Osteoporosis in Asia — Crossing the Frontiers

The following sections are included:

• Preface

• Contents

• List of Contributors

The following sections are included:

• INTRODUCTION

• OSTEOPOROSIS IN ASIA — INCIDENCE, PREVALENCE AND TRENDS
  • Hip Fracture
  • Vertebral Fracture

• AETIOLOGY AND RISK FACTORS FOR OSTEOPOROTIC FRACTURES
  • Genetic Factors
  • Environmental Factors
    • Dietary calcium intake
    • Physical activity
    • Falls

• BONE MINERAL DENSITY AND FRACTURE RISK IN ASIAN POPULATIONS

• PREVENTIVE STRATEGIES FOR OSTEOPOROSIS IN ASIA

• References

• APPENDIX A

The following sections are included:

• INTRODUCTION

• OSTEOPOROSIS

• VERTEBRAL FRACTURE
  • Incidence

• INTERNATIONAL COMPARISONS

• HIP FRACTURE
  • Incidence
  • International Comparisons

• References

The following sections are included:

• TECHNIQUES OF MEASUREMENT

• BMC IN RELATION TO AGE

• BMC IN RELATION TO CALCIUM INTAKE

• BMC AND EXERCISE

• Reference

The following sections are included:

• INTRODUCTION

• AGE OF PEAK BONE MASS ATTAINMENT

• PEAK BONE MASS VALUES IN HONG KONG CHINESE WOMEN
  • Dietary Factors
  • Relation between Other Dietary Variables and Bone Mineral Density
  • Other Lifestyle and Environmental Factors
  • Dietary Calcium Recommendations for Young Chinese Women

• References

The following sections are included:

• INTRODUCTION

• SURVEY METHODS AND SAMPLING

• DIETARY CALCIUM INTAKES

• DIETARY CALCIUM AND BONE DENSITY

• OTHER DIETARY FACTORS

• OTHER LIFESTYLE FACTORS

• SUMMARY

• References

The following sections are included:

• INTRODUCTION

• CHARACTERISTICS OF CLIMACTERIC KOREAN WOMEN
  • Bone Markers and Lipid Profiles Measurement
  • Bone Density Measurement

• HORMONES IN THE TREATMENT OF CLIMACTERIC SYMPTOMS AND PREVENTION OF OSTEOPOROSIS
  • Regimens of Hormone Replacement Therapy

• COMMENTS

• References

The following sections are included:

• INTRODUCTION

• THE MENOPAUSE AND OSTEOPOROSIS

• THE PREVENTION OF POSTMENOPAUSAL OSTEOPOROSIS USING HORMONE REPLACEMENT THERAPY

• CALCIUM SUPPLEMENTS AND POSTMENOPAUSAL OSTEOPOROSIS

• PRESCRIBING HORMONE REPLACEMENT THERAPY

• SUMMARY

• References

Indices of bone turnover and the contribution of biochemical factors to bone mineral density are described for an elderly population in Hong Kong, in an environment with plentiful sunshine, low calcium intake and a relatively high salt intake. Calcium absorption decreased and parathyroid hormone increased with age, but no change in plasma vitamin D was observed. However, bone mineral density was not related to parathyroid hormone levels. Urinary hydroxyproline/creatinine and calcium/creatinine ratios were higher in women, and in those living in institutions. Those who had higher hydroxyproline/creatinine ratios had a higher risk of developing osteoporotic fractures over a period of 30 months. Oral calcium supplementation suppressed plasma parathyroid hormone and urinary hydroxyproline/creatinine ratios. Supplementation over a 10-month period resulted in a decrease in plasma parathyroid hormone levels together with an increase in bone mineral density at Ward's triangle and the intertrochanteric area. In a case control study of elderly women with hip fractures, patients with hip fractures had lower serum albumin, ionized calcium and 25-hydroxyvitamin D levels; however, there was no difference in 1,25-dihydroxyvitamin D and parathyroid hormone concentrations, indicating that vitamin D supplementation may not be as effective in this population as a preventive measure for osteoporotic fractures.

Severe vitamin D deficiency causes a fall of Ca × P product and insufficient bone calcification or osteomalacia, while milder deficiency may simply cause negative calcium balance with normal serum Ca and P, leading to osteoporosis. In addition to malnutrition, insufficient solar exposure may also lead to vitamin D deficiency. Vitamin D treatment for osteoporosis is widely used in Japan and other parts of Asia, mainly because of insufficient vitamin D and calcium intake. In addition to renal insufficiency, old age and estrogen deficiency is also associated with calcitriol deficiency. Vitamin D treatment for osteoporosis seems to be safer and more effective in Japan than in Western countries. Recently suggested vitamin D receptor gene polymorphism may also be related to the clinical effect of vitamin D derivatives on osteoporosis. The polymorphism BB, which may be related to osteoporosis and resistance to treatment with vitamin D derivatives, was found to be much less frequent in Japan and possibly in other Asian countries than in Western countries. This may account for the larger effects of vitamin D therapy on osteoporosis in Asia.

The following sections are included:

• GENETICS OF OSTEOPOROSIS — A COMPLEX DISEASE

• TWIN STUDIES AND GENETIC DETERMINANTS OF BONE MASS (BMD)

• INTERACTION OF GENETICS AND ENVIRONMENT

• VITAMIN D RECEPTOR POLYMORPHISMS AND OSTEOPOROSIS — A REVIEW

• VDR GENOTYPE AND RESPONSE TO TREATMENT

• OTHER CANDIDATE GENES FOR OSTEOPOROSIS

• VDR GENE, OSTEOPOROSIS AND EAST ASIAN POPULATIONS
  • VDR Gene Polymorphism in Asians — A Possible Link with Hip Fracture Incidence
  • The VDR Genotype and Protection from the Effects of a Low Calcium Intake
  • Changes in Lifestyle and the Recent Increase in Hip Fracture Incidence in Hong Kong
  • Summary — The BMD Optimization Hypothesis

• IDENTIFICATION OF OSTEOPOROSIS GENES — FUTURE IMPLICATIONS

• References

The following sections are included:

• INTRODUCTION

• PATHOPHYSIOLOGY

• EPIDEMIOLOGY

• ASSESSMENT OF SEVERITY OF CALCIUM LOSS

• BIOCHEMICAL INDICATOR OF BONE METABOLISM

• OSTEOPOROSIS IN MEN

• SPINAL FRACTURES

• HIP FRACTURES

• TREATMENT

• CALCITONIN

• GROWTH HORMONE

• VITAMIN D

• EXERCISES

• PREVENTION

• RISK FACTORS

• PHOSPHONATES

• THE FUTURE

• References

The following sections are included:

• Index