteopenia, your clinician can still recommend preventive options and counsel you about nutrition and exercise for improving your bone health (see Part 3). If you do not have access to any bone mineral density testing, it is still important to adhere to a regimen of weight-bearing exercises as well as a diet with sufficient calcium, Vitamin D, and other nutrients to maintain healthy bones. You should also make every effort to prevent falls (see Question 79). 29. If I'm x-rayed for...

How soon are test results usually available Should I get a copy of the results ofthe testing

For results Some clinicians do not call if results are normal, so you need to be certain that your clinician has the right contact information and that no news is good news. If your testing shows low bone mass or osteoporosis, will you need to have a follow-up visit with your clinician Or does your clinician want to discuss treatment options over the phone Some people like to have copies of their test results so that they can track their own progress, but it's not necessary to get a copy of the results of your testing. It's more important for you to know if you have osteope-nia or osteoporosis so that if you must seek medical care from other providers or if you have a fall and are taken to a hospital emergency department, you will be able to inform the new providers of your diagnosis and if you are being treated. 36. If my BMD test results are normal, when should I be screened again If my test results show either osteopenia or osteoporosis, when should my test be repeated illness...

What do my results say about my future risk for fracturing a bone

Because fractures are the biggest problem associated with osteoporosis, it is important to know what your results say about your risk for fracture. It's also important to know that there is risk to fracturing your bones whether you are diagnosed with osteoporosis or not (meaning you may have it but don't know it). The lifetime risk of fracturing your hip, spine, or forearm is 40 in white women and 13 in white men. If you include the potential for fracturing other bones, your risk is increased even further. Your lifetime risk of fracturing your hip is equivalent to or more than your combined lifetime risk of developing breast, uterine, or ovarian cancer. If your T-score indicates that you have osteopenia, you could be four times more likely to fracture a bone. But, low bone mass as defined by your T-score is not the only factor that puts you at increased risk for a fracture. Your clinician should help you understand that your age, family history of osteoporosis, previous fractures,...

Are there blood and urine tests that can be used to determine if I have bone loss

In the case of osteoporosis, biochemical markers are chemical substances that indicate bone turnover. When osteoclasts (the cells of bone resorption see Question 5) break down the collagen in bone, byproducts of this breakdown (for example, N-teleopeptide crosslinks NTx ) are released into the bloodstream and excreted in the urine. When new bone is formed, byproducts such as osteocalcin and other substances also find their way to the bloodstream and get excreted in the urine. Currently, blood and urinary biomarkers are not used to diagnose osteoporosis, but they can be helpful in assessing how fast bone is formed and broken down. BMD testing, while important for assigning fracture risk and measuring bone mass, does not provide information about bone turnover or bone quality. Tests for biomarkers do not give any information about bone mass however, there is some evidence that the presence of bone breakdown biomarkers in urine is associated with an increased risk of hip fracture. While...

What is Boniva ibandronate Is it also calledBonviva

Boniva (ibandronate) was recently approved by the FDA for once-a-month dosing. It is the first and only bisphosphonate that can be taken once a month. Although currently only available in the United States, Boniva will be marketed under the brand name Bonviva when it is approved in other countries. Monthly Boniva, taken as one 150-mg tablet, and daily Boniva, taken as 2.5-mg oral tablets, were recently approved for the prevention and treatment of postmenopausal osteoporosis. The daily dose is available in the United States on a limited basis because the monthly dose is more effective and it is easier to remember a monthly pill. Both the daily and monthly dosages increased BMD at the lumbar spine and other bones, but after one year of treatment, bone mineral density of the lumbar spine had increased more with the monthly dose as compared to the daily dose. Although the long-term effects of Boniva are not known yet, the half-life of Boniva is measured in days and therefore does not stay...

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A clinical trial has just recently begun to evaluate Forteo as an effective treatment option in women who have used either Fosamax or Actonel without success. In a study of women who had taken either Fosamax or Evista for almost three years, the women who had been on Evista and switched to Forteo built more bone mineral density, and more quickly, than the women who were switched from Fosamax to Forteo. Table 13 contains further information about Forteo. manufactured forms of calcitonin with action essentially identical to those made in the body but with greater potency and longer duration. They have the same amino acids as the calcitonin found in salmon, which is why they're often designated as calcitonin-salmon. Calcitonin is one of the earliest discovered treatments for osteoporosis. Formerly given as a subcutaneous injection, Miacalcin NS is now taken as a once-a-day nasal spray. Fortical is also a once-a-day nasal spray, but has never been available as a subcutaneous injection....

Have early menopause What does this mean for my bones and will I need treatment

When you are trying to cope with the treatments for cancer, it's hard to think about your bones and the possibility of developing osteoporosis so early in life. But the fact is that when you stop having your menstrual periods for whatever reason, your risk of bone loss increases. When you experience a natural menopause around the average age of 51, you can expect to lose bone most rapidly in the 4 to 8 years following menopause (starting one year after your last period). There are several reasons why you might experience menopause much earlier than that and, therefore, need to cope with a larger stretch of your life without estrogen, an important hormone for bone growth. Surgically-induced menopause (removal of both ovaries) will cause you to lose bone fairly rapidly. It is important for you to prevent bone loss by getting the appropriate amounts of calcium (1,200 to 1,500 mg), Vitamin D (400-800 IU), other necessary nutrients (see Table 6 in Question 54), and exercise. You should...

