Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UNIPROT:P50502 (Hip)
 7,003 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Raloxifene HCl, a selective estrogen receptor modulator, has been shown to increase bone mineral density (BMD) and decrease biochemical markers of bone turnover in postmenopausal women without stimulatory effects on the breast and uterus. However, it is not known whether the changes in BMD and bone turnover are associated with changes at the tissue level, nor how changes with raloxifene compare with estrogen. In this randomized, double blind study, we evaluated the effects of raloxifene (Evista, 60 mg/day) or conjugated equine estrogens (CEE; Premarin, 0.625 mg/day) on bone architecture, bone turnover, and BMD. Iliac crest bone biopsies were obtained at baseline and at the end of the study after double tetracycline labeling and were analyzed for standard histomorphometric indexes. Serum and urinary biochemical markers of bone turnover were measured at baseline and at 4, 10, 18, and 24 weeks of treatment. Total body, lumbar spine, and hip BMD were measured at baseline and at the end of the study by dual energy x-ray absorptiometry. Activation frequency and bone formation rate/bone volume were significantly decreased from baseline in the CEE, but not in the raloxifene, group. Bone mineralization did not change in either group. Most markers of bone resorption and formation decreased in both groups, but to a greater degree in the CEE group (P < .05). Total body and lumbar spine BMD increased from baseline in both groups, with a greater increase in the CEE group (P < 0.05). Hip BMD significantly increased from baseline in the raloxifene group, but the change was not different from that in the CEE group. These results suggest that raloxifene reduces bone turnover and increases bone density, although to a lesser extent than CEE. Thus, raloxifene is an alternative to CEE for the prevention and treatment of osteoporosis in postmenopausal women.
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PMID:A comparison of the effects of raloxifene and estrogen on bone in postmenopausal women. 1085 52

Hip geometry and bone mineral density (BMD) have been shown previously to relate, independently of each other, to risk of hip fracture. We used Lunar DPX "beta" versions of hip strength analysis (HSA) and hip axis length (HAL) software to analyze scans from ten representative age-stratified population samples in the European Prospective Osteoporosis Study (EPOS). All 1617 subjects were >50 years of age, and 1033 were women. The data were modeled with gender and center as categorical variables. The bone mineral density of the upper half of the femoral neck declined at a faster rate with age than that in the lower half. Femoral neck cross-sectional moment of inertia (CSMI), a measure of resistance to bending, showed no significant age reduction in either gender. However, height and weight effects on CSMI were significantly more beneficial in men than in women (0.002 < p < 0.012) and the weight effect appeared to be mediated by bone mineral content (BMC). Compressive stress (Cstress), defined as the stress in the femoral neck at its weakest cross section arising from a standardized fall, was higher in women. Although Cstress increased with body weight when BMC was held constant, in practice it fell through the association and statistical interaction of rising body weight with rising BMC. HAL, as expected, was strongly positively associated with male gender and also height (p < 0.0001). Hip strength-related indices were markedly center-dependent. Significant differences (p < 0.0001) were noted between the centers for all the variables investigated that related to hip geometry. Adjustment for femoral neck bone mineral content (totBMC) showed these center differences to account for >50% of center variation in hip strength, which remained highly significant (p < 0.0001). We conclude that there are substantial geographical differences in femoral neck geometry as well as in BMD. These geometric variations may contribute to the large variations in hip fracture risk across Europe. The effects of aging on hip strength need to be explored in longitudinal studies.
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PMID:Hip geometry, bone mineral distribution, and bone strength in European men and women: the EPOS study. 1086 23

