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Postmenopausal
Osteoporosis
Hormones and Other Therapies
LONDON AND NEW YORK
C
ONTROVERSIAL ISSUES IN CLIMACTERIC MEDICINE SERIES
Postmenopausal
Osteoporosis
Hormones and Other Therapies
Edited by
A. R. Genazzani
Past President of the International Menopause Society
and
Chairman of the Division of Obstetrics and Gynecology
University of Pisa, Italy
Published under the auspices of the
International Menopause Society
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2013 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20151020
International Standard Book Number-13: 978-0-203-00740-2 (eBook - PDF)
This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made
to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibilit y or liability for
any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by
individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the publishers.
The information or guidance contained in this book is intended for use by medical, scienti fic or health-ca re professionals and is pro-
vided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the patient ’s medical history,
relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science,
any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to
consult the relevant national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions,
and their websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. This book does
not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is the sole responsi-
bility of the medical professional to make his or her own professional judgements, so as to advise and treat patients appropriately.
The authors and publishers have also attempted to trace the copyright holders of all material reproduced in this publication and
apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been
acknowledged please write and let us know so we may rectify in any f uture reprint.
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https://t.me/med1917
List of contributors ix
Preface xv
Section I: Introduction
1. Magnitude and impact of osteoporosis and fractures 1
C. Marcocci, F. Cetani, E. Vignali and A. Pinchera
2. Impact of osteoporosis on quality of life and quality of life on 11
osteoporosis: rationale and methodology for accurate assessment
W. H. Utian
Section II: Gonadal steroids and the pathogenesis of osteoporosis
3. Novel signals determining skeletal cell fate and function 17
E. Canalis, V. Deregowski, R. C. Pereira and E. Gazzerro
4. Sex steroid hormones and bone formation 23
R. Civitelli
5. The effect of sex steroids on osteoclast function 31
K. Henriksen, N. A. Sims, L. B. Tankó and M. A. Karsdal
6. Calcium and vitamin D: regulation of mineral homeostasis 45
D. Goltzman
Section III: Epidemiology
7. Genetic regulation of bone mass 55
S. H. Ralston
8. Bone mineral acquisition during infancy and adolescence 63
G. Saggese and G. I. Baroncelli
9. Osteoporosis: influence of life-style 71
R. Rizzoli
10. Postmenopausal osteoporosis and dental health 77
J. Wactawski-Wende
Section IV: Diagnosis
11. Bone quality 97
C. E. Bogado
12. Diagnosis: clinical, hormonal and biochemical evaluation 103
D. M. Reid
13. Advanced imaging assessment of bone quality 113
H. K. Genant and Y. Jiang
v
Contents
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POSTMENOPAUSAL OSTEOPOROSIS
14. Quantitative ultrasonometry of bone in the management of 127
postmenopausal women
P. Hadji
Section V: Pharmacological prevention and treatment
15. Awareness of osteoporosis and related treatments 141
A. D. Woolf
16. Intervention thresholds for osteoporosis 145
J. A. Kanis
17. Vitamin D and calcium supplements 151
R. Nuti, L. Gennari, D. Merlotti and G. Martini
18. Estrogen dose response in bone density and bone histology 171
E. Horner and J. Studd
19. Effects of oral contraceptive preparation on bone health 177
M. Gambacciani
20. Hormone replacement therapy 185
L. B. Tankó and C. Christiansen
21. New physiologic approach to prevention of postmenopausal 193
osteoporosis
B. Ettinger and J. S. Lee
22. Selective estrogen receptor modulators 203
A. Diez-Pérez
23. Bisphosphonates in the management of osteoporosis 209
S. E. Papapoulos
24. Phytoestrogens: food or drug? 219
L. Bacciottini, A. Falchetti, B. Pampaloni, E. Bartolini,
A. M. Carossino and M. L. Brandi
25. Tibolone 233
M. R. McClung
26. Understanding the role of aromatizable androgens in bone-sparing 239
O. Tuncalp, V. Edusa, A. Fadiel and F. Naftolin
Section VI: Specific aspects of selected therapies
27. Strontium ranelate: a new first-line treatment for patients 247
with postmenopausal osteoporosis
S. Ortolani
28. Reconciling risks and benefits of hormone replacement therapy in a single outcome: 255
the QALY approach
J. M. Alt, Y. Zöllner and J. Ryan
vi
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CONTENTS
29. Prevent, treat and maintain: how to optimize the management of 263
postmenopausal osteoporosis
D. Agnusdei
30. Transdermal hormone therapy: effects on bone 271
R. E. Nappi, F. Albani, F. Ferdeghini, S. Detaddei, A. Sommacal,
A. Verza, A. Ornati and F. Polatti
31. Progestogens and bone 275
D. W. Sturdee
32. Effect of different dose options of continuous combined hormone 281
therapy on bone and bone marker N-terminal propeptide of type I procollagen:
results from a long-term study in Finnish postmenopausal women
J. Heikkinen and J. Haapalahti
33. The use of alendronate in osteoporosis treatment: 10-year experience 289
M. L. Brandi
vii
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ix
D. Agnusdei
Medical Fellow – Osteoporosis, Europe and
Latin America
Eli Lilly and Company
Lilly Italia, SpA
Via Gramsci 731
50019 Sesto Fiorentino
Florence
Italy
F. Albani
Department of Obstetrics and Gynecology
Policlinico S. Matteo
University of Pavia
Piazzale Golgi 2
27100 Pavia
Italy
J. M. Alt
Solvay Pharmaceuticals
Hans-Böckler-Allee 20
30173 Hannover
Germany
L. Bacciottini
Department of Internal Medicine
University of Florence
Viale G. Pieraccini 6
50139 Florence
Italy
G. I. Baroncelli
Endocrine Unit
Division of Pediatrics
Department of Reproductive Medicine and
Pediatrics
University of Pisa
Pisa
Italy
E. Bartolini
Department of Internal Medicine
University of Florence
Viale G. Pieraccini 6
50139 Florence
Italy
C. E. Bogado
Clinical Research Department
Instituto de Investigaciones Metabolicas
and
USAL University
Buenos Aires
Argentina
M. L. Brandi
Department of Internal Medicine
University of Florence
Viale G. Pieraccini 6
50139 Florence
Italy
E. Canalis
Department of Research
Saint Francis Hospital and Medical Center
Hartford, CT 06105
USA
and
The University of Connecticut School of
Medicine
Farmington, CT 06030
USA
A. M. Carossino
Department of Internal Medicine
University of Florence
Viale G. Pieraccini 6
50139 Florence
Italy
F. Cetani
Department of Endocrinology and Metabolism
University of Pisa
Via Paradisa 2
56124 Pisa
Italy
C. Christiansen
Center for Clinical and Basic Research
Ballerup Byvej 222
Ballerup
Denmark
List of contributors
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