Which bones am I more likely to break

For all women with or without osteoporosis who are 50 years or older, the lifetime risk of fracturing any bone is about 40 , though most fractures occurring after age 50 are related to osteoporosis. For all U.S. adults, the lifetime risk of fracturing a bone is greater than the combined risk of developing breast, uterine, or ovarian cancers. If you are a woman, the risk of fracturing your hip, your spine, or your wrist is between 15 and 18 each. If you are a white elderly woman who either has hyperthyroidism (overactive thyroid), cannot get out of a chair without using your arms, or has a resting pulse rate of over 80 beats per minute, the risk for fracturing your hip is about 70 . If your only risk factor is that your mother broke her hip, then your risk is about 80 . But it's only about 50 if you fractured any of your bones since the age of 50. Even without any of these specific risk factors, age increases your risk for fracture by about 40 every 5 years. Your risk for hip fracture...

Should I stop exercising if I break a bone

I always hear about older folks fracturing their hips. Is this because of osteoporosis or because of the frequency of falls How are broken hips repaired Breaking a hip may be the first sign that someone has osteoporosis. Because 95 of hip fractures occur as a result of falls, it is important to look at ways of preventing them (see Question 79). Breaking a hip may be the first sign that someone has osteoporosis. If you have already lost 30 to 40 of the bone in your hip, then bone loss may be visible on the x-ray. If your hip fracture occurs from a low level of trauma (like falling out of bed), you may be diagnosed with osteoporosis without having a bone density test done. If not, then you may not be officially diagnosed with osteoporosis until a bone mineral density test confirms it, although it's unlikely that BMD testing would be done while you're in the hospital. As part of your hip fracture management, you may be placed on a medication to treat osteoporosis (see Question 74). I...

What is a dowagers hump Can it be reversed

Figure 15 Osteoporosis can cause irreversible damage to the spine, leading to significant disability. Courtesy of the National Association of Nurse Practitioners in Women's Health (NPWH). Figure 15 Osteoporosis can cause irreversible damage to the spine, leading to significant disability. Courtesy of the National Association of Nurse Practitioners in Women's Health (NPWH). Once you reach a certain point in the curving of the spine, the kyphosis is not reversible. Figure 15 shows the progression from a spine unaffected by osteoporosis to the point at which the kyphosis resulting from osteoporosis cannot be reversed. After your fractures are healed, it is important to begin an exercise program to prevent kyphosis and to even reverse some of the curve before it reaches the point where it cannot be reversed. Figure 16 shows exercises that can be done to stretch the muscles around the spine, increase flexibility, and reduce the likelihood of more fractures. These are great exercises to do...

What is kyphoplasty Would it help my spinal fractures

Spinal (or vertebral) fractures are a major concern for men and women with osteoporosis because they can lead to severe pain and disability (see Question 84). These fractures can also lead to kyphosis (see Figure 13 in Question 83). The spine deteriorates and curves due to fractures in individual vertebrae. Most osteoporotic vertebral fractures are traditionally treated with pain medications and a gradual return to normal activities. Although back braces to prevent twisting and support the spine were used in the past, they are infrequently Figure 16 Exercises to prevent or improve deformity and reduce pain. Source Duke University Medical Center's Bone and Metabolic Disease Clinic. Reprinted with permission. Gold DT, Lee LS, Tresolini CP, eds. Working with Patients to Prevent, Treat, and Manage Osteoporosis A Curriculum Guide for the Health Professions, 3rd ed. Durham, NC Center for the Study of Aging and Human Development, Duke University Medical Center 2001. Figure 16 Exercises to...

Where can I go for more information

While many of your questions have been answered in this book, you likely will want to look for additional information on osteoporosis, osteopenia, and other health-related topics. Refer to Appendix B and the bibliography for a listing of research and resources that may be helpful as you continue to improve your overall health as well as that of your bones.

What is Actonel risedronate Is it like Fosamax alendronate

Actonel (risedronate) is another bisphosphonate prescribed to reduce bone turnover to treat or prevent osteoporosis. It can be taken either daily as 5 mg tablets, or weekly as 35 mg tablets. Like other bisphosphonates, Actonel is FDA-approved for the treatment or prevention of postmenopausal osteoporosis in women. It is also approved for the treatment and prevention of glucocorticoid-induced osteoporosis (GIO) in adults who are initiating or continuing oral glucorcorticoid medications at doses of > 7.5 mg daily. Actonel has also been approved for the treatment of Paget's disease (see Question 60). In a recent study that compared the effect of weekly Fosamax on bone mineral density with the effect of weekly Actonel on bone mineral density, Fosamax showed a greater increase in BMD and a greater decrease in bone turnover. But those taking Actonel had fewer fractures than those taking Fosamax. We already know that both Fosamax and Actonel are effective in reducing fracture risk, which...