To examine longitudinal change in health-related quality of life (HRQoL) following hip fracture in elderly subjects, 32 patients with hip fractures and 29 sex-matched non-fracture control subjects (mean +/- SD age 82 +/- 8 and 86 +/- 6 years respectively) were enrolled in a prospective, case-control study. Fracture subjects completed a generic questionnaire, Short Form 36 (SF-36), and a disease-targeted measure, the revised Osteoporosis Assessment Questionnaire (OPAQ2), on two separate occasions, within 1 week of fracture and 12-15 weeks after fracture. Controls completed both questionnaires on two occasions 12 weeks apart. SF-36 scores were significantly correlated with OPAQ2 in comparable domains of Physical Function (r = 0.76), General Health (r = 0.70) and Mental Health/Tension (r=0.86). Control subjects had stable scores with the OPAQ2 and SF-36. At 3 months after fracture there was a significant reduction in HRQoL in the SF-36 domains Physical Function (-51%), Vitality (-24%) and Social Function (-26%) and in the OPAQ2 domains Physical Function (-20%), Social Activity (-49%) and General Health (-24%). Hip fracture patients thus had a lower baseline HRQoL and experienced a significant deterioration in HRQoL after hip fracture on both the SF-36 and OPAQ2. HRQoL should be part of a comprehensive assessment of the costs of osteoporosis including fracture-associated morbidity.
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PMID:Deterioration in quality of life following hip fracture: a prospective study. 1091 50

(1) Osteoporosis is one of several recognized causes of bone weakness in elderly women, and accounts for the high incidence of fractures. Hip fracture carries the highest rates of morbidity and mortality. (2) Bone density measurement in a given woman is not predictive of her individual risk of fracture. None of the recommendations we examined propose routine screening for osteoporosis by bone density measurement in all postmenopausal women. (3) Women at risk should be identified, so that they can benefit from detection and prevention. Detection is mainly based on clinical evidence. (4) Whatever the age and period of life, prevention of osteoporotic fractures in women is based on adequate supply of calcium (at least 1 g/day, mainly in the diet) and vitamin D, and on regular physical exercise and fall prevention. (5) Oestrogen therapy is the first-line drug-based prevention of osteoporotic fractures, despite worries about possible carcinogenicity. (6) Routine hormone replacement therapy for all women, starting at menopause, is not recommended. The decision should be made individually. (7) Before starting treatment, patients should be informed of the need for long-term compliance. (8) Consensus statements recommend hormone replacement therapy as secondary prevention for women having already had osteoporotic fractures, and as primary prevention for women at risk.
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PMID:Fracture prevention in elderly women: treatment of osteoporosis is one approach, together with physical exercise and fall prevention. 1091 24

Osteoporosis is a major cause of disability and excess mortality in older men and women. Hip fracture incidence accelerates approximately 10 years after menopause in women and after age 70 in men. Approximately 1 million Americans suffer fragility fractures each year at a cost of over 14 billion dollars. The disability, mortality, and cost of hip and vertebral fractures are substantial in the rapidly growing, aging population so that prevention of osteoporosis is a major public health concern. BMD is used to make the diagnosis of osteoporosis before incident fracture and predict fracture risk. Recommendations for treatment and prevention of osteoporosis based on BMD score have been published by the World Health Organization and the National Osteoporosis Foundation. In a process that continues throughout life, bone repairs itself by the coupled action of bone resorption followed by bone formation, sometimes referred to as bone turnover. Osteoblasts and osteoclasts are the primary cells involved in bone formation and resorption, respectively. The process of bone turnover is regulated by hormones, such as PIH and local factors such as IL-1 and prostaglandins. Following attainment of peak bone mass at age 25, bone loss begins, accelerates in women at menopause and slows again but continues into advanced years at a rate of 1% to 2% per year, similar to premenopausal bone loss rate. The leading theories of the mechanism of bone loss in older individuals is calcium deficiency leading to secondary hyperparathyroidism and sex hormone deficiency. Risk factors such as age, gender, ethnic background, smoking, exercise, and nutrition, and medical conditions associated with osteoporosis should be evaluated and modified when possible to prevent further bone loss. Osteoporosis treatment and prevention include weight-bearing exercise, calcium and vitamin D supplementation, estrogen replacement, bisphosphonates, selective estrogen receptor antagonists, and calcitonin. Although there is no currently approved treatment for osteoporosis in men, many of the treatments approved for osteoporosis in women hold promise to be beneficial in men.
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PMID:Osteoporosis. Pathogenesis, diagnosis, and treatment in older adults. 1098 13

