Article Figures & Data
Figures
- Fig 1.
Bone remodeling sequence. A cartoon depiction of the sequential action of osteoclasts and osteoblasts to remove old bone and replace it with new bone. For simplicity of illustration, the cartoon shows remodeling in only 2 dimensions, whereas in vivo, it occurs in 3 dimensions, with osteoclasts continuing to enlarge the cavity at one end and osteoblasts beginning to fill it in at the other end. Reproduced with permission of the American Society for Bone and Mineral Research from J Bone Miner Res (2005;20:177–84).
- Fig 2.
High bone remodeling is associated with increased risk of fracture in postmenopausal women. The x-axis shows lumbar spine bone mineral density (LS-BMD), the y-axis shows vertebral fracture rate (VFR), and the z-axis shows bone remodeling rate (BFR) from iliac crest bone biopsies. The peaks of fracture rate occur with low bone density and a high remodeling rate. 100p-yr indicates 100 patients per year. Reprinted with permission from Elsevier from Riggs et al.9
- Fig 3.
Microstructure of normal (A) and osteoporotic (B) bone. Iliac crest bone biopsy shows normal trabecular connectivity (A) and loss of connectivity in osteoporotic bone (B). The reduction in total bone mass is also evident in osteoporotic bone (original magnification ×1.25).
Tables
Risk Factor Personal history of fracture after 50 years of age Family history of osteoporosis/history of hip fracture in a first-degree relative Female Being thin and/or having a small frame Advanced age Amenorrhea Low lifetime calcium intake Vitamin D deficiency Certain medications (corticosteroids, chemotherapy, anticonvulsants, and others) Certain chronic medical conditions Inactive lifestyle Current cigarette smoking Caucasian or Asian Diseases Genetic disorders Cystic fibrosis Hemochromatosis Idiopathic hypercalciuria Ehlers-Danlos syndrome Marfan syndrome Osteogenesis imperfecta Hypogonadal states Anorexia nervosa Athletic amenorrhea Turner syndrome Hyperprolactinemia Premature ovarian failure Panhypopituitarism Endocrine disorders Cushing syndrome Diabetes mellitus Hyperparathyroidism Hyperthyroidism Gastrointestinal disorders Gastrectomy Malabsorption Primary biliary cirrhosis Inflammatory bowel disease Celiac disease Hematologic disorders Hemophilia Leukemia and lymphoma Systemic mastocytosis Multiple myeloma Sickle cell disease Rheumatic diseases Ankylosing spondylitis Rheumatoid arthritis Lupus Miscellaneous Alcoholism Multiple sclerosis Depression Post-transplant Emphysema End stage renal disease Immobilization Congestive heart failure Drug (Brand names) Dose† Proven Fracture Reduction* Indication Alendronate (Fosamax) 10 mg daily, 70 mg weekly Vertebral, hip, nonvertebral Postmenopausal women, men; glucocorticoid-induced osteoporosis Risedronate (Actonel) 5 mg daily, 35 mg weekly, 75 mg 2 days/month Vertebral, hip, nonvertebral Postmenopausal women, men; glucocorticoid-induced osteoporosis Ibandronate (Boniva) 2.5 mg daily, 150 mg monthly, 3 mg IV every 3 months Vertebral, nonvertebral Postmenopausal women Zoledronic acid (Reclast, Zometa) 5 mg IV yearly Vertebral, hip, nonvertebral Postmenopausal women Raloxifene (Evista) 60 mg daily Vertebral Postmenopausal women Salmon calcitonin (Miacalcin, Fortical) 200 U intranasally daily Vertebral Postmenopausal women Teriparatide (Forteo) 20 mcg subcutaneously daily for ≤2 years Vertebral, nonvertebral Postmenopausal women Note:—IV indicates intravenous.
* In postmenopausal women with osteoporosis.
† Oral unless otherwise noted.