What is a Zscore

A Z-score matches your bone mineral density with individuals of the same age, gender, and ethnicity. The following formula is used to determine your Z-score Z-scores are not helpful in identifying osteopenia or osteoporosis because your Z-score may remain constant throughout your life. Z-scores are more useful in evaluating bone density in children, who have not yet reached peak bone mass. Very low Z-scores, indicating that you have much lower bone mass than your peers, do require further investigation into the causes of bone loss related to secondary osteoporosis (the type of osteoporosis not associated with postmenopause or aging). If you have a Z-score lower than -1.5, your clinician should be looking for reasons why you have significant bone loss compared to your own age group. If you have a medical condition, for example, hyperthyroidism (one of the illnesses Matches your bone mineral density with individuals of the same age, gender, and ethnicity, but is more helpful in...

Big Pharma Has Walked Away and Is Slow to Return

Steve Projan, former head of Wyeth's anti-infective research, calculated that the financial value of a new injectable antibiotic, best estimated at 100 million annually at peak, is minimal compared with a drug for a chronic condition such as osteoporosis, which can earn > 1.5 billion annually.

Small Arteries and Arterioles

Aging and disease modify vascular structure and function. Hypertension is associated with vasoconstriction, VSM hypertrophy and rarefaction in the microcirculation. Pulse volume, pressure, and velocity are important physiological variables that may function as biologic signals to the endothelium and VSM of the microcirculation. The capillary pulse volume modifies and in turn is modified by microcirculatory structure and function. For example, both MAP and PP affect glomerular filtration rate independently, presumably through direct effects on glomerular filtration pressure 61 . Increased systolic BP or PP is associated with a variety of disorders related to aging, including atherosclerotic cardiovascular disease 62, 63 , heart failure 64 , stroke 65, 66 , cognitive disorders 67-69 , white matter lesions 70, 71 , macular degeneration 72 , renal dysfunction 73 , osteoporosis 74 , and glucose intolerance 75-77 . Abnormal microcirculatory pulsation may participate in the pathogenesis of...

Biology of Aging and its Clinical Implications

Underlying loss of entropy and fractality is a chronic and progressive inflammation that represents the biologic hallmark of aging (11). Seemingly, this inflammation originates from the interaction of individual genetics, diseases, and environment. Increased concentrations of inflammatory cytokines, especially interleukin-6 (IL-6) have been associated with increased mortality, functional dependence, and with a number of geriatric syndromes including dementia and osteoporosis (10, 11). In this perspective, it is not far-fetched to hypothesize that anemia may be both a consequence and a cause of aging (Fig. 2.1). Correction of anemia may break this vicious circle and delay the complications of aging. Geriatric syndromes are conditions that are typical, albeit not unique, of aging. Approximately 20 of cancer patients aged 70 and older had some form of early dementia or sub-clinical depression when screened for these conditions (18). Early detection of dementia may allow prompt...

Potential Therapeutic Applications

The patent literature claims a number of other therapeutic applications for CB1 antagonists ranging from migraine to cancer, although they are not all supported by robust biological data. The use of CB1 antagonists for the treatment of sexual behavior dysfunction was recently claimed based on data showing a stimulatory effect of rimonabant on the sexual performance of naive rats 109 . Another patent application claimed the use of CB1 and CB2 inverse agonists and antagonists for the treatment of bone disorders such as osteoporosis 110 . This claim was based on biological data showing that the CB1 antagonist AM251 (2) potently inhibited osteoclast survival in vitro, and was also effective in vivo, in reversing the ovariectomy-induced bone loss in mice.

Bone Resorption Inhibitors

Because the decline in estrogen levels following menopause is a major cause of osteoporosis, estrogen therapy is a logical treatment. Estrogen is most often combined with progesterone in this regimen to reduce the risk of uterine cancer associated with unopposed estrogen. This combination therapy was shown to increase bone mineral density (BMD) but the effect on fracture rate was initially unclear 4,5 . The recently released results of the large, five year, multi-center Women's Health Initiative estrogen plus progesterone (E + P) study indicated that the most commonly prescribed HRT therapy reduces fractures in postmenopausal women by 24 overall, and 33 in the hip 6 . These positive results were tempered by the findings of increased incidences of dementia and ovarian cancer in the same study. Increased caution is thus now recommended when considering the use of HRT for the prevention and treatment of post-menopausal osteoporosis. The study and use of Selective Estrogen Receptor...

SUMO and Cancer Caretakers and Gatekeepers

With BS, most notably a high incidence of cancer. In addition, WS cells, like BS cells, are hypermutable. However, there are marked differences. WS individuals are asymptomatic before puberty, but thereafter develop a panoply of age-related disorders, including cardiovascular disease, cataracts, and osteoporosis. At the biochemical level WRN distinguishes itself from other RecQ-like helicases by possessing, apart from its helicase activity, also an N-terminal 3'-5' exonuclease activity. Several studies have linked WRN function to various DNA metabolic processes as for example replication, restoration of stalled replication forks, rDNA transaction mechanisms, homologous recombination and telomere maintenance 8, 83 . WRN is a nuclear protein that is located predominantly in the nucleolus in interphase cells. Upon DNA damage, however, it delocalizes into discrete DNA damage induced foci in the nucleoplasm 36, 70 . Its redistribution appears to be at least in part driven by p14ARF induced...