Osteoporosis and osteoporosis-related fractures are a major source of both morbidity and cost in the elderly, the fractures that are most commonly associated with osteoporosis being those of the hip, the distal forearm and the vertebrae, although it is believed that most other fractures occurring in the elderly are also related to osteoporosis. In this review, the incidence of all types of fracture is described based on the available literature, and the foreseeable trends resulting from demographic changes are discussed. Emphasis is given to the epidemiology of hip fracture since this is the most serious consequence of osteoporosis. Hip fractures occur all over the world, most currently occurring in Western countries, mainly Europe and the USA, but it is expected that there will be a large increase in the number of hip fractures in other countries because of demographic changes. The incidence of hip fractures increases exponentially with age, resulting in a 1-year incidence of 1% in women aged 80 in Western countries. Most hip fractures occur in women, but this is again partly due to demography, because of the longer life expectancy of women. Wrist fractures occur more often in women and do not show the same increase with age as hip fractures. The incidence reaches a plateau at age 60-70. Vertebral fractures show a modest increase with age and are again more common in women than men. The incidence of all other fractures increases modestly with age
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PMID:Fractures in the elderly: epidemiology and demography. 1103

The aim of non-pharmacological intervention for osteoporosis is to prevent, treat or alleviate the consequences of osteoporosis, the main one of which is fracture. Non-pharmacological interventions consist of a wide spectrum of treatment modalities to decrease pain, correct postural change, improve mobility, enable the patient to follow a normal social life and prevent (further) fracture. An exercise programme can increase bone mass in adolescents and adults, but in the elderly its main emphasis should be on improving muscle strength and balance in order to decrease the risk of falls. Physiotherapy is commonly prescribed to mobilize the patient after a fracture, to decrease muscle spasm and pain, and to improve balance and co-ordination. An orthesis or back support may be used to correct kyphosis and decrease pain. Medication for pain is often needed and should cover both acute severe pain following fracture and chronic pain caused by postural change. A hip fracture is the most severe consequence of osteoporosis. The risk of hip fracture can be decreased by pharmacological treatment to increase bone mass and bone strength. However, in the very elderly the occurrence of falling may be more important than the failure of bone strength. Hip protectors have recently become available and have been shown to decrease the risk of hip fracture after a fall. These shunt the energy from the trochanter away to the sides. Non-pharmacological approaches to treatment are often neglected in daily practice, the emphasis being instead on treatment with drugs that decrease bone resorption and thereby increase bone strength.
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PMID:Non-pharmacological interventions. 1103 6

The aim of all surgical procedures in the treatment of trochanteric fractures in elderly and even geriatric patients is achievement of initial stability. We examined in a clinical trial whether primary stability was achieved in all types of trochanteric fractures following osteosynthesis with the Dynamic Hip Screw (DHS). From 1994 to 1996, 122 patients with trochanteric fractures had osteosynthesis by dynamic hip screw. Patient records were evaluated and all data got registered with a standardized protocol;clinical radiological outcome was analysed after an average period of 1.9 years after injury according to the Traumatic Hip Rating Score. 22% of all patients died meantimes, 51.6% of the remaining 95 patients could get examined. The average age was 75.5 years, the patient population showed an increased preoperative morbidity (2.5 points) according to ASA-Score. 81% showed progressive osteoporosis. According to the AO-classification 47% stable fractures (type A-1) and 53% instable trochanteric fractures (type A-2 and A-3) occurred. Surgery lasted 77 minutes average in osteosynthesis of stable fractures. The duration of 108 minutes in instable fractures was significantly higher, as well as the blood loss was 43% increased in these complex fractures. Complications closely associated to the osteosynthesis appeared only in instable fractures (7%). Also common complications (24.6%) predominated with 15.6% in type A-2 and A-3 fractures versus 9% in type A-1 fractures; mortality was also different with 5.7% versus 1.6%. Assessment of the functional outcome according to THRS showed a significant deterioration of 20 points in 71% of all patients compared with the preoperative score. The results show that dynamic hip screw osteosynthesis in instable trochanteric fractures is associated to a higher incidence of complications. While the dynamic hip screw still represents the standard implant in stable fractures of the trochanteric region, being aware of improved intramedullary implants regarding biomechanical features and surgical technique, the results justify to critical consider the use of DHS for osteosynthesis in instable fractures of the trochanteric region.
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PMID:[Stable and unstable pertrochanteric femoral fractures. Differentiated indications for the dynamic hip screw]. 1103 94

