Osteoporosis and the Osteoporosis of Rheumatic Diseases: A Companion to Rheumatology, Third Edition

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Other companion titles in the Rheumatology series

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OSTEOPOROSIS AND THE OSTEOPOROSIS OF RHEUMATIC DISEASES A COMPANION TO RHEUMATOLOGY Copyright © 2006 Mosby, Inc, an affiliate of Elsevier Inc.

ISBN-13: 9780323 034371 ISBN-10: 0-323-03437-3

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1) 215 239 3804, fax: (+1) 215 239 3805, email: [email protected]. You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting “Customer Support” and then “Obtaining Permissions.”

Notice Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on his or her own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Authors assume any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book.

Library of Congress Cataloging-in-Publication Data Osteoporosis and the osteoporosis of rheumatic diseases: a companion to Rheumatology / [editors] Nancy E. Lane, Philip N. Sambrook.–1st p. ; cm. Includes bibliographical references and index. ISBN 0-323-03437-3 1. Osteoporosis. 2. Rheumatism–Complications. I. Lane, Nancy E. II. Sambrook, Philip N. III. Rheumatology. [DNLM: 1. Osteoporosis. 2. Rheumatic Diseases–complications. WE 250 085116 2006] RC931.O73O88 2006 616.7'16–dc22 2005058428

Acquisitions Editor: Kimberly Murphy Developmental Editor: Denise Lemelledo Publishing Services Manager: Frank Polizzano Senior Project Manager: Natalie Ware Design Direction: Gene Harris

Printed in the United States of America. Last digit is the print number:

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We would like to dedicate this text to our parents (living or blessed memory), our wives or husbands, and children: Fred. M. Tileston, Jr., Trevor Lane Tileston, and Reid Lane Tileston. Brenda L. Sambrook, Andrew M. Sambrook, and Kate L. Sambrook

Contributors

Jonathan (Rick) Adachi, MD Professor of Medicine, Alliance for Better Bone Health; Chair in Rheumatology, McMaster University, Hamilton; Director, Hamilton Arthritis Center; Head of Rheumatology, St. Joseph’s Healthcare, Hamilton, Ontario, Canada The Use of Calcium Supplementation in the Management and Prevention of Osteoporosis Kristina Åkesson, MD, PhD Associate Professor, Senior Lecturer, Faculty of Medicine, Lund University, Department of Clinical Sciences, Malmo; Senior Consultant, Department of Orthopedics, Malmo University Hospital, Malmo, Sweden The Patient with Osteoporosis Yves Boutsen, MD Professor, Louvain University, Yvoir, Head, Department of Rheumatology, University Hospital in Mont-Godinne, Yvoir, Belgium The Pathogenesis of Glucocorticoid-Induced Bone Loss David B. Burr, PhD Professor and Chairman of Anatomy; Professor of Orthopedic Surgery and Biomedical Engineering, Indiana University-Purdue University, Indianapolis, Indiana Principles of Bone Biomechanics Cyrus Cooper, MA, DM, FRCP, FMedSci Professor of Rheumatology, The MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, United Kingdom The Epidemiology of Osteoporotic Fractures Elaine Dennison, MA, MB, B.Chir, MSc, PhD Senior Lecturer, The MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, United Kingdom The Epidemiology of Osteoporotic Fractures

Jean-Pierre Devogelaer, MD Professor of Rheumatology, Université Catholique de Louvain; Associate Head, Department of Rheumatology, Saint-Luc University Hospital, Brussels, Belgium The Pathogenesis of Glucocorticoid-Induced Bone Loss Kenneth G. Faulkner, PhD Vice President of Business Development, Synarc, Inc., San Francisco, California Investigations of Bone: Densitometry Patrick Garnero, PhD, DSC Vice President, Molecular Markers, Synarc, and Senior Research Scientist INSERM 403, Lyon, France Biochemical Markers of Bone Turnover Piet P.M.M. Geusens, MD, PhD Professor, Department of Rheumatology, University Hospital, Maastricht, The Netherlands; Professor, Biomedical Research Institute, Limburgs Universitair Centrum, Diepenbeek, Belgium The Evaluation of the Patient for Osteoporosis: Case Finding Using Diagnostic Tests for Treatment Interventions David J. Handelsman, MB, BS, PhD, FRACP Director, ANZAC Research Institute; Head, Department of Andrology, Concord Hospital, University of Sydney, Sydney, Australia Sex Steroids and Skeletal Health in Men Nicholas Harvey, MAMB, B.Chir, MRCP Clinical Research Fellow, The MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, United Kingdom The Epidemiology of Osteoporotic Fractures