Patrick Laharrague and Louis Casteilla

Bone marrow (BM) adipose tissue should no longer be considered simply as a filling material for bone cavities that is not needed for hematopoietic activity. In addition to its potential role as an energy store, BM adipose tissue exhibits a considerable adaptive plasticity and secretes a broad spectrum of hormones, cytokines and growth factors whose receptors are present on different cells of the stromal microenvironment. BM adipocytes, originating like osteoblasts from mesenchymal stem cells, display a marked metabolic and secretory activity. Among the various secreted adipokines, leptin, and adiponectin have opposite effects on hematopoiesis, immunity, inflammation, and bone remodeling. As a whole, a counterbalance exists between adipogenesis and erythropoiesis, and between adipose and bone formation. The better knowledge of the different paracrine and endocrine agents involved in the subtle and complex regulation of hematopoiesis and its osseous environment suggests that BM adipose...

Firstline Pharmacotherapy

Mild disease can be treated with 5-ASA's, but many patients eventually require corticosteroids to control symptoms. Glucocorticoids (eg. prednisolone) are some of the most effective therapies for inducing clinical remission in patients with active CD and UC when used for short periods of treatment. However, adverse effects (incl. obesity, osteoporosis, hypertension and adrenal suppression) as well as the fact that chronic dosing invariably culminates in development of clinically-challenging, steroid-refractory disease, limits their use. Moreover, significant numbers of patients are unable to discontinue glucocorticoid therapy without disease exacerbation. Budesonide (2) is a second-generation corticosteroid and is available as a controlled-release oral formulation for distal CD and as an enema for topical treatment in UC. Budesonide has an extensive first-pass metabolism and lower systemic bioavailability (-11 ), enabling it to achieve similar efficacy to prednisolone, but with...

Clinical Implications of Leptin Physiology in the Elderly

In recent years, investigators have hypothesized that leptin may be involved in the pathogenesis of chronic disease states including diabetes, metabolic syndrome, dyslipidemia, anorexia, and malnutrition as well as hypertension, atherosclerosis, osteoporosis, and osteoarthritis 2-5 . Although these diseases are highly prevalent in old age, existing data on the role of leptin in a specific disease state has not been unequivocal. Furthermore, the available literature data were not always obtained in an elderly population. Because of this limitation, the second part of the review addresses those diseases in which the role of leptin has been supported by relevant and unequivocal findings from data collected in elderly populations.

Primary Human BM Adipocytes

These contrasting properties are all the more puzzling, as adipocytes and osteoblasts share a common progenitor, the MSC. These distinct characteristics (probably because of different secretory and or surface factors) could be significant in some situations, such as increased BM adipogenesis during aging or osteoporosis.

Other potential indications

CB2 agonists have shown promise in other indications at the preclinical level. GW833972A (8), a 1,000-fold CB2-selective compound, was shown to inhibit citric acid-induced cough in a conscious guinea-pig model 22 . The CB2 antagonist SR144528 but not the CB1 antagonist SR141716A, reversed the effect of 8, demonstrating involvement of the CB2 receptor. A potential role for CB2 agonists in the treatment of osteoporosis has been proposed based on in vitro suppression of trabecular osteoclasto-genesis due to inhibition of proliferation of osteoclast precursors and receptor activator of NFkB ligand, RANKL, by the CB2 agonist 7 23 . In the same report, 7 was tested in an ovarectomized mouse model of postmenopausal osteoporosis. The CB2 agonist HU-308 attenuated trabecular bone loss from 41 in the untreated mice to 27 in this model. A potential role for CB2 in treatment of atherosclerosis in apoli-poprotein E knockout mice has been reported using the non-selective cannabinoid agonist...

Disorders of the Small Intestine

Treatment for celiac disease is to follow a strict gluten-free diet. You will need to avoid wheat, rye, barley, and other grains that contain gluten. You also will need to watch for hidden gluten in foods such as pasta and beer. Rice and corn are safe to eat, and gluten-free flour and other food products also are available. Symptoms will begin to improve within a few days of beginning the diet, though full recovery may take up to 2 years. If left untreated, celiac disease can lead to intestinal cancer, osteoporosis (see page 301), and seizures.

Disorders of the Bones

Osteoporosis Osteoporosis is a disease in which the bones become thin, porous, weak, and more susceptible to fractures. Although osteoporosis is generally regarded as a women's health concern, the disease also can develop in men. Because men have larger, denser skeletons, they usually experience bone loss later in life than women. However, older men are at increased risk for hip fracture and other joint fractures as a result of osteoporosis. Men and women lose bone mass at an increased rate after age 65, and calcium absorption decreases with age in both sexes. About a third of men over age 75 have been diagnosed with osteoporosis, and one of every eight men over age 50 will experience a bone fracture as a result of osteoporosis. Therefore all men need to take steps to prevent osteoporosis (see following page). Bone mass increases throughout childhood and young adulthood, reaching its peak at about age 20. After age 35, bone tissue breaks down faster than new bone is formed. Bone...

