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目次

1 Osteoporosis: The Clinical Problem.- Epidemiology.- Pathogenesis.- Classifications of Osteoporosis.- Clinical Manifestations of Osteoporosis.- Diagnostic Studies in Osteoporosis.- Calcitropic Hormones and Biochemical Markers of Bone Remodeling.- Medical Therapy.- Selecting a Therapy and Monitoring the Response to Therapy.- References.- 2 Epidemiology of Osteoporosis.- Skeletal Development and Aging.- Skeletal Development.- Prevalence of Low Bone Density.- Fracture Incidence and Prevalence.- Vertebral Fractures.- Hip Fractures.- Other Fractures.- Secular Trends.- Lifetime Risk.- Mortality and Morbidity.- Mortality.- Economic Costs and Morbidity.- Summary.- References.- 3 The Physiology of Bone Turnover.- Cytokines and Bone Remodeling.- Role of the Bone Matrix in the Regulation of Bone Turnover.- Effect of Menopause and Estrogen Replacement on the Production of Bone Resorbing Cytokines.- Effect of Menopause on the Stromal Cell Responsiveness to Cytokines.- Conclusions.- References.- 4 Growth Factors and the Skeleton.- Platelet-Derived Growth Factors.- Fibroblast Growth Factors.- Transforming Growth Factors-b.- Insulin-Like Growth Factors I and II.- Growth Factors and Clinical Medicine.- References.- 5 Cellular Basis of Bone Resorption.- Osteoclast Morphology and Functions.- Coupling Between Osteoclast and Osteoblast Activity.- Systemic and Local Factors in Bone Remodeling.- References.- 6 Biochemical Markers of Bone Turnover.- Parameters of Bone Formation.- Serum Alkaline Phosphatase.- Serum Osteocalcin (Bone Gla Protein).- Serum Type I Procollagen Propeptide.- Parameters of Bone Resorption.- Urine Hydroxyproline.- Urine Hydroxylysine Glycosides.- Plasma Tartrate-Resistant Acid Phosphatase.- Urine Pyridinoline Cross-Links.- Clinical Applications.- Diagnostic Value in Osteoporosis.- Prediction of Bone Loss and Fracture Risk.- Selection of Treatment.- Monitoring Treatment Compliance and Efficacy.- Diagnostic Value in Other Metabolic Bone Diseases.- Future Directions.- References.- 7 Determinants of Bone Loss.- Genetic Factors.- Age.- Estrogen Deficiency.- Body Weight.- Smoking.- Alcohol.- Nutrition.- Calcium.- Vitamin D.- Protein and Phosphate.- Caffeine.- Sodium Intake.- Physical Exercise.- Conclusions.- References.- 8 Biomechanical Properties of Bone.- What Are Bones Made For?.- Why Be Stiff?.- How To Achieve Stiffness?.- Why Not Just Be Massive?.- What Is Necessary To Be Strong?.- Are Bone Strength and Bone “Quality” Equivalent Concepts?.- How Do Bones Acquire an Optimal Mechanical Quality?.- Are Bones No More Than “Mechanical Structures”?.- What Then Is a “Bone-Weakening” Disease?.- How Should a Bone-Weakening Condition Be Diagnosed and Controlled?.- How Can Bone Absorptiometry Assess Bone Quality?.- Bone Mass Measurements.- Bone Material Quality Determinations.- Bone Macroarchitecture Assessment.- Noninvasive Estimations of Whole-Bone Quality.- References.- 9 Risk Factors for Osteoporosis Fractures.- Risk Factors for Osteoporosis Fractures.- Anthropometric Measurements.- Height.- Body Weight.- Body Mass Index.- Previous Fractures.- Falling Tendency.- Physical Activity.- Risk Factors in Men.- Combination of Risk Factors for Prediction of Hip Fractures.- References.- 10 Bone Biopsy in Metabolic Bone Disease.- The Bone Biopsy.- The Microscopic Structure of Bone.- Bone Remodeling.- Bone Biopsy in Metabolic Bone Diseases.- Conclusions.- References.- 11 Radiology of Osteoporosis.- Principal Radiographic Findings in Osteopenia and Osteoporosis.- Diseases Characterized by Generalized Osteopenia.- Involutional Osteoporosis.- Osteopenia and Osteoporosis of the Axial Skeleton.- Vertebral Fractures and Their Diagnosis.- Osteopenia and Osteoporosis at Other Skeletal Sites.- Other Causes of Generalized Osteoporosis.- Endocrine Disorders Associated with Osteoporosis.- Medication-Induced Osteoporosis.- Miscellaneous Causes of Generalized Osteoporosis.- Regional Osteoporosis.- References.- 12 Assessment of Vertebral Fracture.- Standardized Visual Assessment of Vertebral Fractures.- Quantitative Morphometric Assessment of Vertebral Fractures.- Defining Vertebral Deformity Using Quantitative Morphometry.- Applying Standardized Visual and Quantitative Morphometric Diagnosis of Vertebral Fracture.- Summary and Conclusion.- References.- 13 Basic Considerations and Definitions in Bone Densitometry.- Acronyms in Bone Densitometry.- Bone Mineral Density Is Not Bone Mineral Density Is Not Bone Mineral Density.- Quantity Versus Quality: Diagnosing Osteoporosis with Quantitative Ultrasound Techniques.- Being in Conformity to Fact: Accuracy.- Being Within Specified Limits: Precision and Its Impact on Serial Bone Mass Measurements.- Which Site To Measure?.- Interpretation of Bone Densitometry for Diagnosing Osteoporosis and Predicting Future Fractures.- Radiation Exposure in Bone Densitometry.- Quality Control in Bone Densitometry.- Summary and Conclusion.- References.