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Quotes from Source [Section 3 is good too but this is long enough]
Chapter 3 Osteoporosis and Fragility in Elderly Patients
Section 4 The Physiology of Bone
…Bone remodelling is the process by which bone is renewed to maintain bone strength and mineral homeostasis. Remodelling involves continuous removal of discrete packets of old bone, replacement of these packets with newly synthesised matrix, and subsequent mineralisation of the matrix to form new bone. The main functions of bone remodelling are preservation of the mechanical strength of bone by replacing the older, micro-damaged bone with newer, healthier bone and calcium and phosphate homeostasis…
Osteoclast-mediated bone resorption takes only approximately 2–4 weeks during each remodelling cycle.
…Bone formation takes approximately 4–6 months to complete.
…Bone remodelling increases in perimenopausal and early postmenopausal women and then slows down with further ageing but continues at a faster rate than in premenopausal women.
…Normal rates of bone loss are different in men and women. In men, bone mass is lost at a rate of 0.3% per annum, while in women this rate is 0.5%. By way of contrast, bone loss after menopause, in particular during the first 5 years after its onset, can be as high as 5–6% per annum....
Chapter 4 Osteoporosis and Fragility in Elderly Patients...
2.1 The Nature of Sarcopenia
Sarcopenia is characterised by motor neurone loss, reduced muscle mass per motor unit, relatively more loss of fast-twitch fibres and reduced strength per unit of cross-sectional area. Muscle fibres are lost by drop-out of motor neurones. Reinnervation of fibres by sprouting from surviving neurones cause less even distribution of fibre types cross-sectionally and a relatively greater loss of type II fibres that are associated with the generation of power (the product of force generation and speed of muscle contraction).
Muscle mass and strength are of course related but not linearly. Function is more important than mass for physical performance and disability. Leg power accounts for 40% of the decline in functional status with ageing. Men who maintain physical activity into their 80s show compensatory hypertrophy of muscle fibres to compensate for the decrease in fibre number. Loss of efficiency also results from an accumulation of fat within and between fibres and an increase in non-contractile connective tissue material. Muscle strength and function also depend on neuromuscular integrity and muscle performance as well as muscle characteristics.
Current and Emerging Treatment of Osteoporosis
2.2 Before treatment it is important to make a differential diagnosis between primary and secondary osteoporosis because the anti-osteoporotic drug treatment would be useless if the main illness causing osteoporosis is not treated too.
In hospital, during the acute phase, it is important to investigate the osteoporosis to exclude secondary forms, by means of simple first-level blood tests (erythrocyte sedimentation rate, blood count, serum levels of protein, calcium, phosphorus, alkaline phosphatase and creatinine, 24 h urinary calcium) and some second level tests (TSH, Parathormone, 25-OH-vitamin D, serum protein electrophoresis). These tests are sufficient to exclude 90% of the secondary causes of osteoporosis. Only the evaluation of these parameters will guarantee that we are giving to the patient appropriate treatment
It is important to make at any age a diagnosis of secondary causes of osteoporosis, such as hyperthyroidism and hyperparathyroidism, because these can now be treated with drugs and not only by surgery.
The orthogeriatric patient with non-vertebral fracture has specific characteristics: they are normally very old (over 75 years) and present all the characteristics of frailty (reduced mobility, malnutrition, comorbidity, cognitive impairment, polypharmacy, neurosensory deficits). ...
Chapter 3 Osteoporosis and Fragility in Elderly Patients
Section 4 The Physiology of Bone
…Bone remodelling is the process by which bone is renewed to maintain bone strength and mineral homeostasis. Remodelling involves continuous removal of discrete packets of old bone, replacement of these packets with newly synthesised matrix, and subsequent mineralisation of the matrix to form new bone. The main functions of bone remodelling are preservation of the mechanical strength of bone by replacing the older, micro-damaged bone with newer, healthier bone and calcium and phosphate homeostasis…
Osteoclast-mediated bone resorption takes only approximately 2–4 weeks during each remodelling cycle.
…Bone formation takes approximately 4–6 months to complete.
…Bone remodelling increases in perimenopausal and early postmenopausal women and then slows down with further ageing but continues at a faster rate than in premenopausal women.
…Normal rates of bone loss are different in men and women. In men, bone mass is lost at a rate of 0.3% per annum, while in women this rate is 0.5%. By way of contrast, bone loss after menopause, in particular during the first 5 years after its onset, can be as high as 5–6% per annum....
Chapter 4 Osteoporosis and Fragility in Elderly Patients...
2.1 The Nature of Sarcopenia
Sarcopenia is characterised by motor neurone loss, reduced muscle mass per motor unit, relatively more loss of fast-twitch fibres and reduced strength per unit of cross-sectional area. Muscle fibres are lost by drop-out of motor neurones. Reinnervation of fibres by sprouting from surviving neurones cause less even distribution of fibre types cross-sectionally and a relatively greater loss of type II fibres that are associated with the generation of power (the product of force generation and speed of muscle contraction).
Muscle mass and strength are of course related but not linearly. Function is more important than mass for physical performance and disability. Leg power accounts for 40% of the decline in functional status with ageing. Men who maintain physical activity into their 80s show compensatory hypertrophy of muscle fibres to compensate for the decrease in fibre number. Loss of efficiency also results from an accumulation of fat within and between fibres and an increase in non-contractile connective tissue material. Muscle strength and function also depend on neuromuscular integrity and muscle performance as well as muscle characteristics.
Current and Emerging Treatment of Osteoporosis
2.2 Before treatment it is important to make a differential diagnosis between primary and secondary osteoporosis because the anti-osteoporotic drug treatment would be useless if the main illness causing osteoporosis is not treated too.
In hospital, during the acute phase, it is important to investigate the osteoporosis to exclude secondary forms, by means of simple first-level blood tests (erythrocyte sedimentation rate, blood count, serum levels of protein, calcium, phosphorus, alkaline phosphatase and creatinine, 24 h urinary calcium) and some second level tests (TSH, Parathormone, 25-OH-vitamin D, serum protein electrophoresis). These tests are sufficient to exclude 90% of the secondary causes of osteoporosis. Only the evaluation of these parameters will guarantee that we are giving to the patient appropriate treatment
It is important to make at any age a diagnosis of secondary causes of osteoporosis, such as hyperthyroidism and hyperparathyroidism, because these can now be treated with drugs and not only by surgery.
The orthogeriatric patient with non-vertebral fracture has specific characteristics: they are normally very old (over 75 years) and present all the characteristics of frailty (reduced mobility, malnutrition, comorbidity, cognitive impairment, polypharmacy, neurosensory deficits). ...
As far as I know, my yearly physical, mammogram, and bone density scan are all covered in full. I do pay a small amount for the blood work on the physical.