Fractures and Their Repair

There are multiple ways of classifying bone fractures. A stress fracture is a break caused by abnormal trauma to a bone, such as fractures incurred in falls, athletics, and military combat. A pathologic fracture is a break in a bone weakened by some other disease, such as bone cancer or osteoporosis, usually caused by a stress that would not normally fracture a bone. Fractures are also classified according to the direction of the fracture line, whether or not the skin is broken, and whether a bone is merely cracked or broken into separate pieces (table 7.3 fig. 7.17).

Treatment of thromboembolism in pregnancy

Treatment of thromboembolism is with intravenous heparin initially (although subcutaneous low-molecular weight heparins (LMWHs) are increasingly used) and should not be delayed whilst awaiting investigation. Warfarin is associated with fetal abnormalities and in particular should be avoided in the first trimester and after 36 weeks' gestation. Acute treatment is followed by subcutaneous prophylactic heparin. It had been thought that prophylactic heparin caused stillbirth, prematurity and haemorrhage but more recent reviews controlling for maternal comorbidity have cast doubt on this assertion. Prophylaxis with LMWHs is now recommended because their use is associated with a lower incidence of osteoporosis and thrombocytopenia than unfractionated heparin, they require less monitoring, and they may be given as a once daily dosage. However, LMWHs have a prolonged action and are only partially reversible with protamine, meaning that LMWH prophylaxis may delay administration of regional...

How are MS attacks treated Why are there different drugs to treat attacks of MS

Any opacification (loss of transparency) of the lens or its capsule. Osteoporosis trast, oral steroids had no effect except to double the risk of relapse of optic neuritis as compared with IV Medrol. There often is a rapid response to either drug in patients with acute, severe relapses, but there are no good studies of either IV compared with any dose of oral steroids to evaluate this in MS. The side effects of steroids include an increased risk of infection, including viral, bacterial, yeast, fungal, and parasitic types. This includes progressive multifocal leukoen-cephalopathy (PML), which has been recently reported in two study patients treated with Avonex and Tysabri. Other complications include psychiatric problems, cataracts, osteoporosis, and ischemic necrosis of hips and other joints (as well as others).

Interconnecting Disease Target Validation Models And Pharmacological Response

The study of osteoclast differentiation is important for understanding potential new treatments for osteoporosis. Such therapies are typically explored in tissue culture models such as the Raw264 mouse monocytic cell line, which is capable of differentiation into functional multinuclear osteoclasts after treatment with the cytokine Rankl. Use of transformed cell lines raises the concern that results may not be extrapolated to normal tissue. To address this question, the transcriptional responses for Rankl treatment of the Raw264 cell line, and of two ex vivo primary cell systems (bone marrow macrophages, and hematopoetic stem cells) were compared using Affymetrix GeneChips 23 . The models proved to

Post Genomic View of Aging Definitions Theories and Observations

Rather than individual chronological age, aging may be more closely related to epigenetic and environmental factors, including stress and the absence of disease. The aging human populations may develop different physiological or anatomical defects and may die from different age-dependent diseases. Diseases such as Alzheimer disease, cardiovascular disease, osteoporosis, cancer, diabetes, and arthritis, affect too many older men and women, and seriously compromises the quality of their lives.

Joseph D Spahn md and Ronina Covar md

Glucocorticoids (GCs) are the most effective therapy we have for the treatment of asthma. Systemically administered GCs are first-line agents for acute severe asthma, whereas topical (i.e., inhaled) GCs are first line agents for the long-term management of all patients with persistent asthma. In the treatment of acute asthma exacerbations, early institution of systemic GCs can prevent further worsening of symptoms, reduce emergency room visits, and hospitalizations. Inhaled GCs are the recommended controller class of medications for all patients with persistent asthma, including children. They are the most effective class of agents in reducing symptoms, improving lung function, and decreasing bronchial hyperresponsiveness, in addition to reducing asthma morbidity and mortality. Long-term administration of oral GCs is associated with multiple adverse effects including adrenal insufficiency, weight gain, increased skin fragility, myopathy, osteoporosis, cataracts, and mood changes....

Reason for steroid therapy

These are well known and no different in the pregnant state to those in the nonpregnant state, and they may be of relevance to the anaesthetist (e.g. electrolyte disturbance, osteoporosis). In general, hydrocortisone and prednisolone are about 90 metabolised by the placenta and therefore little reaches the fetus. However, maternal dosage above 10 mg prednisolone per day has been associated with neonatal adrenal suppression, and similar effects are theoretically possible in breastfed neonates, although reported measured concentrations of steroids in breast milk have been extremely low. There are unlikely to be adverse maternal effects of short-term administration of steroids given for premature delivery, although transient reductions in fetal heart rate variability have been reported.

