PART 16: Endocrinology and Metabolism
SECTION 2 Disorders of Bone and Mineral Metabolism
354 Osteoporosis
 | Figure 354-1 Epidemiology of vertebral, hip, and Colles' fractures with age. (Adapted from C Cooper, LJ Melton III: Trends Endocrinol Metab 3:224, 1992; with permission.) |
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 | Figure 354-2 Lateral spine x-ray showing severe osteopenia and a severe wedge-type deformity (severe anterior compression). |
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 | Figure 354-3 Factors leading to osteoporotic fractures. |
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 | Figure 354-4 Mechanism of bone remodeling. The basic molecular unit (BMU) moves along the trabecular surface at a rate of about 10 μm/d. The figure depicts remodeling over ∼120 days. A. Origination of BMU-lining cells contracts to expose collagen and attract preosteoclasts. |
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 | Figure 354-5 Hormonal control of bone resorption. A. Proresorptive and calciotropic factors. B. Anabolic and antiosteoclastic factors. RANKL expression is induced in osteoblasts, activated T cells, synovial fibroblasts, and bone... |
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 | Figure 354-6 Relationship between Z-scores and T-scores in a 60-year-old woman. BMD, bone mineral density; SD, standard deviation. |
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 | Figure 354-7 FRAX calculation tool. When the answers to the indicated questions are filled in, the calculator can be used to assess the 10-year probability of fracture. The calculator (available online at http://www.shef.ac.uk/FRAX/tool.jsp?locationValue=9) also can risk adjust for various ethnic groups. |
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 | Figure 354-8 Effects of hormone therapy on event rates: green, placebo; purple, estrogen and progestin. CHD, coronary heart disease; VTE, venous thromboembolic events. (Adapted from Women's Health Initiative. WHI HRT Update. Available at http://www.nhlbi.nih.gov/health/women/upd2002.htm.) |
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 | Figure 354-9 Effects of various bisphosphonates on clinical vertebral fractures A., nonvertebral fractures B., and hip fractures C. Plb, placebo; RRR, relative rish reduction. (After DM Black et al: J Clin Endocrinol Metab 85:4118,... |
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 | Figure 354-10 Effects of two doses of raloxifene on incident vertebral fractures in the MORE trial. (After B Ettinger et al: JAMA:282:637, 1999.) |
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 | Figure 354-11 Effects of denosumab on new vertebral fractures A. and times to nonvertebral and hip fracture B. and C.(After SR Cummings et al: N Engl J Med:361:756, 2009.) |
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 | Figure 354-12 Effects of teriparatide on new vertebral fractures A. and nonvertebral fragility fractures B. and C.(After RM Neer et al: N Engl J Med 344:1434, 2001.) |
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 | Figure 354-13 Effect of parathyroid hormone (PTH) treatment on bone microarchitecture. Paired biopsy specimens from a 64-year-old woman before A. and after B. treatment with PTH. (From DW Dempster et al: J Bone Miner Res 16:1846,... |
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