Bone Loss and Osteoporosis

by Agarwal, Sabrina C.; Stout, Samuel D.

• ISBN13: 9780306477676
• ISBN10: 030647767X
• Format: Hardcover
• Copyright: 2003-12-31
• Publisher: Plenum Pub Corp

Summary

With the growing incidence of fragility fractures in Europe and North America over the last three decades, bone loss and osteoporosis have become active areas of research in skeletal biology. Bone loss is associated with aging in both sexes and is accelerated in women with the onset of menopause. However, bone loss is related to a suite of complex and often synergistically related factors including genetics, pathology, nutrition, mechanical usage, and lifestyle. It is not surprising that its incidence and severity vary among populations. Each chapter highlights the multifaceted nature of bone loss and fragility. Several underlying themes are common between the chapters, particularly the value of biocultural an evolutionary perspectives in the study of bone loss and fragility. The contributors come from a variety of fields, and this volume is intended for a diverse audience including physical anthropologists, osteologists, bioengineers, and clinicians in sub-disciplines such as rheumatology, orthopedics, and general medicine.

Table of Contents

Current Concepts of Bone Loss and Osteoporosis
New Concepts of Bone Remodeling: A Unified Spatial and Temporal Model with Physiologic and Pathophysiologic Implications
Introduction	p. 3
The Purposes of Bone Remodeling	p. 5
The Basic Multicellular Unit as the Instrument of Bone Remodeling	p. 6
Disordered Remodeling and Age Related Bone Loss	p. 11
References	p. 15
On Changing Views about Age-Related Bone Loss
Introduction	p. 19
On the Two Paradigms	p. 19
The 1960 Paradigm	p. 20
The Utah Paradigm	p. 20
Age-Related Bone Loss	p. 24
A Proposed Synthesis	p. 26
Conclusions	p. 26
References	p. 27
Glossary	p. 30
The Role of Bone Quality on Bone Loss and Fragility
Introduction	p. 33
Determination of Bone Quality	p. 34
Aging Changes in the Skeleton	p. 34
The Problem of Diagenesis	p. 35
Changes in Bone Mineralization with Diseases and Treatments	p. 36
What Determines Skeletal Fragility?	p. 39
Conclusions	p. 40
References	p. 41
Population Approaches
Ethnic Differences in Bone Mass and Architecture
Introduction	p. 47
Osteoporosis	p. 47
Bone Densitometry and Assessment of Bone Architecture	p. 47
Bone Density and Fracture Incidence	p. 48
Use of "Race" and "Ethnicity" in Biomedical Literature on Osteoporosis	p. 49
Bone Mass and Bone Density	p. 50
Definitions of Bone Density	p. 50
Ethnic Differences in Bone Density	p. 50
Bone Quality and Bone Turnover	p. 51
Factors Affecting Bone Mass and Bone Loss	p. 51
Adjusting Bone Density for Body Size	p. 51
Body Size and Composition, and Preservation of the Skeleton	p. 52
Calcium Nutrition	p. 53
Physical Activity	p. 54
Bone Geometry	p. 55
Hip Axis Length	p. 55
Cross-Sectional Geometry	p. 56
Fracture Incidence	p. 57
Summary	p. 58
References	p. 58
Bone Loss, Fracture Histories, and Body Composition Characteristics of Older Males
Background	p. 63
Definition of Terms	p. 63
Bone Loss in Other Primates	p. 64
Population Differences	p. 64
Risk Factors	p. 65
Factors Influencing Bone Turnover	p. 65
Peak Bone Mass	p. 66
Endocrinological Factors	p. 66
Vitamin D and Vitamin D Receptors	p. 67
Body Composition and Mechanical Factors	p. 68
The Sun City/Tucson Longitudinal Study	p. 69
Objectives	p. 69
Subjects	p. 69
Methods	p. 70
Results	p. 70
Discussion	p. 80
Observed Bone Loss	p. 80
Changes in Body Composition	p. 81
Nutrition, Bone Density, and Prostate Cancer	p. 83
Summary and Conclusions	p. 84
References	p. 85
The Histomorphometry of the Subadult Rib: Age-Associated Changes in Bone Mass and the Creation of Peak Bone Mass
Introduction	p. 91
Intracortical Bone Remodeling in the Subadult Rib	p. 91
Peak Bone Mass and Age-Associated Bone Loss	p. 92
Factors Determining Peak Bone Mass	p. 93
A Study of Subadult Rib Histomorphometry	p. 94
Cross-Sectional Areas and Bone Mass	p. 95
Intracortical Remodeling: Osteon Population Density and Osteon Size	p. 97
Summary and Conclusions	p. 97
References	p. 99
Evolutionary Perspectives
An Evolutionary and Biocultural Approach to Understanding the Effects of Reproductive Factors on the Female Skeleton
Introduction	p. 105
Pregnancy	p. 106
Parity	p. 107
Lactation	p. 108
Animal Models	p. 110
Evolutionary and Historical Evidence	p. 111
Discussion	p. 113
Conclusions	p. 115