Adverse Effects of Systemic Glucocorticoid Therapy

As all nucleated cells in the body have a common GC receptor, all are potentially affected by GC therapy and thus susceptible to the development of untoward effects. These effects can occur immediately (i.e., metabolic effects) or can develop insidiously over several months to years (i.e., osteoporosis and cataracts). In addition, some adverse effects are limited to children (growth suppression) while others appear to require interaction with other drugs (nonsteroidal anti-inflammatory agents and peptic ulcer disease). Most adverse effects occur in a dose-dependent and duration-of-treatment manner, although this has not been uniformly noted. Table 3 lists many of the common adverse effects associated with chronic GC use. Osteoporosis Osteoporosis, a significant and common adverse effect, is often overlooked secondary to its insidious onset and the insensitivity of conventional diagnostic methods. All patients who have been on more than 7.5 mg prednisone (or equivalent) daily for at...

What Information Is Provided by Imaging

Noninvasive imaging technologies have become increasingly important over the past 20 years in the management of human diseases. Diagnostic radiology is the medical specialty that is responsible for imaging, providing critical information in three general areas, namely (i) anatomy blood flow, (ii) metabolism, and (iii) receptor expression. The first area is the most widely applied in terms of the number of studies. This type of imaging affords an opportunity to detect the abnormality, since many conditions result in the disruption of normal anatomy, function, or blood flow. One example is the detection of a mass in an abnormal location on a chest radiograph, which, with further tests leads to a diagnosis of cancer. Another example is the identification of fractures following traumatic injury, or decreased bone density resulting from osteoporosis. These basic radiology techniques remain an important component of disease management. They are routinely accomplished by radiography and...

Anabolic Androgenic Steroids

The sex hormone testosterone stimulates muscular growth and aggressive behavior, especially in males. In Nazi Germany, testosterone was given to SS troops in an effort to make them more aggressive, but with no proven success. In the 1950s, pharmaceutical companies developed compounds related to testosterone, called anabolic-androgenic30 steroids, to treat anemia, breast cancer, osteoporosis, and some mus-

Ovarian Selective Serms

With gonadotropin-releasing hormone (GnRH) agonists. These injectable pep-tides inhibit estrogen synthesis and result in the reduction of both uterine volume and fibroid size 27 . However, GnRH therapy can result in hot flushes and osteoporosis, a side-effect that restricts use for chronic treatment. Because leio-myomas are dependent on estrogen for growth, antagonism of this steroid hormone receptor is a viable therapeutic approach.

Pharmacological Management

Additional safety concerns regarding ICSs include effect on bone mineral density (BMD) and hypothalamic-pituitary-adrenal (HPA) axis. The CAMP trial also examined the interaction between BMD and the use of low to moderate doses of ICS in growing children and found no effect on BMD. There is conflicting information in the literature whether ICSs lead to HPA axis suppression. However, when low to moderate doses of ICSs are used, there appears to be little effect on HPA axis. For both BMD and HPA axis, the long-term effects of higher doses of ICS in growing children are unresolved. Oral Corticosteroids. Short bursts of oral corticosteroids (3-10 d) are administered for use in children with acute asthma exacerbations. The initial starting dose is 1-2 mg kg followed by 1 mg kg over the next 24-48 h. There is no significant difference in efficacy between oral and parenteral formulations of corticosteroids because gastrointestinal absorption is rapid. Parenteral corticosteroids can be used...

Ciclesonide Asthma Copd [69

Ciclesonide, a new inhaled corticosteroid (ICS), is indicated for the prophylactic treatment of persistent asthma. ICS treatment is a widely accepted standard of care for maintenance therapy of chronic asthma, and the currently available agents include fluticasone propionate, budesonide, triamcinolone acetonide, flunisolide, and beclomethasone dipropionate. These agents exert their potent anti-inflammatory effects via modulation of the glucocorticoid receptor (GR). Although ICS drugs are generally safe and well tolerated compared with oral corticosteroids, many have measurable systemic exposures, and concerns over potential side effects resulting from it severely limit the dose at which they can be administered for long-term therapy. Systemic adverse effects associated with corticosteroids include HPA axis suppression, osteoporosis, abnormal glucose metabolism, cataracts, and glaucoma, some of which could potentially occur with the long-term use of high dose ICS. The key...

Ayurvedic Tips Fot Controling Troponin

Not come into play giving the skeleton more weight bearing strength 120 . It may be concluded that there is a balance between these two pathways, with a predominance of peripheral and positive effects of leptin only in conditions of central leptin resistance, as in obesity, or when serum leptin levels rise above a threshold. This hypothesis appears supported by recent observations in hemodialysis patients in which bone mineral density (BMD) was positively associated with leptin only when circulating levels were higher than the threshold for blood-brain transport saturation 134 .

Adiposity vs Bone Formation

Aging of the human skeleton is characterized by decreased bone formation and bone mass. The decrease in bone volume associated with age-related osteopenia is accompanied by an increase in marrow adipose tissue as determined by histomorphometry (38,39). Adipogenesis is also observed in almost all conditions that lead to osteoporosis (40,41), such as ovariectomy (42), limb immobilization (43), alcoholism (44), and excessive treatment with glucocorticoids (45). Conversely, adipogenesis is inhibited in conditions with increased bone formation (46). Studies in an age-related osteopenia animal model, SAMP6 mice, show that increased adipogenesis and myelopoiesis in the bone marrow are associated with a reduced number of osteoblast progenitors and decreased bone formation (47). Hindlimb suspension in the rat, a model of skeletal unloading, induces osteopenia by inhibiting bone formation in long bones (48). This results from impaired recruitment of osteoblasts and decreased expression of bone...

