Elderly women with osteoporotic fracture: from clinical and biochemical assessments, bone density studies to bisphosphonate treatment.

Or Pui Ching.Thesis submitted in: December 1999.Thesis (M.Phil.)--Chinese University of Hong Kong, 2000.Includes bibliographical references (leaves 174-201).Abstracts in English and Chinese.acknowledgement --- p.iabstract (english version) --- p.iiabstract (chinese version) --- p.viitable of contents --- p.xiabbreviations --- p.xvilist of tables --- p.xviiilist of figures --- p.xxiiChapter chapter 1. --- introduction --- p.1Chapter chapter 2. --- literature review --- p.3Chapter 2.1. --- Bone structure --- p.3Chapter 2.1.1. --- Composition --- p.3Chapter 2.1.2. --- Cortical and Trabecular bone --- p.3Chapter 2.2. --- Bone Remodeling --- p.4Chapter 2.3. --- Bone Mass --- p.5Chapter 2.3.1. --- Peak Bone Mass --- p.5Chapter 2.3.1.1. --- Racial and Genetic Factors --- p.5Chapter 2.3.1.2. --- Gonadal Factors --- p.6Chapter 2.3.1.3. --- Nutrition Factors --- p.6Chapter 2.3.1.4. --- Exercise and Physical Activity --- p.7Chapter 2.3.2. --- Bone Loss --- p.7Chapter 2.3.2.1. --- Determinants of Osteoporotic Bone Loss --- p.7Chapter 2.3.2.2. --- Estrogen Deficiency --- p.8Chapter 2.3.2.3. --- Dietary Calcium deficiency and Vitamin D deficiency --- p.8Chapter 2.3.2.4. --- Physical Activity --- p.9Chapter 2.3.2.5. --- Alcoholism and Smoking --- p.9Chapter 2.3.2.6. --- Disease-specific Osteoporosis --- p.9Chapter 2.3.2.7. --- Drug-induced Osteoporosis --- p.10Chapter 2.3.3. --- Bone Mass and Fracture Risk --- p.11Chapter 2.4. --- Clinical Presentation of Osteoporosis --- p.12Chapter 2.4.1. --- Vertebral Fractures --- p.12Chapter 2.4.1.1. --- Radiological Aspects of Vertebral Fracture --- p.13Chapter 2.4.1.1.1. --- Changes in Trabecular Pattern --- p.13Chapter 2.4.1.1.2. --- Changes in Shape of the Vertebral bodies --- p.13Chapter 2.4.1.1.3. --- Changes of Intervertebral Discs --- p.14Chapter 2.4.1.2. --- Back Pain --- p.15Chapter 2.4.2. --- Hip Fractures --- p.15Chapter 2.4.3. --- Quality of Life --- p.16Chapter 2.5. --- Treatment of Established Osteoporosis --- p.18Chapter 2.5.1. --- Pain Relief --- p.18Chapter 2.5.2. --- Drug Therapy --- p.19Chapter 2.5.2.1. --- Calcium Supplement --- p.19Chapter 2.5.2.2. --- Vitamin D --- p.20Chapter 2.5.2.3. --- Estrogen --- p.21Chapter 2.5.2.4. --- Fluorides --- p.22Chapter 2.5.2.5. --- Calcitonin --- p.23Chapter 2.5.2.6. --- Bisphosphonates --- p.24Chapter 2.5.2.6.1. --- Physicochemical effects --- p.27Chapter 2.5.2.6.2. --- Mechanisms --- p.27Chapter 2.5.2.6.3. --- Therapeutic Use --- p.27Chapter 2.5.2.6.4. --- Side effects --- p.29Chapter 2.5.2.6.5. --- Alendronate --- p.30Chapter 2.5.2.7. --- Summary of drug treatment --- p.33Chapter 2.6. --- Diagnostic Methods of Osteoporosis --- p.40Chapter 2.6.1. --- Biochemical Markers of Bone Metabolism in Osteoporosis --- p.40Chapter 2.6.1.1. --- Bone Formation Markers --- p.41Chapter 2.6.1.1.1. --- Bone-specific Alkaline Phosphatase (bALP) --- p.41Chapter 2.6.1.2. --- Bone Resorption Markers --- p.42Chapter 2.6.1.2.1. --- Deoxypyridinoline (Dpd) --- p.43Chapter 2.6.2. --- Bone Densitometry --- p.45Chapter 2.6.2.1. --- Dual Energy X-ray Absorptiometry (DEXA) --- p.45Chapter 2.6.2.2. --- Peripheral Quatitative Computed Tomography (pQCT) --- p.47Chapter 2.6.2.3. --- Quantitative Ultrasound (QUS) --- p.48Chapter 2.6.3. --- Summary of Diagnostic Methods --- p.49Chapter chapter 3. --- methodology --- p.50Chapter 3.1. --- Study on Vertebral Structures --- p.51Chapter 3.1.1. --- Procedures --- p.51Chapter 3.1.2. --- Data analysis --- p.53Chapter 3.2. --- Alendronate Treatment --- p.54Chapter 3.2.1. --- Subject Selection --- p.54Chapter 3.2.2. --- Study design and drug administration --- p.55Chapter 3.2.3. --- Bone Densitometry --- p.56Chapter 3.2.3.1. --- Dual Energy X-ray absorptiometry --- p.56Chapter 3.2.3.2. --- Peripheral Quantitative Computed Tomography (pQCT) --- p.58Chapter 3.2.4. --- Biochemical Markers --- p.63Chapter 3.2.4.1. --- Bone formation marker --- p.63Chapter 3.2.4.2. --- Bone resorption marker --- p.64Chapter 3.2.5. --- Quality of Life --- p.65Chapter 3.2.6. --- New fracture assessment --- p.66Chapter 3.2.7. --- Statistical analysis --- p.67Chapter 3.3. --- Proximal femur fracture study --- p.68Chapter 3.3.1. --- Subject and study design --- p.69Chapter 