Animal Models 6. Evolutionary and Historical Evidence 7. Discussion 8. Conclusions References 8. Functional Adaptation and Fragility of the Skeleton 1.
Mechanisms of Functional Adaptation 2. Effector Cells 2. Sensor Cells 2. Strain and the Mechanostat 2. The Two Poles of Adaptation 2. Disuse: Subnormal Loading 2. Overuse: Supernormal Loading 3. Skeletal Maintenance 3. Fatigue Damage Activates Remodeling 3. Remodeling Reduces Skeletal Weight 3.
Responsive vs. Permissive Remodeling 3. Somatic vs.
Evolutionary Adaptation 4. Skeletal Fragility 4. The Mechanostat and Sexual Dimorphism 4. Mechanical Priorities in Male and Female Bones 4. Estrogen and the Mechanostat Set Point 4. Menopause, the Set Point, and Postmenopausal Fragility 5. Summary Acknowledgments References 9.
Skin and Vitamin D Uptake 2. Metabolism of Vitamin D 3. What is Lack of Vitamin D? Bone Loss and Osteoporosis in Past Populations Introduction 1. Background 1. Problems with Diagenetic Change 2. Visual Examination of Complete Bones 3. Investigations of Cortical Bone 3.
Metacarpal Radiogrammetry 3. Cortical Histomorphometry 4. Investigations of Trabecular Bone 4. Visual Examination of Trabecular Bone Structure 4. Singh Index 4. Image Analysis of Trabecular Architecture 4. Stereometry 4. Investigative Techniques that Measure Whole Bone 5. Conclusions References Intravitam Changes 3. Primary Osteoporosis 3. Idiopathic Osteoporosis 3.
Postmenopausal Osteoporosis 3. Senile Osteoporosis 3. Secondary Osteoporosis 3. Osteoporosis due to Inactivity and Immobilization 3. Bone Loss Caused by Inflammatory Processes 3. Bone Loss Caused by Tumorous Processes 4.
Causes of Postmortem Bone Loss 4. Soil and water 4. Plant Roots 4. Fungi, Algae, Bacteria, and Protozoa 4. Arthropods and their larvae 5. Conclusions and Summary Acknowledgments References Mechanobiology Methods for Preserved Skeletal Remains 2. Bone Microstructure and Mechanical Loading History 3. Skeletal Sample 3. Methods and Findings 3. Changes through Time at Paloma 4. Principles and Methodology of Bone Histomorphometry 2.
Cortical Bone Sample Preparation 2. Diagenesis 2. Age-at-Death 3. Previous Applications of Histomorphology in Past Populations 3. African Populations 3. European Populations 3. Native American Populations 3. Other Populations 4. Materials 4. Methods 4. Results 4. Cortical Area in Isola Sacra 4. Bone Remodeling in Isola Sacra 4. Comparison of Isola Sacra with Modern samples 4. Future Directions Acknowledgments References Index Show More. Average Review. Among QCT's disadvantages: it requires a high radiation dose compared to DXA, CT scanners are large and expensive, and because its practice has been less standardized than BMD, its results are more operator-dependent.
Quantitative ultrasound has many advantages in assessing osteoporosis. The modality is small, no ionizing radiation is involved, measurements can be made quickly and easily, and the cost of the device is low compared with DXA and QCT devices. The calcaneus is the most common skeletal site for quantitative ultrasound assessment because it has a high percentage of trabecular bone that is replaced more often than cortical bone, providing early evidence of metabolic change. Also, the calcaneus is fairly flat and parallel, reducing repositioning errors.
The method can be applied to children, neonates, and preterm infants, just as well as to adults. The U. In men the harm versus benefit of screening for osteoporosis is unknown. Lifestyle prevention of osteoporosis is in many aspects the inverse of the potentially modifiable risk factors. In people with coeliac disease adherence to a gluten-free diet decreases the risk of developing osteoporosis  and increases bone density.
