Peak bone mass (PBM) is the maximum bone density achieved by late adolescence/early adulthood. Reaching optimal PBM is important for reducing osteoporosis risk later in life. PBM is determined by genetics, nutrition (especially calcium and vitamin D), sex hormones, growth factors like IGF-1, and mechanical loading from physical activity. The document discusses factors like pubertal timing, exercise levels, and heredity that influence the attainment of PBM and subsequent fracture risk.
Osteoporosis is a poorly recognized entity in India, especially among the non-endocrine physicians. Talk given to chest physicians focusing on glucocorticoid induced osteoporosis
Osteoporosis is a poorly recognized entity in India, especially among the non-endocrine physicians. Talk given to chest physicians focusing on glucocorticoid induced osteoporosis
MedicYatra provides the safe Genu Valgum (Knock knee) treatment and Surgery at its affiliate & trusted hospitals & clinics in various metro cities of India, like Mumbai, Delhi, Bangalore, Chennai, Pune etc.Our Associate Board certified doctors are extensively trained and vastly experienced and have performed hundreds of such cases at our state of the art JCI accredited hospitals & Clinics. Our aim is to provide you the best of the services at the most affordable costs. Don't forget to say hi at info@medicyatra.com
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management of seizures,
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Osteoporosis: Classification, Causes, Symptoms, Treatment & Prevention
In this article, we’ll discuss what osteoporosis is, osteoporosis definition, osteoporosis types, osteoporosis causes, osteoporosis symptoms, osteoporosis medicine, osteoporosis treatment and osteoporosis prevention.
Osteoporosis:
Osteoporosis is a condition of low bone mass and decay of bone tissue prompting bone delicacy and conceivably breaking with numerous preventable and intrinsic danger factors. Osteoporosis influences bones and makes them more defenseless against sudden and unanticipated breaks and breakage. The term osteoporosis is derived from the Greek words osteon (bone) and poros (pore). For complete article, click on the given link, https://diseases8804.blogspot.com/2021/08/all-you-need-to-learn-about-osteoporosis.html
Feature story from the Garvan Institute of Medical Research's December 2012 issue of Breakthrough newsletter. More at https://www.garvan.org.au/news-events/newsletters
Osteoporosis is a progressive systemic skeletal disease characterized by low bone mass and microarchitecture deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Peak Bone Mass
• Peak Bone Mass (PBM) is the Bone mass
achieved at the end of the growth period. It
plays an essential role in the risk of
osteoporotic fractures occurring in adulthood.
• It is considered that an increase of PBM by
one standard deviation would reduce the
fracture risk by 50%.
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Peak Bone Mass and osteoporosis
• The World Health Organization (WHO)
expert panel has defined osteoporosis as a
bone mineral density (BMD) 2.5 SD or
more below the population-specific peak
bone mass (PBM)
where PBM is the BMD during the stable
period following growth and accrual of bone
mass and prior to subsequent bone loss.
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Structural development
• During growth, areal bone mineral density
(aBMD in g/cm2) increment is essentially
due to an increase in bone size, which is
closely linked to a virtually increment in
the amount of mineralized tissue
contained within the periosteal envelope.
• Consequently, volumetric BMD (vBMD)
increases very little from infancy to the end
of the growth period
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• There is no evidence of a gender difference in
bone mass at birth; the vBMD is similar in
female and male newborns.
• This absence of sex differences in bone mass
is maintained until the onset of pubertal
maturation.
• The gender difference in bone mass is
expressed during puberty. This difference
appears to be due mainly to a more prolonged
bone maturation period in males than in
females, resulting in increased bone size and
cortical thickness
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• Puberty affects bone size much more than it
does vBMD. There is no significant sex
difference in volumetric trabecular density
at the end of pubertal maturation.
• Bone mass accumulation rate at both
lumbar spine and femoral neck levels
increases 4 to 6-fold over a 3- and 4-year
period in females and males, respectively.
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• At the end of puberty, the sex difference is
essentially due to a greater bone size in male
than female subjects.
• This is achieved by larger periosteal
deposition in boys(endosteal in girls), thus
conferring a higher PBM and thus a better
resistance to mechanical forces in men than
in women.
• Sex hormones and the IGF-1 system are
implicated in the bone sexual dimorphism
occurring during pubertal maturation.
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• In boys, the onset of puberty occurs later
than in girls and the period of accelerated
bone growth lasts for four as compared to
three years in girls.
• These two characteristics probably
account to a large extent for the gender
difference in mean PBM observed in
healthy young adults
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• The increment in bone mass gain is less
marked in long bone diaphyses.