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CONTRIBUTORS

Marc C. Hochberg, MD, MPH Professor of Medicine and Epidemiology and Preventive Medicine; Head Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, Maryland Recommendations for Performing Bone Densitometry to Diagnose Osteoporosis and Identify Persons to Be Treated for Osteoporosis Mary Beth Humphrey, MD, PhD Assistant Professor, Department of Medicine and Microbiology and Immunology, University of California San Francisco, San Francisco, California Pathogenesis of Inflammation-induced Bone Loss Graeme Jones, MBBS, FRACP, MD, MmedSc, FAFPHM Professor of Rheumatology and Epidemiology, Menzies Research Institute, University of Tasmania, Hobart, Tasmania Relevance of Peak Bone Mass to Osteoporosis and Fracture Risk in Later Life Dina Kulik Student in MD Programme, McMaster University, Hamilton, Ontario, Canada The Use of Calcium Supplementation in the Management and Prevention of Osteoporosis Nancy E. Lane, MD Director and Distinguished Professor Aging Center, Medicine and Rheumatology, University of California at Davis Medical Center, Sacramento, California Parathyroid Hormone for the Treatment of Osteoporosis: The Science and the Therapy; Corticosteroid-Induced Osteoporosis Peter Y. Liu, MBBS, PhD Postdoctoral Research Fellow, Department of Andrology, Concord Hospital and ANZAC Research Institute, University of Sydney, Sydney, Australia Sex Steroids and Skeletal Health in Men Sharmila Majumdar, PhD Professor, Department of Radiology, University of California San Francisco, San Francisco, California Imaging Bone Structure and Osteoporosis Using MRI Naim M. Maalouf, MD Assistant Professor of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas Osteoporosis After Solid Organ Transplantation

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Daniel Henri Manicourt, MD, PhD Professor, School of Medicine, Université Catholique de Louvain, Brussels; Head of Clinic in Rheumatology, Saint-Luc University Hospital, Department of Rheumatology, Brussels, Belgium The Pathogenesis of Glucocorticoid-Induced Bone Loss Christian Meier, MD Clinic for Endocrinology, Diabetology, and Clinical Nutrition, University of Basel, Basel, Switzerland Sex Steroids and Skeletal Health in Men Paul D. Miller, MD Clinical Professor of Medicine, University of Colorado Health Sciences Center, Denver; Medical Director, Colorado Center for Bone Research, Lakewood, Colorado Combination Therapy for Osteoporosis: What Do the Data Show Us? Mary C. Nakamura, MD Associate Professor of Medicine, in residence, Division of Rheumatology, Department of Medicine, University of California San Francisco; Staff Physician, San Francisco Veterans Affairs Medical Center, San Francisco, California Pathogenesis of Inflammation-induced Bone Loss Ian R. Reid, MD Professor of Medicine and Endocrinology, University of Auckland, Auckland, New Zealand Bisphosphonates in the Prevention and Treatment of Postmenopausal Osteoporosis Evange Romas, MBBS, FRACP, PhD Senior Lecturer, University of Melbourne; Senior Consultant, Department of Rheumatology, St. Vincent’s Hospital, Melbourne, Australia The Prevention and Treatment of Inflammationinduced Bone Loss: Can It Be Done? Graham Russell, PhD, DM, FRCP, PRC Path, F Med Sci Norman Collisson Professor of Musculoskeletal Sciences, Institute Director and Head of Department, The Botnar Research Centre and Oxford University Institute of Musculoskeletal Sciences, Nuffield Department of Orthopedic Surgery, Nuffield Orthopedic Centre, Headington, United Kingdom Pathogenesis of Osteoporosis