Why should I take drugs that have side effects

What are the side effects of the drugs that are used for treatment of MS attacks Are cataracts a result of steroid use Is osteoporosis a complication of MS Bone damage The use of steroids results in the loss of calcium from bones that underlies the development of osteopenia and osteoporosis. Subsequently, this may lead to the collapse of vertebrae and an increased risk of fracture of the long bones. Even more serious is the increased likelihood of ischemic (aseptic) necrosis of the hips and other joints. When diagnosed early, treatment can reverse or limit permanent damage. Con

P Michael Conn Series Editor

Braverman, 2003 Developmental Endocrinology From Research to Clinical Practice, edited by Erica A. Eugster and Ora Hirsch Pescovitz, 2002 Osteoporosis Pathophysiology and Clinical Management, edited by EricS. Orwolland Michael Bliziotes, 2002 Challenging Cases in Endocrinology, edited by

Other Novel Serm Scaffolds

Isothiochroman 27 have been prepared based on structural analogy to lasofoxifene 52 . Compound 27 demonstrates potent affinity to both ERs but is a mixed agonist antagonist on the uterus of immature rats. A series of benzopyrans, such as 28, demonstrate partial estrogen antagonist activity in rats 53 , and a benzo-pyranone SERM 29 that binds with good affinity to ERa, is a functional antagonist of breast cancer cell proliferation and inhibits IL6 production in an osteosarcoma cell line transfected with ERa 54 . A related class of analogs, benzopyran 30 55 , binds with high affinity to ERa and ERp, is a uterine antagonist, and prevents bone loss in rats 56 . Benzothienoindole SERM 31 shows high affinity to both ERs and significantly increases the bone mineral density of ovx mice while being less uterotrophic than 2 57 . Novel quinoline-derived SERMs have been identified through the use of co-factor recruitment assays thus providing a complementary method for discovering SERM chemotypes...

Serms For Hot Flushes

Benzopyran SERM 4 displays dose-dependent activity in the morphine-withdrawal rat model of hot flush efficacy 21 . This compound also increases bone mineral density, lowers serum cholesterol, and exhibits minimal uterine agonist activity in ovx rats. SERM 4 binds with high affinity to both ERa and ERp and is an antagonist in the breast and uterine cancer cell lines, MCF-7, and Ishikawa, respectively. Spiroindane 5 has shown estrogen-like effects on thermoregulation, bone, and lipids in ovx rats. Additionally, 5 had minimal stimulatory activity toward the uterus in ovx rats. Distinct from 3 and 4, this compound acts as a weak estrogen agonist in the uterus of immature rats and has modest stimulatory effects on breast cancer cell proliferation. Further SAR studies show that the piperazin-1-yl basic side chain in 6 is bioequivalent to the traditional piperidinyl side chain in 5 22 . The spirocyclic SERM 7 has been reported 23 to bind with high affinity to both ERa and ERp, while the...

Chronic Bacterial Sinusitis Antiinflammatories

Long-term, low dose macrolide therapy represents one attempt at controlling the inflammation associated with chronic sinusitis (80). Medicines that have anti-inflammatory properties and are well tolerated are sought to help ease the reliance on systemic corticosteroids that affect both the number and function of inflammatory cells. When used in a topical form, nasal steroid sprays have been shown to be safe and effective in reducing the symptoms of alleric rhinitis (81). Their use in patients with chronic sinusitis can decrease the size of nasal polyps, and diminish sinomucosal edema (82). There are no set guidelines for the duration of use, and the expected side effects from long-term use are not yet known. Experience in using oral steroids for the treatment of chronic sinusitis is only anectodal. The extended use of oral steroid may result in serious side effects that include muscle wasting and osteoporosis. Because of the side effects, steroids are tapered and given in short...

Second Edition

Braverman, 2003 Developmental Endocrinology From Research to Clinical Practice, edited by Erica A. Eugster and Ora Hirsch Pescovitz, 2002 Osteoporosis Pathophysiology and Clinical Management, edited by Eric S. Orwoll and Michael Bliziotes, 2002 Challenging Cases in Endocrinology, edited by

Content Changes

I have updated information on the following, drawing on research and review literature as recent as April 2002, even as the book was in production genetic translation in the nucleus (4), signal peptides (4), stem cell research (5), hair analysis (6), osteoporosis treatments (7), knee surgery (9), muscle-connective tissue relationships (11), mitosis in cardiac muscle (11), astrocyte functions (12), surgical treatment of parkinsonism (12), amyotrophic lateral sclerosis (13), memory consolidation (14), functional MRI (14), the sensory role of filiform papillae (16), a new class of retinal photoreceptors (16), the history of anesthesia (16), the relationship of growth hormone to somatomedins (17), cytotoxic T cell activation (21), asthma (21), neuroimmunology (21), atrial natriuretic peptide (23), hunger and body weight homeostasis (26), heritability of alcoholism (26), the functions of relaxin (28), contraceptive options (28), the fate of sperm mitochondria (29), Werner syndrome (29),...

