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Query: UNIPROT:P50502 (Hip)
 7,003 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

More than a fifth of all females suffer from the risk to develop spinal osteoporosis. Hip fractures occur about 50,000 times per year in Federative Republic of Germany, about 1/3 in males and 2/3 in females. Estrogen deficiency is a risk factor of major importance for females; both sexes gain risk because of nutritional calcium deficiency and reduced mobility. Estrogen replacement therapy was proven to reduce the risk in females; and calcium supply reduces risk in both sexes. Therapy of developed spinal osteoporosis includes fluorides, calcium, vitamin D and calcitonin. No drug therapy has been developed so far for patients with senile osteoporosis and hip fractures.
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PMID:[Osteoporosis as a cause of pathological fractures]. 220 Nov 37

Hip fractures are common in the elderly, affecting 1 in 4 women by the age of 90 years and 1 in 8 men. These fractures have caused an "epidemic" during the last 20 years because the age specific rate for such fractures has doubled, and there has been a significant increase in the size of the elderly population in Europe. Hip fracture patients occupy a quarter of all orthopedic beds, the treatment is costly and the rehabilitation slow. Fifteen percent die in hospital; 33% are dead by one year. Of survivors only 2/3 return to their own home. There is now a move to prevent such fractures. Hip fractures arise in the elderly for two reasons: deteriorating bone stock and increasing falls. Hip fracture prevention needs to address both issues, but most work has looked at bone stock. Predictions of hip fracture risk even if based on bone density are poor, so preventive measures need to target the whole population. Bone density rises to a peak at 35 to 40 years in both sexes; men have a higher bone density at all times than women. Thereafter there is a steady loss of 1-2% per year. Women have 10 years of accelerated loss after the menopause. Hip fracture prevention starts by ensuring that peak bone mass is reached. This is under genetic influence but may be maximized by adequate dietary calcium and physical activity in adolescence. Smoking, alcohol and steroid use reduce bone density and their use should be moderated. In women amenorrhea reduces bone density. For women, estrogen may stop menopausal loss and maintain bone density for at least 15 years and in retrospective studies can reduce the fracture risk by 50%. Calcitonin may be an alternative. Five years beyond the menopause primary or secondary prevention may be started. Estrogen is still the best therapy but may be less popular because of the return of menstrual periods. Calcitonin or oral calcium supplements may also be of benefit. Drugs in combination may be more effective than alone. Over age 70, when calcium absorption diminishes, vitamin D, calcium and calcitonin may be effective. For men, treatment options are calcium, calcitonin or, later on, vitamin D. The role of exercise in bone density protection is unclear but should be encouraged for general health reasons. Bisphosphonates are new drugs that may be useful. Falls become increasingly common in the elderly such that up to 80% of all 80-year-olds may sustain at least one fall per year.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The epidemiology of hip fractures and methods of prevention. 805 45

In the 50-year "modern" history of osteoporosis, there have been about 17 antifracture studies with sufficient attention to design to allow inference regarding efficacy. Antivertebral fracture efficacy has been reported with etidronate, estrogen patch, calcitonin, and 1,25-dihydroxyvitamin D. Two studies using fluoride were positive, and two were negative. Hip fractures have been neglected. One study showed efficacy of hip protectors, one showed efficacy of vitamin D and calcium in nursing home dwellers. The source of most hip fractures is the community. One community based antihip fracture efficacy study using annual injections of vitamin D was positive. There have been no antivertebral or antihip fracture studies in men, or in corticosteroid-related osteoporosis in men or women. Lack of independently repeated demonstration of efficacy, small fracture numbers, and data pooling in some of these (the best) studies leave great uncertainty. Estrogen and bisphosphonates appear to be the best options at this time. New data suggest that calcium supplementation is likely to reduce the rate of bone loss and perhaps reduce fracture rates. The challenge is to maintain and restore the constituents of bone mineral density (BMD), that is: to promote periosteal and endosteal bone formation; reduce endosteal bone resorption and cortical porosity; and increase trabecular thickness, number, and connectivity. There are many opportunities, for instance, intermittent parathyroid hormone (PTH) increases bone strength and, with estrogen, may increase connectivity. The anabolic effects of PTH may be partly mediated by IGF-1. IGF-1 increases periosteal, endosteal, and trabecular bone formation, cortical and trabecular width, and trabecular and endocortical connectivity.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Present and future of osteoporosis therapy. 857 94

We present a case of idiopathic transient osteoporosis of the hip in a 43 year-old male. The patient presented with pain in the hip and limb. Hip x ray showed osteoporosis and scintigraphy revealed a diffuse uptake in the femoral head. Magnetic resonance imaging showed decreased signal intensity on the T1 weighted images and increased signal intensity on T2 weighted images in the femoral head and neck. Blood tests were normal. Healing was achieved by restricting weight-bearing and administering calcitonin and calcium. Radiographic remineralization occurred simultaneously with clinical resolution.
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PMID:[Transient osteoporosis of the hip. Presentation of a case and literature review]. 866 58