Ego Seeman, BSc, FRACP, MD Professor of Medicine and Endocrinology, Austin and Repatriatian Medical Center, University of Melbourne, Melbourne, Australia Exercise and the Prevention of Bone Fragility Markus J. Seibel, MD, PhD Professor and Chair of Endocrinology; Director, Bone Research Program, ANZAC Research Institute, University of Sydney; Head, Department of Endocrinology, Concord Hospital, Sydney, Australia Sex Steroids and Skeletal Health in Men

Luigi Sinigaglia, MD Chair, Department of Rheumatology, Gaetano Pini Institute, University of Milan, Milan, Italy Epidemiology of Osteoporosis in Rheumatic Diseases Tim D. Spector, MD, MSc, FRCP Consultant Rheumatologist, Twin Research and Genetic Epidemiology Unit, St. Thomas’ Hospital; Honorary Professor in Genetic Epidemiology, St. Geroge’s Medical School, London, United Kingdom The Genetics of Osteoporosis Charles H. Turner, PhD Professor of Biomedical Engineering and Orthopedic Surgery, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana Principles of Bone Biomechanics Massimo Varenna, MD Professor, Department of Rheumatology, Istituto Ortopedicao Gaetano Pini, University of Milan, Milan, Italy Epidemiology of Osteoporosis in Rheumatic Diseases

Elizabeth Shane, MD Professor of Clinical Medicine, College of Physicians and Surgeons, Columbia University; Attending Physician in Medicine, Columbia University Medical Center, New York, New York Osteoporosis After Solid Organ Transplantation

Sarah Westlake, BM, MRCP Specialist Registrar, The MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, United Kingdom The Epidemiology of Osteoporotic Fractures

Sandra J. Shefelbine, BSE, MPhil, PhD Lecturer, Department of Bioengineering, Imperial College of London, London, United Kingdom Imaging Bone Structure and Osteoporosis Using MRI

Frances M.K. Williams, MBBS, MRCP Honorary Senior Research Fellow, Twin Research and Genetic Epidemiology Unit, St. Thomas’ Hospital, London, United Kingdom The Genetics of Osteoporosis

Stuart L. Silverman, MD, FACP, FACR Clinical Professor of Medicine and Rheumatology, Cedars-Sinai Medical Center, University of California Los Angeles, Greater Los Angeles VA Medical Center, and the OMC Clinical Research Center; Medical Director, Fibromyalgia Rehabilitation Program, Cedars-Sinai Medical Center, Los Angeles, California Calcitonin in the Treatment of Osteoporosis

Contributors

Philip N. Sambrook, MD FRACP Florance and Cope Professor of Rheumatology, University of Sydney; Head, Department of Rheumatology, Royal North Shore Hospital, St. Leonard’s, Sydney, Australia Vitamin D and Its Metabolites in the Prevention and Treatment of Osteoporosis; Selective Estrogen Receptor Modulators (SERMs); Corticosteroid-Induced Osteoporosis

Anthony D. Woolf, BSc, MB, BS, FRCP Professor of Rheumatology, Institute of Health and Social Care Research, Peninsula Medical School, Universities of Exeter and Plymouth; Consultant Rheumatologist, Duke of Cornwall Department of Rheumatology, Royal Cornwall Hospital, Truro, Cornwall, United Kingdom The Patient with Osteoporosis