• In the lumbar spine, when PBM is attained
there is increased vertebral body diameter in
the frontal plane of males as compared to
females. This gender-related structural
dimorphism does not attenuate with ageing.
• It represents an important macro-
architectural determinant in the increased
incidence of vertebral fragility fractures
observed in females than males in later life.
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Time of peak bone mass
attainment
• In adolescent females, gain in bone mass
declines rapidly after menarche; no further
statistical gains are observed 2 years later at
least in sites such as the lumbar spine or
femoral neck.
• In adolescent males, the gain in BMD is
accelerated particularly from 13-17 years
declines markedly thereafter, although it
remains significant between 17-20 yrs in both
lumbar spine BMD and in midfemoral shaft
BMD
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AGE RANGE FOR PBM
• The PBM age range is defined to be the
age range of the BMD plateau (stable) or
the age range 3 years following attainment
of the highest BMD value if there was no
stable period
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AGE RANGE FOR PBM
• Lumbar spine PBM (1.0460.123 g/cm2)
occurred at ages 33 to 40 years in women
and at 19 to 33 years in men (1.0660.129
g/cm2).
• Total hip PBM (0.9810.122 g/cm2)
occurred at ages 16 to 19 years in women
and 19 to 21 years in men (1.0930.169
g/cm2).
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Importance of peak bone
mass
• The relative contribution of peak bone
mass to fracture risk has been explored by
studying the variability of individual aBMD
values in relation with age. It was found
that
1) The average annual rate of bone loss
was relatively constant and tracked well
within one person.
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• 2) Prediction of fracture risk based on one
single measurement of femoral neck aBMD
remains reliable in the long term.
• 3) Femoral neck aBMD values show little
variation during adult life in individual Z-
scores or percentiles.
• Thus bone mass acquired at the end of the
growth period appears to be more important
than the bone loss occuring during adult life
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• It was calculated that an increase in peak bone
mass of 10% would delay the onset of
osteoporosis by 13 years.
• In comparison, a 10% increase in the age of
menopause, or a 10% reduction in age-related
(non-menopausal) bone loss would only delay the
onset of osteoporosis by 2 years.
• This theoretical analysis indicates that peak bone
mass could be the single most important factor for
the prevention of osteoporosis later in life
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Determinants of peak bone mass
and strength
• The physiological determinants classically
include
I. Heredity(genetics)
II. Vitamin D and Bonetropic nutrients
(calcium, proteins)
III. Endocrine factors (sex steroids, IGF-I
1.25(oh)2d),
IV. Mechanical forces (physical activity, body
weight)
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Genetic
• Comparison between pairs of monozygotic
versus dizygotic twins and parent- offspring
studies allows one to estimate the
contribution of heritability to the variance of
bone mineral mass
• This “genetic effect” appears to be greater in
skeletal sites like the lumbar spine compared
to the femoral neck as mechanical factors
exert greater influence on the cortical
component of the proximal femur than on the
prevailing trabecular framework of vertebral
bodies.
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Endocrine factors: Sex hormones
• An androgen receptor has been localized in
growth plate chondrocytes in humans during
pubertal maturation.
• But there is no evidence that androgens
stimulate longitudinal bone growth by a direct
action on the skeleton.
• In adulthood, patients affected by the
androgen insensitivity syndrome, with XY
genotype and a marked female phenotype
are taller than the average standing height of
the corresponding female population
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• It is well documented that estrogens play
an essential role in longitudinal bone
growth. It exert biphasic effects by
accelerating bone growth at the beginning
of puberty whereas in both genders,
estrogens are key determinants for the
closing of growth plates
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• A later age at menarche was found to be
associated with lower aBMD in the spine
and proximal femur and higher risk of
vertebral and hip fracture in adulthood due
to the influence of pubertal timing on PBM
attainment
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The Growth Hormone-insulin-like Growth
Factor-1 System
• IGF-1 positively influences the growth in
both length and width of the skeletal
pieces. This factor exerts a direct action
on both growth plate chondrocytes and
osteogenic cells.
• This activity is also expressed by parallel
changes in the circulating biochemical
markers of bone formation, osteocalcin
and alkaline phosphatase.
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• IGF-1 receptors are localized in the renal
tubular cells. They are connected to both the
production 1,25(OH)2D and to the transport
system of inorganic phosphate (Pi) localized
in the luminal membrane of the tubular cells.