References	p. 116
Functional Adaptation and Fragility of the Skeleton
Introduction	p. 121
Mechanisms of Functional Adaptation	p. 122
Effector Cells	p. 123
Sensor Cells	p. 123
Strain and the Mechanostat	p. 124
The Two Poles of Adaptation	p. 125
Disuse: Subnormal Loading	p. 125
Overuse: Supernormal Loading	p. 126
Skeletal Maintenance	p. 126
Fatigue Damage Activates Remodeling	p. 127
Remodeling Reduces Skeletal Weight	p. 128
Responsive vs. Permissive Remodeling	p. 128
The Volume Effect on Strength and Fatigue Life	p. 129
Somatic vs. Evolutionary Adaptation	p. 130
Skeletal Fragility	p. 131
The Mechanostat and Sexual Dimorphism	p. 132
Mechanical Priorities in Male and Female Bones	p. 133
Estrogen and the Mechanostat Set Point	p. 133
Menopause, the Set Point, and Postmenopausal Fragility	p. 134
Summary	p. 135
Acknowledgments	p. 136
References	p. 136
Effects of Vitamin D on Bone and Natural Selection of Skin Color: How Much Vitamin D Nutrition are We Talking About?
Introduction	p. 139
Skin and Vitamin D Uptake	p. 141
Metabolism of Vitamin D	p. 142
What is Lack of Vitamin D?	p. 142
"Normal" Requirements for Calcium and Vitamin D	p. 144
Fur-Bearing Primates Obtain Vitamin D by Mouth	p. 145
Vitamin D Deficiency Affecting Genetic Selection for Lighter Skin Color	p. 147
Nutritional Implications of Vitamin D in Human Biology	p. 149
References	p. 151
Bone Loss and Osteoporosis in Past Populations
Techniques for the Investigation of Age-Related Bone Loss and Osteoporosis in Archaeological Bone
Introduction	p. 157
Background	p. 158
Problems with Diagenetic Change	p. 158
Visual Examination of Complete Bones	p. 159
Investigations of Cortical Bone	p. 160
Metacarpal Radiogrammetry	p. 160
Cortical Histomorphometry	p. 161
Investigations of Trabecular Bone	p. 162
Visual Examination of Trabecular Bone Structure	p. 162
Singh Index	p. 163
Image Analysis of Trabecular Architecture	p. 163
Stereometry	p. 164
Energy Dispersive Low Angle X-Ray Scattering (EDLAXS)	p. 165
Investigative Techniques that Measure Whole Bone	p. 165
Optical/Photo Densitometry	p. 166
Dual Energy X-Ray Absorptiometry (DEXA)	p. 166
Conclusions	p. 168
References	p. 168
Differentail Diagnoses of Intravitam and Postmortem Bone Loss at the Micro-Level
Introduction	p. 173
Methods and Techniques Used in Histological Research of Macerated Bone Specimens	p. 173
Intravitam Changes	p. 174
Primary Osteoporosis	p. 175
Idiopathic Osteoporosis	p. 175
Postmenopausal Osteoporosis	p. 175
Senile Osteoporosis	p. 175
Secondary Osteoporosis	p. 177
Osteoporosis due to Inactivity and Immobilization	p. 177
Bone Loss Caused by Inflammatory Processes	p. 179
Bone Loss Caused by Tumorous Processes	p. 179
Causes of Postmortem Bone Loss	p. 180
Soil and water	p. 180
Plant Roots	p. 183
Fungi, Algae, Bacteria, and Protozoa	p. 183
Arthropods and their larvae	p. 184
Conclusions and Summary	p. 186
Acknowledgments	p. 186
References	p. 186
Histomorphology, Geometry, and Mechanical Loading in Past Populations
Introduction	p. 189
Mechanobiology Methods for Preserved Skeletal Remains	p. 190
Interpreting Preserved Evidence of Mechanical Loading History from Bone Geometry	p. 190
Bone Microstructure and Mechanical Loading History	p. 192
Application of Geometric and Histologic Biomechanical Approaches to Past Populations: The Palomans	p. 196
Skeletal Sample	p. 196
Methods and Findings	p. 197
Changes through Time at Paloma	p. 201
Conclusions	p. 203
References	p. 203
Bone Remodeling and Age-Associated Bone Loss in the Past: A Histomorphometric Analysis of the Imperial Roman Skeletal Population of Isola Sacra
Introduction	p. 207
Principles and Methodology of Bone Histomorphometry	p. 208
Cortical Bone Sample Preparation	p. 209
An Algorithm for Estimating Bone Remodeling rates in Ancient Skeletal Samples	p. 210
Diagenesis	p. 211
Age-at-Death	p. 211
Previous Applications of Histomorphology in Past Populations	p. 211
African Populations	p. 212
European Populations	p. 212
Native American Populations	p. 213
Other Populations	p. 215
Present Study: An Example in Histomorphology and Bioarchaeology	p. 215
Materials	p. 215
Methods	p. 218
Results	p. 218
Cortical Area in Isola Sacra	p. 218
Bone Remodeling in Isola Sacra	p. 220
Comparison of Isola Sacra with Modern samples	p. 222
Age Associated Bone Loss in the Imperial Romans	p. 225
Future Directions	p. 225
Acknowledgments	p. 226
References	p. 226
Index	p. 229
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