Portal de Periódicos da CAPES

Osteoporosis: A Review of Pathogenesis and Treatment

1963; American College of Physicians; Volume: 58; Issue: 3 Linguagem: Inglês

10.7326/0003-4819-58-3-539

1539-3704

JACOB BASSAN,

Bone health and treatments

Review1 March 1963Osteoporosis: A Review of Pathogenesis and TreatmentJACOB BASSAN, M.D., BOY FRAME, M.D., F.A.C.P., HAROLD FROST, M.D.JACOB BASSAN, M.D.Search for more papers by this author, BOY FRAME, M.D., F.A.C.P.Search for more papers by this author, HAROLD FROST, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-58-3-539 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptOsteoporosis is a generic term used to designate a metabolic bone disorder characterized by a decrease in bone mass with normal mineral content. It occurs as a result of varied pathogenic mechanisms and is associated with a number of different disease processes.Osteoporosis was first described by Pommer in 1885 (1). Though little was then known about its incidence and etiology, Pommer thought that the condition was the result of decreased bone formation, while bone resorption remained normal (2). Dietary deficiency of calcium was initially considered the major etiological factor, thus most patients were treated with calcium supplements and vitamin...References1. POMMER G: Rachitis and Osteomalacie, F. C. W. Vogel, Leipzig, 1885. Google Scholar2. POMMER G: Über Osteoporose, ihren Urspung und ihre Diffential Diagnostiche Redeutung. Arch. Klin. Chir. 136: 1, 1925. Google Scholar3. ADAMSBOOTHBYSNELL MWMAM: Metabolic studies in osteoporosis. J. Clin. Invest. 7: 75, 1929. MedlineGoogle Scholar4. BAUERMARBLE WA: Studies on the mode of action of irradiated ergosterol. J. Clin. Invest. 11: 21, 1932. CrossrefMedlineGoogle Scholar5. MEULENGRACHT E: Osteomalacia of the spinal column from deficient diet or from disease of the digestive tract. Acta Med. Scand. 101: 138, 1939. CrossrefGoogle Scholar6. ALBRIGHTBLOOMBERGSMITH FEPH: Postmenopausal osteoporosis. Trans. Ass. Amer. Physicians 55: 298, 1940. Google Scholar7. ALBRIGHTSMITHRICHARDSON FPHAM: Postmenopausal osteoporosis. JAMA 116: 2465, 1941. CrossrefGoogle Scholar8. REIFENSTEINALBRIGHT ECF: The metabolic effect of steroid hormone in osteoporosis. J. Clin. Invest. 26: 24, 1947. CrossrefMedlineGoogle Scholar9. ALBRIGHTREIFENSTEIN FEC: Parathyroid Gland and Metabolic Bone Disease, The Williams & Wilkins Company, Baltimore, 1948. Google Scholar10. REIFENSTEIN EC: The rationale for the use of anabolic steroids in controlling the adverse effects of corticoid hormones upon protein and osseous tissues. Southern Med. J. 49: 933, 1956. CrossrefMedlineGoogle Scholar11. REIFENSTEIN EC: Anabolic steroid therapy for the protein depletion and osteoporosis induced corticoid hormones. Clin. Orthop. 9: 30, 1957. MedlineGoogle Scholar12. REIFENSTEIN EC: The relationships of steroid hormones to the development and management of osteoporosis in aging people. Clin. Orthop. 10: 206, 1957. MedlineGoogle Scholar13. REIFENSTEIN EC: Bone as a Tissue, ed. by Fourman, P., McGraw-Hill Book Company, Inc., New York, 1960, pp. 83-99. Google Scholar14. SNAPPER I: Osteoporosis. Med. Clin. N. Amer. 36: 847, 1952. CrossrefMedlineGoogle Scholar15. MOLDAWER M: Senile osteoporosis. Arch. Intern. Med. (Chicago) 96: 202, 1955. CrossrefGoogle Scholar16. MOLDAWER M: Pathogenesis and treatment of senile osteoporosis. Geriatrics 11: 319, 1956. MedlineGoogle Scholar17. BARTTER FC: Osteoporosis. Amer. J. Med. 22: 797, 1958. CrossrefGoogle Scholar18. BAUERBARTTER WFC: Osteoporosis, in Textbook of Medicine, ed. by Cecil, R. L., and Loeb, R. F., 10th ed., W. B. Saunders Company, Philadelphia, 1959, p. 1388. Google Scholar19. PINES KL, Bone and metabolic disease of bone. Amer. J. Med. 15: 99, 1953. CrossrefMedlineGoogle Scholar20. NICOLAYSEN R: The physiology of calcium metabolism. Physiol. Rev. 33: 424, 1953. CrossrefMedlineGoogle Scholar21. NORDIN BE: Osteoporosis and calcium deficiency, in Bone as a Tissue, ed. by Fourman, P., McGraw-Hill Book Company, Inc., New York, 1960, pp. 46-47. CrossrefGoogle Scholar22. NORDIN BE: Osteomalacia, osteoporosis and calcium deficiency. Clin. Orthop. 