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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Corticosteroid-induced osteoporosis, the principal cause of "secondary" osteoporosis, is usually observed in patients under prolonged systemic corticosteroid therapy and results from the multiple effects exerted by these drugs on bone cell metabolism. Corticosteroids reduce the intestinal absorption of calcium and its tubular reabsorption, thereby negativating the calcium balance and inducing a parathyroid reaction. This reaction is responsible for an increase in bone cell remodelling, but the main manifestation of the direct effect of corticosteroids on bone is osteoblast depression, so that there is disparity between bone resorption and formation, which in turn is responsible for bone tissue deficit. Sex hormone deficiency (due to menopause or treatment) and lack of physical activities (due to the causal disease or to iatrogenic myopathy) amplify bone rarefaction. By quantifying the bone loss, modern densitometry methods provide an early risk evaluation. Osteoporosis of varying intensity exposes some 20% of patients to fractures, vertebral collapse and rib fractures. Preventive measures are always recommended, including minimal effective dose corticosteroid therapy, sodium-free diet, calcium and vitamin D supplement, sex hormone replacement and pursuance of physical activities. Once the stage of fractures by osteoporosis has been reached, the "curative" treatment aims at reducing the incidence of new fractures, either by slowing down osteoclast resorption, or by restoring the bone tissue reserve through stimulation of the osteoblasts. The usefulness of these therapeutic measures in the preventive treatment of corticosteroid-induced osteoporosis remains controverted.
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PMID:[Cortisone-induced osteoporosis: from physiopathology to treatment]. 179 40

A 53-year-old man with cushingoid appearance--obesity, osteoporosis causing lumbar and thoracic vertebral collapse and a past history of hypertension and depression presented with symptoms and signs of adrenocortical insufficiency. He denied the use of corticosteroid medication. However, it was eventually discovered that he had used clobetasol propionate (Dermovate), a potent topical steroid cream, for five years. The development of adrenal insufficiency symptoms coincided with the withdrawal of the cream.
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PMID:Unrecognised Cushing's syndrome and adrenal suppression due to topical clobetasol propionate. 193 50

Osteoporosis, a metabolic bone disease most prevalent in older adults, is a major public health problem. Although management of osteoporosis through diet, exercise, and medication has improved, little is known about the psychosocial consequences of this disabling disease. In an attempt to identify patient characteristics that would provide physicians with insight into appropriate management styles for older osteoporotics, we assessed 103 patients with osteoporosis for their health locus of control (HLOC) orientation. We examined the relationship between HLOC and patient outcomes after participation in the Duke University Preventive and Therapeutic Program for Osteoporosis (DUPATPO) to determine whether HLOC was associated with functioning after program participation. More specifically, we asked whether internal or external HLOC was associated with decreases in depression, psychiatric symptoms, and stress symptoms, or with increases in self-esteem, exercise, and disease knowledge. We have shown in our earlier work (Gold et al, J Am Geriatr Soc 1989; 37:417) that program participation is associated with improved functioning in older adults. We now asked whether knowledge of a patient's HLOC would help predict these improvements. A comparison group (ie, older osteoporotics who did not participate in DUPATPO) was also assessed for HLOC to examine the possible association between HLOC and health behaviors regardless of the DUPATPO intervention. Our findings indicate that HLOC provided little useful information regarding patient outcomes. Although improvements were seen in the mental health of program participants, no association between these improvements and HLOC could be found.
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PMID:Osteoporosis in late life: does health locus of control affect psychosocial adaptation? 206 32

Treatment of osteoporosis with a complete reconstruction of the normal three dimensional architecture of trabecular bone is an unsolved problem. In addition to the well established fluoride therapy new concepts in the treatment of osteoporosis were developed. There is growing interest in the so called ADFR concept (activation, depression of resorption, formation, repeat the cycle) as a physiological stimulation of osteoblastic bone formation. The histological results following ADFR treatment in 8 patients are reported. After 12 months of treatment with parathyroid hormone [1-38)hPTH) (stimulation of the basic metabolic units) and the diphosphonate EHDP (depression of osteoclastic resorption) no change of remodelling processes at the trabecular bone surface could be observed. The results demonstrate many doubts in the importance of the ADFR concept for the treatment of osteoporosis.
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PMID:[Morphologic study of iliac crest spongiosa in patients with osteoporosis treated according to the ADFR (activation, depression of resorption, formation, repeat the cycle) with parathyroid hormone and diphosphonates (Hannover PTH I study)]. 213 78

An exercise program for menopausal women that includes both aerobic and resistance training may prevent or relieve problems such as cardiovascular disease, obesity, muscle weakness, osteoporosis, and depression. The risk of cardiovascular disease increases in women after menopause; in both men and women, regular aerobic exercise may improve cardiorespiratory endurance and reduce the risk of cardiovascular disease. Aerobic exercise also prevents some age-related increases in body fat and it elevates resting metabolic rate, which correlates directly with lean body mass. Inactivity, not hormonal change, is the most common cause of obesity. Resistance training can improve muscle strength and bone density. Increases in bone mineral content have been found at lumbar vertebral and distal radial sites in women who participate in exercise programs. Weight-bearing exercise in conjunction with estrogen replacement therapy and calcium supplementation helps to prevent osteoporosis. Many women experience mood changes at menopause. Some of these symptoms are caused by chronic sleep deprivation due to night flushes and respond best to estrogen; others are related to levels of brain chemicals and respond favorably to exercise.
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PMID:Exercise in the menopausal woman. 217 91