- 14 Radiogrammetry and Radiographic Absorptiometry.- History.- Radiogrammetry.- Radiographic Absorptiometry.- Outline of Present Techniques.- Radiogrammetry.- Radiographic Absorptiometry.- Applications.- Radiogrammetry.- Radiographic Absorptiometry.- Future Developments.- References.- 15 Single- and Dual-Energy: X-Ray Absorptiometry.- Past Radionuclide Methods.- Single-Photon Absorptiometry.- Dual-Photon Absorptiometry.- Present Photon Absorptiometric Methods.- Single-Energy X-Ray Absorptiometry.- Dual-Energy X-Ray Absorptiometry.- Indications for DXA Bone Densitometry.- Interpretation of DXA Bone Densitometry and Reference Ranges.- Conclusions.- References.- 16 Quantitative Computed Tomography at the Axial Skeleton.- Spinal QCT.- Measurement of BMD Using Volumetric CT Images of the Spine and Hip.- High-Resolution Imaging of Trabecular Microarchitecture Using CT.- Conclusion.- References.- 17 Peripheral Quantitative Computed Tomography.- Development of the pQCT Technology.- Technical Aspects of pQCT.- Precision.- Clinical Evaluation of the pQCT Technology.- Animal Models Assessed by pQCT.- Noninvasive Estimation of Bone Stability.- Future Prospects.- References.- 18 Comparison of Quantitative Computed Tomography and Dual X-Ray Absorptiometry at the Lumbar Spine in the Diagnosis of Osteoporosis.- Quantitative Computed Tomography.- Dual X-Ray Absorptiometry.- Comparison of QCT and DXA.- Age-Related Changes and Response to Treatment.- Influence of Degenerative Joint Disease on BMD Assessed by DXA and QCT.- Fracture Association.- Estimates of Volumetric Bone Density from DXA.- Conclusions.- References.- 19 Quantitative Ultrasound for Assessing Bone Properties.- Quantitative Ultrasound Parameters.- Attenuation and Broadband Ultrasound Attenuation.- Velocity of Ultrasound.- Composite Parameter.- Quantitative Ultrasound Equipment.- Calcaneus.- Tibia.- Finger Phalanges.- Other Skeletal Sites.- Quality Control of QUS Systems.- Investigation of Quantitative Ultrasound In Vitro.- Investigation of Quantitative Ultrasound In Vivo.- Precision and Sensitivity.- QUS and Bone Mineral Density.- Age-Related Change.- Quantitative Ultrasound and Osteoporotic Fracture Risk.- QUS and Type of Hip Fracture.- Combining QUS and DXA to Improve Fracture Prediction.- QUS and Longitudinal Monitoring During Intervention.- Conclusions.- References.- 20 Applications of Magnetic Resonance Imaging in the Study of Osteoporosis.- Effect of Trabecular Bone on MR Relaxation Time T2*.- High-Resolution Magnetic Resonance Imaging of Trabecular Bone Structure.- Specimen Studies.- In Vivo Studies.- Conclusion.- References.- 21 Beyond Bone Densitometry: Assessment of Bone Architecture by X-Ray Computed Tomography at Various Levels of Resolution.- Assessment of Bone Macrostructure.- In Vivo Assessment of Bone Microstructure.- Ultrahigh-Resolution In Vitro Assessment of Bone Microstructure and In Vivo Examinations of Small Animals.- A Digital Bone Model as a Standard to Investigate Segmentation and Analysis Techniques.- Conclusions and Outlook.- References.- 22 Which Site, Which Method? Dilemmas in Bone Densitometry.- Dilemmas in Bone Densitometry.- Correlations Between Techniques for Measuring BMD.- Correlation Between the Techniques in Monitoring Age- and Menopause-Related BMD Loss.- Discrimination of Osteoporotic Women.- Considerations in Choosing Measurement Sites and Methods.- Conclusions.- References.- 23 Quality Assurance in Bone Densitometry.- Review of Techniques for Bone Mass Measurement.- Monitoring Densitometer Performance.- Standards for Quality Control.- Lunar Spine Phantom.- Norland Spine Phantom.- Hologic Spine Phantom.- European Spine Phantom.- Daily Quality Control Procedures of the DXA Manufacturers.- Analysis of Longitudinal Quality Control Data.- Replacing Old Densitometers with New Equipment.- Quality Control of the DXA Examination.- References.- 24 Clinical Application of Bone Densitometry.- References.- 25 Bone Densitometry in Children.- Dual-Energy X-Ray Absorptiometry.- Quantitative Computed Tomography.- Ultrasound.- References.- 26 Bone Mass and Bone Loss in Secondary Osteoporosis.- Glucocorticoids.- Heparin.- Hyperthyroidism.- Diabetes Mellitus.- Gastrointestinal Disorders and Alcohol Abuse.- Immobilization.- Anorexia Nervosa.- Pregnancy and Lactation.- References.- 27 Assessing the Response to Treatment for Osteoporosis.- References.- 28 Periprosthetic Bone Mineral Density and Other Orthopedic Applications.- Assessment of Bone Reaction to Metal Implants.- Total Hip Arthroplasty.- Total Knee Arthroplasty.- Other Implants.- Assessment of Bone Healing and Bone Regeneration.- Bone Healing After Fracture and New Bone Formation During Limb Lengthening.- Post-traumatic Osteopenia.- References.- 29 Osteoporosis and Oral Bone Loss: Mandibular Bone Density and Its Relationship to Systemic Osteoporosis in Edentulous Women.- Materials and Methods.- Subjects.- Bone Densitometry.- Patient Positioning.- Results.- Discussion.- References.