Hormonal Lifting

The administration of somatotropine can biochemically decelerate the processes of ageing fat cells are reduced and muscle cells are stimulated. Such cures can cost a fortune, however j 10,000-15,000 (US 12,000-18,000) per year. Sex hormones are glorified as true beauty elixirs. Oestrogen promotes hydronic acid, collagen, and elastine fibres and combats free radicals, osteoporosis, and hair loss. Testosterone tightens the epidermis and the connective tissue.

Clinical Data

Fourteen-day administration of 50 mg balicatib to post-menopausal Japanese women was safe and well-tolerated and showed an elimination half-life of 15.5 h 71 . A 12-week placebo-controlled dose-ranging study of balicatib in postmenopausal women at 5, 10, 25 and 50 mg daily (n 28 group) showed a dose-dependent decrease in serum CTx, a biochemical marker of bone resorption. At the 50 mg dose, a 70 reduction in sCTx was observed (22). A subsequent 1-year study at the same doses (n 135 group) found a 61 decrease in sCTx at 50 mg qd and a 55 decrease in urinary NTx. Serum osteocalcin and bone-specific alkaline phosphatase, markers of bone formation, were similar to placebo after 1 year of dosing 72 . This apparent decoupling of bone resorption and bone formation, based on bone turnover markers, distinguishes Cat K inhibition from other anti-resorptives such as bisphosphonates, denosumab and SERMs, all of which suppress markers for both resorption and formation. Increases in bone mineral...

Conclusions

The past 3 years have seen tremendous advances in both the design of Cat K inhibitors and in our understanding of the effect of Cat K inhibition on bone remodeling. The structural diversity of Cat K inhibitors has expanded considerably from simple peptidomimetics to non-peptidic derivatives and even non-covalent inhibitors. The potency, selectivity and pharmacokinetic properties of key compounds are very attractive and seem well-suited to further development. The disclosure of clinical validation of the effect of Cat K inhibition on bone mineral density, plus the provocative data suggesting a decoupling of bone resorption and bone formation provides a compelling framework for further development of Cat K inhibitors for the treatment of osteoporosis.

In Vitro Experiments

While promoting adipogenic conversion of MSCs (103,104). Studies of animals treated with PPARy ligand TZDs have yielded conflicting results concerning BM fat cell differentiation and bone status either significant loss of bone mineral density (105,106) and increased fat content in bones (107,108), or no adverse effect (109,110). Procedural differences may account for these discrepancies.

Back Pain

Being overweight increase the back's vulnerability to stress and injury. Strenuous Bones and sports activities and physically demanding jobs can also cause stress and injury to the back. In addition, aging increases the risk of back injury due to age-related changes, osteoporosis, and arthritis. A prolapsed disk (when one of the pads of cartilage between the vertebrae of the spine protrudes and presses on a ligament or a nerve, causing back pain) also is more likely to occur in older adults.

EP2agonists

Recently a similar strategy has been applied in designing analogs of AH-13205 38 in which 9b-chloro substitution along with addition of the 5,6-cis unsaturation has provided potent and selective EP2-agonists 39 . 7-(N-alkylmethanesulfonamido)heptanoic acid 9, a seco-prostanoid, had been previously reported as having PG-like activity 40 . Recent modification and SAR of seco-prostanoid compounds have been exploited in an approach to potent, selective EP2-agonists targeting the treatment of osteoporosis 41 . Compound 10 (Ki 8 nM, cAMP Kb 3 nM) 42 and other cinnamic acid derivatives have recently been reported as EP2-agonists 43 .

GnRH agonists

As analogues of GnRH (gonadotropin-releasing hormone) agonists suppress LH (luteinising hormone) and FHS (follide-stimulating hormone) secretion from the pituitary. This results in ovarian suppression and significant reduction in the secretion of oestrogen, which results in thinning of the endometrium. They are generally only given for a 6-month period, as 6 per cent of bone mineral density may be lost in the first 6 months. It takes two years for the loss to be restored. It can provide up to 90 per cent relief of symptoms in patients.

Chronic hepatitis

Chronic persistent hepatitis is usually unaffected by pregnancy. Chronic active hepatitis is associated with impaired fertility if pregnancy does occur it may be associated with accelerated deterioration in liver function. Treatment includes corticosteroids and antiviral drugs, including interferon. Lupus antibodies may occur in up to 20 of women with chronic active hepatitis. Chronic active hepatitis may be complicated by arthritis, impaired renal function, myocarditis and neuropathies. Diabetes, hypertension and osteoporosis may also occur as a result of long-term steroid therapy.

Heparin

The potential complications of heparin treatment during pregnancy includes hemorrhage, osteoporosis, fracture, and hep-arin-induced thrombocytopenia. The reported rate of osteoporosis and associated fracture is low, though cases have occurred. Whether LMWH during pregnancy is associated with decrease of bone density remains controversial. Calcium and vitamin D supplements may be added during this treatment. Heparin-induced thrombocytopenia is infrequent in pregnant women.