95 million worldwide have undergone sterilization, 6 million of the in the US, and on the North American continent 800,000 sterilizations are performed annually. Since 1972, sterilization has been available liberally in Czechoslovakia. 85% of women bear 2 children by age 30, and more than 40% of abortions are repeat abortions, a large percentage of them for women 30. Microsurgery can restore fertility in 50-70% of cases. The negative effect of tubal sterilization on the menstrual cycle was studied in a caseload of 52,026 operations at 45 institutes in 24 countries. 1555 women aged 25-34 with a parity of 2-6 children were selected, and they were followed up for 3 cycles prior and 3 cycles after sterilization. 82% claimed regular menstruation, 54% had irregularity, in 8% irregularity changed after the operation, and in 5% the regular cycle became irregular. In 26%, the days of bleeding decreased, and they increased in 22%. In 2 groups of 86 women each who underwent tubal ligation and hysterectomy in the course of Cesarean section, postoperative infection was 9.3% with hysterectomy and 19.7% with tubal ligation. The negative effect of tubal sterilization on ovarian steroid genesis was shown in 112 women under age 46 with regular menstruation 2 years subsequently: urogenital, cardiovascular, and psychological disorders occurred. In a group of 59 women 41 and another group of 59 women aged 20-41, a significant drop of total estrogen excretion was found 24 hours after sterilization. In another 14 cases, depression and chronic mastopathy developed 2 years after the procedure, necessitating bilateral mastectomy; 3 years later osteoporosis occurred; 4 years later hemotological dysfunction ensued, and another 2 years later angina pectoris developed. In another 15 women, postoperational hypoestrinism was demonstrated after breast carcinoma surgery. A comparative study of 1107 sterilized women and 530 controls showed no change in the regularity or intensity of menstruation; however, dysmenorrhea increased: 10.8% in the sterilized caseload vs. 2.1% in controls. According to some studies, the restoration of fertility was possible in 80% of cases.
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PMID:[Is tubal sterilization harmful to the health of women?]. 220 90

Osteoporosis and epiphyseal aseptic bone necrosis are side-effects of corticosteroid therapy that must be detected and prevented. The incidence of osteoporosis depends on whether radiology or densitometry are used for its evaluation. Bone loss is accounted for by osteoblast depression and decreased intestinal absorption of calcium, responsible for secondary hyperparathyroidism. The clinical progress of steroid-induced osteoporosis is often impressive. Plasma osteocalcin levels are lowered. Nowadays, non-invasive methods of bone mass measurement are indispensable for detection and follow-up. Prevention rests on adjustment of corticosteroid therapy and, above all, on the prescription of calcium and vitamin D; fluoride constitutes the curative treatment. Corticosteroid dosage plays a role in the occurrence of aseptic bone necrosis at an early stage of treatment. The lesions, often multiple and progressive, mostly affect the femur. MRI is the most sensitive examination for early detection. When medical treatment has failed, total hip replacement may be considered.
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PMID:[Bone and osteo-articular complications of corticotherapy]. 232 Aug 82

Osteoporosis and its sequelae have been associated with genetic predisposition, aging, nutritional factors, inactivity, substance abuse, and anorexia nervosa. We report three cases of pathologic osteoporotic hip fractures in elderly females with major depression. Biological consequences of depression and mobilization during hospital treatment are discussed as possible mediators of osteoporotic morbidity.
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PMID:Osteoporosis with pathologic hip fractures in major depression. 234 82

Participants in a therapeutic program for osteoporosis were studied to determine if program participation improved psychological outcomes. The 4-day program included intensive education about the disease and its prognosis, physical therapy education, nutritional counseling, and medical evaluation and treatment. All therapeutic patients enrolled in the program over a one-year period (N = 38) were interviewed individually pre- and post-participation. Knowledge of osteoporosis, level of social support, coping styles, and perceptions of the impact of pain and chronicity were assessed. Patients reported improved future outlook despite continued concern about pain and chronicity. Mention of depression was reduced, and knowledge of osteoporosis increased significantly. In addition, there were meaningful changes in patients' understanding of disease management. These included knowing when to make specific changes and avoid harmful actions. The findings suggest that an educational program can have a positive impact on patients' coping. Educational efforts may be an important component in the management of chronic disease.
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PMID:Treatment of osteoporosis. The psychological impact of a medical education program on older patients. 270 39

More and more people are turning to exercise as a means of achieving long-term health. The World Health Organization has endorsed this concept. The best available evidence suggests that an employee fitness programme will result in decreased health-care costs, decreased absenteeism and increased productivity for the employer. Regular physical activity is also associated with lower mortality rates. Appropriate physical activity may be a valuable tool in therapeutic regimens for the control and amelioration (rehabilitation) of cardiovascular disease, coronary artery disease, hypertension, congenital heart disease, peripheral vascular disease, obesity, chronic obstructive pulmonary disease, diabetes mellitus, musculoskeletal disorders, end-stage renal disease, stress, anxiety and depression, etc. Regular physical activity, independent of other factors, reduces the probability of coronary artery disease and early death. Patients with risk factors for coronary artery disease need more intensive preexercise evaluation than those not a risk, and those with known or suspected cardiovascular disease need the most intensive evaluation and follow-up. Participation in vigorous sports activities, such as jogging, swimming, tennis, etc., helps to protect against the development of hypertension, even when other predisposing factors are present. Several studies have been conducted on the use of exercise in the treatment of hypertension. Physical exercise also contributes to the control of body weight. Consideration of the metabolic abnormalities in patients with type II (adult onset) diabetes indicates that they would make excellent candidates for an exercise programme. Osteoporosis is an important health problem for the elderly. The best treatment available at present is prevention, and a high level of physical activity throughout life can result in a larger skeletal mass during old age.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The role of physical activity in the prevention and treatment of noncommunicable diseases. 323 11


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