Hip fracture risk has been associated with hyperthyroidism and thyroidectomy in men and with hyperthyroidism in women, but the influence of thyroidectomy on fracture risk in women has not been adequately addressed. The 630 Rochester, MN women who underwent thyroidectomy in 1950-1974 were followed subsequently for 12,804 person-years (retrospective cohort study) during which 601 fractures were observed. Relative to incidence rates in the community, there was no increase in overall fracture risk (standardized incidence ratio [SIR] 0.9; 95% confidence interval [CI] 0.8-1.00). No increase was seen in limb fractures generally or in distal forearm fractures specifically (SIR 1.1, 95% CI 0.8-1.4). There was a modest but statistically significant increase in the risk of hip fractures following thyroidectomy (SIR 1.3, 95% CI 1.01-1.8), but much greater increases were apparent in the risk of subsequent fractures of the ribs, spine, and pelvis. There was almost a threefold increase in vertebral fractures (SIR 2.8, 95% CI 2.3-3.3), but the excess was mostly observed long after the original operation and may be attributable to ascertainment bias. Fracture risk was associated with advancing age and with the presence of one or more of the diseases that have been associated with secondary osteoporosis but not with a history of hyperthyroidism, extent of thyroid surgery, or subsequent use of thyroid replacement therapy. Thus, with the exception of some fractures of the axial skeleton, which might have been more completely diagnosed among affected women, there was no increase in fracture risk among women following thyroidectomy performed mainly for adenoma or goiter.
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PMID:Fractures following thyroidectomy in women: a population-based cohort study. 1106 58

Models proposed so far for the pathogenesis of osteoporosis often do not take into account the factors underlying the different incidences of hip fracture in different populations. To address this issue, we identified 34 female patients with hip fracture (HF) and 16 women with at least four vertebral fractures (VF) in a population-based retrospective study. Each participant had a bone mineral density (BMD) measurement of the lumbar spine and hip using a Hologic QDR-2000 scanner, in single beam mode for the latter site. Hip axis length (HAL) was determined automatically (precision 1.5%). HAL derived from 149 normal subjects (age range 19-75 years) was 10.3 +/- 0.5 cm. BMD values found at the femoral neck were almost similar, but differed significantly at the spine between the two groups. Mean values of femur HAL in HF patients (10.55 +/- 0.5 cm) were significantly higher compared with VF patients (9.85 +/- 0.54 cm; p < 0.001). Interestingly, both mean values differed significantly from the mean for normal subjects. Our results demonstrate that patients with multiple vertebral fractures have significantly lower vertebral BMD values but similar femoral neck values compared with patients who fracture at the hip; furthermore, hip axis length was more than 1 SD higher in these latter patients compared with that of VF patients. These results suggest that the size and shape of the hip can explain part of the observed aetiologic differences between these two types of osteoporotic fractures.
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PMID:Hip axis length in an Italian osteoporotic population. 1106 50


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