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Preface

This monograph takes a very in-depth look at the key aspects of osteoporosis and presents significant advances that have occurred in the field over the past five years. Specifically, this book gathers the works of the top practitioners in the field to discuss the epidemiology, pathogenetic mechanisms, clinical aspects of the disease, treatment options, and secondary osteoporosis and the osteoporosis of the rheumatic diseases. We discuss bone biology and the new emerging field of osteoimmunology, that connects the field of immunology with inflammatory bone loss. In addition, we carefully provide up-to-date reviews on the epidemiology, pathogenesis, diagnosis, and management of osteoporosis. The epidemiology of osteoporosis and the role of bone mineral density in the definition and prediction of fractures are reviewed, as well as the most current information on the geographical distribution of the disease. The role of peak bone mass acquisition in the prevention of osteoporosis, and a thoughtful review on who should be treated for osteoporosis are included in the first section. Section II covers the pathogenesis of osteoporosis, and the biomechanics of bone - information any clinician needs to know on what makes bone strong and why it fractures. The section on the clinical aspects of the disease covers the latest technologies for imaging bone structure and biomechanical markers of bone metabolism. This part of the text is unique in that we review not only the use of DXA and QCT, but also the latest technologies being applied in clinical research, including MRI, that can assess bone structure and apply sophisticated non-invasive modeling to assess bone strength. There has also been a tremendous increase in the number of biochemical tests that measure proteins associated with both bone formation and resorption. In some studies, these biochemical markers of bone turnover appear to be surrogate markers for increased risk of fracture. Also, in some studies, the reduction in thee markers

with anti-resorptive therapies, is associated with a reduction in incident fracture risk. These detailed reviews also emphasize how these markers can be used in combination with bone mineral density measurements to educate patients about their potential risk for fracture and their responses to different osteoporosis therapies. In the next section we present the available modalities for the prevention and treatment of osteoporosis. Among them are the most important aspect of any treatment program, e.g., calcium and vitamin D supplementation, followed by the anti-resorptive agents, including the selective estrogen receptor modulators (SERMs), androgens, gonadal steroids, and calcitonin, and lastly, bisphosphonates. Anabolic agents, such as PTH, and the use of combination and sequential therapies are also discussed in depth. Lastly, we offer a broad and informative discussion of the newest area of intense investigation: osteoimmunology and the bone loss that is so prevalent in inflammatory conditions like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We begin with a review on the epidemiology of osteoporosis in RA, SLE, and ankylosing spondolytic (AS) patients. The pathogenesis of inflammation-induced bone loss and the treatment of inflammation-induced bone loss are also covered. Throughout this book, there has been an emphasis on the advances in scientific knowledge as they relate to the biology of postmenopausal bone loss and inflammation-induced bone loss in both women and men, and on the diagnosis and therapy for the prevention and treatment of established disease. Although this book presents major advances in the understanding and treatment of osteoporosis, many outstanding questions remain to be addressed. We hope that the next edition of this monograph will answer some of these questions. Nancy E. Lane, MD Philip N. Sambrook, MD

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Acknowledgments

The editors would like to acknowledge all of the authors who contributed to this monograph on osteoporosis. In addition, we thank Mollie McGee for her editorial assistance.

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Figure 1-2. Hip fracture incidence around the world. (Data derived from Kanis JA et al.20)

GEOGRAPHICAL VARIATION IN HIP FRACTURE INCIDENCE Men

Women

Incidence (per 105 Person-years)

1400 1200 1000 800 600 400 200 0 Europe N. America/ Latin Oceania America

Asia Europe N. America/ Latin Oceania America

Figure 1-3. Estimated numbers of hip fractures among men and women in different regions of the world in 1990 and 2050.

HIP FRACTURE PROJECTIONS 3,500

Men

1990

Hip fractures, 000s

3,000 2,500

Asia

Women

2025 2050

2,000 1,500

Men

Women

1,000 500 0 North America, Europe, Oceania, and Russia

Middle East, Asia, Latin America, and Africa Region

Figure 1-6. Health-related quality of life related to age and number of vertebral deformities.

AGE, NUMBER OF VERTEBRAL DEFORMITIES, AND HRQOL

Mean QUALEFFO total score

45 35

Age >71 Age 65–71

25

Age