NOTE It is important to know that this is just a presentation for bones disease class with scarce information (as it should be in any presentation).

1. C.P.Chourpiliadis

4.  Important issue of Public health
 14%
5%
 50 %
 20 %
 1/6 OP Fracture vs 1/9 ca Breast
>50 ys, Caucasians

5. 2050 6,3
milion.
2050 8,2
milion.
1990 1,7
milion.

6. 22 εκ.
OP POPULATION

7. OP FRACTURES
OP T OP F

8. Shreyasee Amin Chapter 28 – Epidemiology of Fractures. Osteoporosis in Men (Second Edition), San
Diego, 2010, Pages 351–360

9. Shreyasee Amin Chapter 28 – Epidemiology of Fractures. Osteoporosis in Men (Second Edition), San
Diego, 2010, Pages 351–360

12. Fracture
Morbidity
Cost
Mortality

13. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002 May 18;359(9319):1761-7.

14. 1,18 mil. QALY (2010)
 37 bil. (2010) EU
46,25 bil. (2025)

15. Screening tests
 CT (cost, radiation)
 DXA sensitivity
 SXA
 FRAXTM
 QFRACTURE
specificity

16. QFRACTURE
 Age
 Sex
 glucocorticoids
 Alcohol
Intake
 OP fractures histor
 BMI
 RA
 smoking Family history of
femoral fractures
• DM 1
• Untreated
Hyperthyroidism
• Hypogonadism
• Premature Menopause
• Inflammatory Bowel
Disease
• Long-term Immobility
• Chronic hepatic
disease
p.o.

20. Osteoporosis: From Bone Biology to Individual Treatment Decision.
GONÇALVES et al. Acta Med Port 2013 Jul-Aug;26(4):445-455

21.  Failure of maximizing BMD
during development
 Increased loss of bone mass
during bone absorption
 Inadequate bone formation
during bone remodelling

22.  During Menopause
 Activation of of new bone remodeling sites Bone Mass Loss
 Maximizing the inequity of bone formation- absorption during remodelling
New sites of bone
remodelling
Inequity of bone
absorption-
formation
Bone Loss
possibility of
trabecular bone
damage
substrate of
new bone
formation

23. In Estrogen inadequacy:
 T-cells upregulation pro-inflammatory
pool pre-osteoclasts
More negative bone turnover
http://www.rndsystems.com/Cytokine_cb10i1_cytokines_ccr2.aspx

25. What is the process with which bone absorption is
mediated in advanced-age-men who do not undergo
menopause?
Reduction in testosterone levels occurs in men at the end of the 3rd or 4th decade of their age.This
decrease entails a decline in estradiol levels,which is produced under the effect of aromatase as
it is presented in the following figure.
Simpson et al.: Local estrogen biosynthesis in males and females. Endocrine-Related Cancer
(1999) 6 131-137

26. What is the process with which bone absorption is
mediated in advanced-age-men who do not undergo
menopause?
Edith A. Perez et al. Aromatase Inhibitors and Bone Loss. Palliative And Supportive Care, Bone Metastases, Breast Cancer, Oncology Journal August 01,
2006

27. • Osteoblasts- Reduced biosynthetic potential
• Osteoprogenitors- Limited proliferation
• Growth Factors- Minimum mitogenic activity
• Senile Osteoporosis

28. • Bone density among athletes
• Exercise type

30.  Glucocorticoids
 Antiepileptic drugs
 Cyclosporins
 Aromatase inhibitors
 Heparin
 Lithium
 Anti coagulants (π.χ. Warfarin)

31. ‘non-specific’ impact on bones
 Weight OP fractures

33. ‘non-specific’ impact on bones
 Weight OP fractures
VAF negative effect on bone
But
SAF positive effect

35. Toxic effect on osetoblasts
Changes on estrogen metabolism

36. B cells, T cells, Dendritic, Neutrophils, Monocytes: RANKL, DKK-1, cytokines
Mast Cells important regulators
Indications
 Attract Osteoclast Progenitors
 IL-1, IL-3, IL-6,TGF-β
 Animal models for Histamine decarboxylase deficiency
 H2 receptors inhibition with cimetidine

38.  VDR alleles polymorphisms

39.  Osteoporosis: now and the future. Rachner et al. Lancet 2011; 377: 1276–87
 Osteoporosis: From Bone Biology to Individual Treatment Decision. GONÇALVES et al. Acta
Med Port 2013 Jul-Aug;26(4):445-455
 The Role of Mast Cells in Osteoporosis. Chiappetta et al. j.semarthrit.2006
 Osteoporosis.Sambrook et al. Lancet 2006; 367: 2010–18
 Epidemiology and outcomes of osteoporotic fractures Cummings et al.Lancet 2002; 359: 1761–67
 Osteoporosis in the European Union: a compendium of country-specific reports. Svedbom et al.
Arch Osteoporos (2013) 8:137
 Clinical impact of recent genetic discoveries in osteoporosis. Mitchell et al. Appl Clin
Genet. 2013; 6: 75–85.
 Reciprocal Relations of Subcutaneous andVisceral Fat to Bone Structure and Strength.
Gilsanz et al. J Clin Endocrinol Metab. 2009 September; 94(9): 3387–3393.
 Fatty acid consumption and the risk of osteoporotic fracture. McLaughlin et al. Nutrition Reviews®
Vol. 71(9):600–610