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Focus Issue on Osteoporosis

Focus Issue on Osteoporosis: Introduction

Andersson, Gunnar B. J., MD, PhD; Weinstein, James N., DO, MS

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This, our fourth focus issue, brought together a multi-talented group of investigators to discuss osteoporosis. Osteoporosis is a clinical problem of concern to all practitioners providing spine care. Osteoporosis affects one-third of postmenopausal women; 16% have osteoporosis of their lumbar spine. Vertebral fractures, secondary to osteoporosis, affect about one-fourth of postmenopausal women. The cost to society was nearly $250 million dollars in 1995. These fractures have significant impact on function and quality of life. The diagnosis of osteoporosis focuses on severity of bone loss as determined by various techniques, two of which are densiometry and radiographic imaging. Biochemically, bone-specific alkaline phosphatase and osteocalcin in serum are the best markers for bone formation. Collagen degradation products in urine are highly specific bone resorption markers. Mechanically, osteoporotic compression fractures represent a structural failure of bone. With aging and osteoporosis, there is a loss of the strength of mainly the trabecular bone affecting the structural capacity of the vertebral bodies. Medical preventions aim at maximizing bone mass through proper nutrition, including appropriate calicum and vitamin D intake and physical exercises. Hormone replacement, calcitonin, and biphosphonates are appropriate for conditions of high turnover osteoporosis. Several drugs like fluorides and various parathyroid hormone parahormone analogues are currently in clinical trials. Surgical intervention, though rare, is considered by some, in the form of vertebral augmentation and various stabilization procedures. Finally, this focus issue benefits from a discussion regarding the quantitative methods of cost-effectiveness evaluation to help identify favorable interventions, wherein the concept of quality-adjusted life years is used as an endpoint for accessing the effectiveness of interventions in osteoporosis. Overall, this issue represents a unique summary of current epidemiologic, diagnostic, and therapeutic measures in the diagnosis and treatment of osteoporosis, and is put forth by leading authorities in this field. We are excited and proud to present this focus issue to the readership. We thank the participants in our discussions and publications, and Sofamor Danek for providing financial support.

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