Osteoporosis is a public health scourge that is usually eminently preventable. Some risk factors, such as low calcium intake, vitamin D deficiency, and physical inactivity, are amenable to early interventions that will help maximize peak bone density. Other risk factors subject to modification are cigarette smoking and excessive consumption of protein, caffeine, and alcohol. Hip fractures are the most serious outcome of osteoporosis, with enormous personal and public health consequences. The ongoing Study of Osteoporotic Fractures has identified additional independent predictors of hip fracture risk, including maternal hip fracture, absence of significant weight gain since age 25, height, hyperthyroidism, use of long-acting benzodiazepines or anticonvulsants, spending < 4 hours a day on one's feet, inability to rise from a chair without using one's arms, poor visual depth perception and contrast sensitivity, and tachycardia. In an individual perimenopausal woman, the risk of osteoporotic fracture and the urgency of estrogen replacement therapy can be best estimated on the basis of bone mineral density, as measured by dual-energy x-ray absorptiometry, coupled with the presence or absence of existing fractures and clinical risk factors evident from the history and physical examination. Estrogen, calcitonin, and bisphosphonates have all been proved effective in retarding postmenopausal bone loss and therefore reducing the risk of fracture. The use of sodium fluoride is more controversial, although a recent study has suggested a possible role for slow-release fluoride combined with high-dose calcium supplementation.
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PMID:Osteoporosis: prevention, diagnosis, and management. 921 58

Osteoporosis is a disease of low bone mass that may not manifest until a patient has a fracture. Hip fracture is the most devastating, but vertebral fracture is the most common, occurring in 25% of women over 50 years of age and 40% of those age 80-85 years. Although 60% of vertebral fractures are clinically silent, they are easily diagnosed radiographically. They are associated with height loss, deformity, impaired mobility, and pain. Patients should be evaluated for the cause of both the fracture and osteoporosis. Therapy includes education about the disease, an exercise program, and advice about tailoring routine activities. Pharmacotherapy includes annual influenza vaccines, and daily calcium (1200-1500 mg elemental calcium/day) and vitamin D (400-800 IU/day) supplements. New antiresorptive agents alendronate, hormone replacement therapy, and salmon calcitonin should be offered to all patients as they reduce fracture rates.
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PMID:Management of patients with vertebral compression fractures. 991 58

Nearly 1.5 million American men age 65 and older have osteoporosis, and another 3.5 million are at risk. Hip fractures in older men have a higher mortality than in women and represent a growing medical problem. Glucocorticoid treatment, hypogonadism, and excessive alcohol consumption are important secondary etiologies for loss of bone mass in men. Detection of hypogonadism may be difficult, and testosterone replacement is indicated for only a well-defined subset of patients. Because of a lack of data on pathogenesis, risk factors, and therapeutic interventions in men, treatment decisions are usually based on extrapolation from studies in women. None of the medications approved by the FDA for the treatment of osteoporosis in postmenopausal women has been approved for use in older men, but physicians are prescribing bisphosphonates and calcitonin.
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PMID:Osteoporosis in older men: discovering when and how to treat it. 1049 25

This study compared the effects of oral alendronate and intranasal calcitonin for treatment of osteoporosis in postmenopausal women. Women at least 5 yr postmenopause (n = 299) were randomized to either 10 mg alendronate, matching alendronate placebo, or open-label intranasal calcitonin 200 IU daily for 12 months. Hip and spine bone mineral density (BMD) and markers of bone turnover were measured, and safety and tolerability were assessed. Alendronate produced greater increases in BMD than calcitonin at 12 months at the lumbar spine (5.16% vs. 1.18%; P < 0.001), trochanter (4.73% vs. 0.47%; P < 0.001), and femoral neck (2.78% vs. 0.58%; P < 0.001). Changes in BMD with calcitonin were greater than with placebo at the femoral neck, but were not different from placebo at either the trochanter or lumbar spine. Greater decreases in bone turnover were seen with alendronate than with calcitonin (serum bone-specific alkaline phosphatase, 43% vs. 9%, P < 0.001; urinary N-telopeptide, 62% vs. 11%, P < 0.001). Similar percentages of patients in each group reported an adverse experience during the study. We conclude that, in postmenopausal women with osteoporosis, 12 months of therapy with alendronate produced significantly greater increases in BMD of the hip and spine and greater decreases in bone turnover than intranasal calcitonin.
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PMID:Comparison of alendronate and intranasal calcitonin for treatment of osteoporosis in postmenopausal women. 1084 52

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

DEFINITION AND SOCIOECONOMIC ASPECTS: Osteoporosis is a disease characterized by low bone mass and an increased susceptibility to fractures. It represents an enormous burden for the social security systems in developed countries. In Germany, approximately two million women and 800,000 men suffer from vertebral fractures and estimates for hip fracture incidence are in the range of 70,000-130,000 per year. The resulting costs for hip fractures alone could be calculated to 3-5 billion German marks. THERAPY ACCORDING TO EVIDENCE-BASED MEDICINE (EBM): According to Sackett et al. 1996, evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external evidence from systematic research. OSTEOPOROSIS THERAPY: The goal of osteoporosis therapy is to prevent fractures and several therapeutic options are available for this disease. With respect to proven fracture benefit, however, the quality of evidence from randomized clinical trials varies substantially among therapies. From systematic research the best external evidence is available for a supplementation with calcium and vitamin D and a therapy with the bisphosphonates alendronate or risedronate, as well as the SERM raloxifene. For other therapeutic agents like fluorides, vitamin D metabolites, calcitonin, and etidronate the quality of evidence is much lower. So far, there is no evidence for other pharmaceutical therapies. Hip protectors are effective for the prevention of hip fractures.
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PMID:[Therapy of osteoporosis from the viewpoint of evidence-based medicine]. 1139 91


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