Sabrina C. Agarwal
Studies of the benefits of supplementation with calcium and vitamin D are conflicting, possibly because most studies did not have people with low dietary intakes. While supplementation does not appear to affect the risk of death,   there is an increased risk of myocardial infarctions with calcium supplementation,   kidney stones ,  and stomach problems. Vitamin K deficiency is also a risk factor for osteoporotic fractures. Functional polymorphisms in the gene could attribute to variation in bone metabolism and BMD. Vitamin K2 is also used as a means of treatment for osteoporosis and the polymorphisms of GGCX could explain the individual variation in the response to treatment of vitamin K.
Good dietary sources of calcium include dairy, leafy greens, legumes, and beans. The National Academy of Sciences recommends 1, mg of calcium for those ages , and 1, mg for those ages 50 and above. However, this would equate to glasses of milk, which is over the required amount or a healthy diet. Currently, there is not sufficient evidence to show that drinking more than 1 glass of milk a day prevents fractures, and due to evidence about possible increased risks of ovarian and prostate cancer with increased dairy, it is recommended to avoid high intakes of dairy. There is limited evidence indicating that exercise is helpful in promoting bone health.
Low-quality evidence suggests that exercise may improve pain and quality of life of people with vertebral fractures. There is some evidence for hip protectors specifically among those who are in care homes. Bisphosphonates are useful in decreasing the risk of future fractures in those who have already sustained a fracture due to osteoporosis. For those with osteoporosis but who have not had a fracture evidence does not support a reduction in fracture risk with risedronate  or etidronate.
Fluoride supplementation does not appear to be effective in postmenopausal osteoporosis, as even though it increases bone density, it does not decrease the risk of fractures. Teriparatide a recombinant parathyroid hormone has been shown to be effective in treatment of women with postmenopausal osteoporosis. Certain medications like alendronate, etidronate, risedronate, raloxifene, and strontium ranelate can help to prevent osteoporotic fragility fractures in postmenopausal women with osteoporosis. Although people with osteoporosis have increased mortality due to the complications of fracture, the fracture itself is rarely lethal.
The six-month mortality rate for those aged 50 and above following hip fracture was found to be around Vertebral fractures, while having a smaller impact on mortality, can lead to a severe chronic pain of neurogenic origin, which can be hard to control, as well as deformity. Though rare, multiple vertebral fractures can lead to such severe hunch back kyphosis , the resulting pressure on internal organs can impair one's ability to breathe. Apart from risk of death and other complications, osteoporotic fractures are associated with a reduced health-related quality of life.
The condition is responsible for millions of fractures annually, mostly involving the lumbar vertebrae, hip, and wrist. Fragility fractures of ribs are also common in men. Hip fractures are responsible for the most serious consequences of osteoporosis. In the United States, more than , hip fractures annually are attributable to osteoporosis. The incidence of hip fractures increases each decade from the sixth through the ninth for both women and men for all populations.
The highest incidence is found among men and women ages 80 or older. In the United States, , vertebral fractures occur annually, but only about a third are recognized. In a series of women aged In the United States, , wrist fractures annually are attributable to osteoporosis. Fragility fractures of the ribs are common in men as young as age These are often overlooked as signs of osteoporosis, as these men are often physically active and suffer the fracture in the course of physical activity.
An example would be as a result of falling while water skiing or jet skiing. However, a quick test of the individual's testosterone level following the diagnosis of the fracture will readily reveal whether that individual might be at risk. It is estimated that million people have osteoporosis. Postmenopausal women have a higher rate of osteoporosis and fractures than older men. There are 8. It has been shown that latitude affects risk of osteoporotic fracture. There is also an association between Celiac Disease and increased risk of osteoporosis.
About 22 million women and 5. The EU spends 37 billion euros per year in healthcare costs related to osteoporosis, and the US spends an estimated 19 billion USD annually for related healthcare costs. The link between age-related reductions in bone density and fracture risk goes back at least to Astley Cooper , and the term "osteoporosis" and recognition of its pathological appearance is generally attributed to the French pathologist Jean Lobstein. Anthropologists have studied skeletal remains that showed loss of bone density and associated structural changes that were linked to a chronic malnutrition in the agricultural area in which these individuals lived.
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Bone Loss and Osteoporosis - An Anthropological Perspective | Sabrina C. Agarwal | Springer
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