• By enhancing the production and circulating
level of 1,25(OH)2D, IGF-1 indirectly
stimulates the intestinal absorption of Ca and
Pi
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• During pubertal maturation, there is an
interaction between sex steroids and the
GH-IGF-1 system.
• Relatively low concentrations of estrogens
would appear to stimulate the hepatic
production of IGF-1, whereas large
concentrations apparently exert an inhibitory
effect.
• Androgens act mainly at the pituitary level,
but can be converted into estrogens by the
enzymatic activity of aromatase
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Mechanical Factors
• The density, distribution and extensive
communication network of osteocytes
make to function as detectors of
mechanical strain by sensing fluid
movement within the bone canaliculi.
• They can direct the formation of new bone
by activating lining cells to differentiate in
preosteoblasts
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SCLEROSTIN
• A key molecule in mechanotransduction
process appears to be sclerostin, the
product of the SOST gene.
• Patients with sclerosteosis and high bone
mass can have mutations in either the
LRP5 or SOST gene.
• Sclerostin can bind and antagonize LRP5,
a Wnt co-receptor that is required for bone
formation in response to mechanical load.
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• Mechanical loading can induce a marked
reduction of sclerostin in both osteocytes
and in the canaliculi network.
• Administration of sclerostin monoclonal
antibodies to primates leads to a dramatic
increase in bone formation, trabecular
thickness, radial, femoral and vertebral
BMD as well as in bone strength
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• Genes coding for the LRP5-Wnt co receptor
and sclerostin are implicated in the bone
anabolic response to increased mechanical
strain.
• The mechanosensation and transduction in
osteocytes still involve other factors
including nitric oxide (NO), prostaglandins
and ATP.44 IGF-1, membrane ion channels,
integrins and connexins are also locally
implicated in the response of cells to
mechanical signaling in bone.
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AGE AND OPTIMAL RESPONSE TO
LOADING
• Growing bones are usually more
responsive to mechanical loading than
adult bones.
• Physical activity increases bone mineral
mass accumulation in both children and
adolescents. The impact appears to be
stronger before the pubertal maturation.
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• Exercise-induced BMD benefits during
growth gets partially reduced after
retirement from sports
• Higher PBM may contribute to the lower
incidence of fragility fractures observed in
retired athletes beyond 60 years of age
compared to matched controls
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Skeletal site specificity
• Some sites, such as the tibia diaphysis,
loading will result in geometrical changes
with larger bone and greater cortical area,
whereas at sites consisting predominantly
of trabecular tissue, such as the distal
radius and tibia, physical activity may
increase the volumetric mineral density.
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Negative impact of intensive physical
exercise
• Impaired bone mass acquisition can occur
when intensive physical activity leads to
hypogonadism and low body mass.
• Both nutritional and hormonal factors
probably contribute to this impairment.
• Hypogonadism, as expressed by the
occurrence of oligomenorrhea or
amenorrhea, can lead to bone loss in
females who begin training intensively
along with diets after menarche.
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Nutrition: The differential impact
of calcium
• The benefit of supplemental calcium was
usually greater in the appendicular than in
the axial skeleton in prepubertal children.
• The skeleton appears to be more
responsive to calcium supplementation
before the onset of pubertal maturation
than during the peripubertal period
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• Two co-twin studies strongly suggest that
increasing calcium intake after the onset of
pubertal maturation above a daily
spontaneous intake of about 800-900 mg
does not exert a significant positive effect
on bone mineral mass acquisition.
• This contrasts to the belief that the period
of pubertal maturation with its acceleration
of bone mineral mass would be the most
attractive time for enhancing calcium intake
well above the prepubertal requirements
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• In 8-year-old prepubertal girls with
relatively low spontaneous calcium intake,
increasing the calcium intake resulted in
an additionnal gain by about 0.25 SD as
compared to the placebo group after one
year of supplementation. In contrast, the
additional gain was minimal in those girls
with a relatively high calcium intake.
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vitamin D
• vitamin D given in physiological doses
(400 IU=10μg) to female infants for an
average of one year was associated with a
significant increase in aBMD measured at
the age of 7-9 years.
• In this study, the aBMD difference
between the vitamin D-supplemented and
non-supplemented infants was most
significant at the femoral neck, trochanter
and radial metaphysis
Fournier PE, Rizzoli R, Slosman DO, Buchs B, Bonjour JP. Relative contribution of vertebral body and posterior arch in female and male lumbar spine peak bone mass. Osteoporos Int 1994;4(5):264-272
PEAK BONE MASS FROM LONGITUDINAL DATA Journal of Bone and Mineral Research