3.3.2. --- Statistical analysis --- p.70Chapter chapter 4. --- results of study on vertebral structures --- p.71Chapter 4.1. --- Results of morphological change of vertebral bodes in osteoporotic patients --- p.71Chapter 4.2. --- Morphological changes of intervertebral discs --- p.71Chapter 4.3. --- Correlation between morphological changes of vertebrae and bulging ratio --- p.72Chapter chapter 5. --- results of alendronate study --- p.76Chapter 5.1. --- Baseline measurement --- p.76Chapter 5.1.1. --- Demographic characteristics --- p.76Chapter 5.1.2. --- Reasons for admission --- p.77Chapter 5.1.3. --- Social support --- p.77Chapter 5.1.4. --- Number of vertebral fracture(s) --- p.78Chapter 5.1.5. --- BMD measurement (Baseline) --- p.79Chapter 5.1.5.1. --- BMD of Lumbar spine and Hip (measured by DEXA) --- p.79Chapter 5.1.5.2. --- BMD of distal tibia and radius measured by pQCT --- p.80Chapter 5.1.6. --- Biochemical Markers (Bone formation and resorption) --- p.86Chapter 5.2. --- After treatment --- p.88Chapter 5.2.1. --- Bone mineral density measurement (measured by DEXA) --- p.90Chapter 5.2.1.1. --- Lumbar spine --- p.90Chapter 5.2.1.2. --- Femoral Neck --- p.93Chapter 5.2.1.3. --- Trochanter --- p.95Chapter 5.2.1.4. --- Ward's Triangle --- p.98Chapter 5.2.1.5. --- Summary --- p.101Chapter 5.2.2. --- Bone Mineral Density measured by pQCT --- p.103Chapter 5.2.2.1. --- Distal Radius (Program 1) --- p.103Chapter 5.2.2.1.1. --- BMD change of D50 --- p.103Chapter 5.2.2.1.2. --- BMD changes of D100 --- p.106Chapter 5.2.2.1.3. --- BMD change of P100 --- p.108Chapter 5.2.2.2. --- Distal Radius (Program 2) --- p.111Chapter 5.2.2.2.1. --- BMD change of pure trabecular bone --- p.112Chapter 5.2.2.2.2. --- BMD changes of pure cortical bone --- p.114Chapter 5.2.2.3. --- Distal Tibia (Program 1) --- p.118Chapter 5.2.2.3.1. --- BMD changes of D50 --- p.118Chapter 5.2.2.3.2. --- BMD changes of D100 --- p.121Chapter 5.2.2.3.3. --- BMD changes of P100 --- p.124Chapter 5.2.2.4. --- Distal Tibia (Program 2) --- p.128Chapter 5.2.2.4.1. --- BMD changes of pure trabecular bone --- p.128Chapter 5.2.2.4.2. --- BMD changes of pure cortical bone --- p.131Chapter 5.2.3. --- Bone turnover --- p.135Chapter 5.2.3.1. --- Bone Resorption Marker (urinary Deoxypyridinoline) --- p.135Chapter 5.2.3.2. --- Bone Formation Marker (Bone Specific Alkaline Phosphatase) --- p.137Chapter 5.2.4. --- Quality of Life (QOL) --- p.139Chapter 5.2.5. --- Oswestry Disability Index (ODI) --- p.139Chapter 5.2.6. --- Pain --- p.141Chapter 5.2.6.1. --- Pain frequency --- p.141Chapter 5.2.6.2. --- Night Pain --- p.142Chapter 5.2.6.3. --- Administration of pain relief drugs --- p.143Chapter 5.2.7. --- Activity of daily living --- p.144Chapter 5.2.8. --- Prevention of new vertebral fracture(s) --- p.146Chapter 5.2.9. --- Safety and Tolerability --- p.147Chapter chapter 6. --- results on proximal femoral fractures study --- p.149Chapter 6.1. --- Epidemiological study on proximal femoral fractures --- p.149Chapter 6.2. --- The role of ultrasound equipment in the assessment osteoporosis in patients with proximal femoral fractures --- p.154Chapter 6.3. --- Summary --- p.155Chapter chapter 7. --- discussion --- p.156Chapter 7.1. --- The study on vertebral structures --- p.156Chapter 7.1.1. --- Changes in Shape of Vertebral Bodies --- p.156Chapter 7.1.2. --- Changes of Interevertbral Discs --- p.157Chapter 7.2. --- Alendronate treatment on Chinese elderly women with Osteoporotic vertebral fracture --- p.158Chapter 7.2.1. --- The Effect of Alendronate on BMD of Lumbar Spine --- p.159Chapter 7.2.2. --- The Effects of Alendronate on BMD of Proximal Femur --- p.159Chapter 7.2.3. --- The Effects of Alendronate on the BMD of Trabecular and Cortical Bone in the Distal Radius and Distal Tibia --- p.160Chapter 7.2.4. --- The Effects of Calcium Supplementation in the study --- p.162Chapter 7.2.5. --- The Effect of alendronate on Biochemical Turnover --- p.162Chapter 7.2.6. --- The Efficacy of Alendronate on Prevention of New Fractures --- p.163Chapter 7.2.7. --- The Effect of Alendronate on Quality of Life --- p.164Chapter 7.2.8. --- Adverse Effects of Alendronate --- p.165Chapter 7.3. --- Proximal Femur Fracture Study --- p.165Chapter chapter 8. --- conclusion --- p.168bibliography --- p.174epilogue --- p.202appendix --- p.xx