17: 235, 1960. Google Scholar23. NORDIN BE: The pathogenesis of osteoporosis. Lancet 1: 1011, 1961. CrossrefMedlineGoogle Scholar24. FRASERHARRISONIBBERTON RMK: The rate of calcium turnover in bone. Quart. J. Med. 29: 85, 1960. MedlineGoogle Scholar25. HARRISONFRASERMULLAN MRB: Calcium metabolism in osteoporosis. Lancet 1: 1015, 1961. CrossrefMedlineGoogle Scholar26. FROST HM: Human osteoblastic activity. Henry Ford Hosp. Med. Bull. 9: 76, 1961. MedlineGoogle Scholar27. SMITHEYLERMELLINGER RWWRRC: On the incidence of senile osteoporosis. Ann. Intern. Med. 52: 773, 1960. LinkGoogle Scholar28. URIST MR: Observations bearing on the problem of osteoporosis, in Bone as a Tissue, ed. by Fourman, P., McGraw-Hill Book Company, Inc., New York, 1960, pp. 18-45. Google Scholar29. COOK AM: Osteoporosis. Lancet 1: 877, 1955. CrossrefGoogle Scholar30. MCLEANURIST FCMR: Bone, University of Chicago Press, Chicago, 1961. Google Scholar31. PFEIFFERGARDNER CAWV: Skeletal changes and blood serum calcium levels in pigeons receiving estrogen. Endocrinology 23: 485, 1938. CrossrefGoogle Scholar32. GARDNERPFEIFFER WVCA: Influence of estrogen and androgen in the skeletal system. Physiol. Rev. 23: 139, 1943. CrossrefGoogle Scholar33. BLOOMBLOOMMCLEAN WMAFC: Calcification and ossification, medullary bone changes in reproductive cycle of female pigeons. Anat. Rec. 81: 443, 1941. CrossrefGoogle Scholar34. BUDY AM: Osteogenetic properties of estrogenic hormones. Ann. NY Acad. Sci. 64: 428, 1958. CrossrefGoogle Scholar35. ALBRIGHT F: Osteoporosis. Ann. Intern. Med. 27: 861, 1947. LinkGoogle Scholar36. ANDERSON IA: Postmenopausal osteoporosis. Quart. J. Med. 19: 67, 1950. Google Scholar37. BOGDONOFFSHOCKPARSON MDNWJ: The effects of stilbestrol on the retention of nitrogen, calcium, phosphorus, and potassium in aged males with and without osteoporosis. J. Geront. 9: 262, 1954. CrossrefMedlineGoogle Scholar38. SHORRCARTER EAC: Studies on the effect of estrogens, androgens, and vitamin D2 on the calcium and the strontium metabolism, in Conference on Metabolic Aspects of Convalescence, ed. by Reifenstein, E. C., Jr., sponsored by the Josiah Macy, Jr. Foundation, New York, 1947, vol. 15, pp. 99-113. Google Scholar39. SOLOMONDICKERSONEISENBERG GFWJE: Psychologic and osteometabolic responses to sex hormones in elderly osteoporotic women. Geriatrics 15: 46, 1960. MedlineGoogle Scholar40. PINCUSROMANOFFCARLO GLPJ: The excretion of urinary steroids by men and women of various ages. J. Geront. 9: 113, 1954. CrossrefMedlineGoogle Scholar41. HAMBURGER C: Normal urinary excretion of neutral 17-ketosteroids with special reference to age and sex variation. Acta Endocr. (Kobenhavn) 1: 19, 1948. CrossrefMedlineGoogle Scholar42. EISENBERGGORDAN EGS: Skeletal dynamics in man measured by non-radioactive strontium. J. Clin. Invest. 40: 1809, 1961. CrossrefMedlineGoogle Scholar43. LIGHTFREY RFCN: Bone fractures due to low calcium diets. Proc. Soc. Exp. Biol. Med. 48: 356, 1941. CrossrefGoogle Scholar44. GREAVESSCOTTSCOTT JPMGPP: Calcium deficiency in cats on a high protein diet, raw heart. J. Physiol. 146: 36P, 1959. Google Scholar45. HARRISONFRASER MR: Bone structure and metabolism in calcium-deficient rats. J. Endocr. 21: 197, 1960. CrossrefMedlineGoogle Scholar46. CARLSSON A: Experiments with radiocalcium on the interrelationships between vitamin D and dietary calcium and phosphorus. Acta Pharmacol. (Kobenhavn) 9: 32, 1953. CrossrefMedlineGoogle Scholar47. HARRISONFRASER MR: The parathyroid glands and calcium deficiency in the rat. J. Endocr. 21: 207, 1960. CrossrefMedlineGoogle Scholar48. HEANEYWHEDON RPDC: Radiocalcium studies of bone formation rate in human metabolic bone disease. J. Clin. Endocr. 18: 1246, 1958. CrossrefGoogle Scholar49. RICHENSIRCKFELLOWS CJH: The use of continuous infusion of calcium45 and strontium85 to study skeletal function. J. Clin. Endocr. 21: 611, 1961. CrossrefGoogle Scholar50. MITCHELLCURZON HHEG: The Dietary Requirements of Calcium and its Significance, Hermann, Paris, 1939. Google Scholar51. ACKERMANTORO PGG: Calcium and phosphorus balance in elderly men. J. Geront. 8: 289, 1953. CrossrefMedlineGoogle Scholar52. BOGDONOFFSHOCKNICHOLS MDNWMP: Calcium, phosphorus, nitrogen and potassium balance studies in the aged male. J. Geront. 8: 272, 1953. CrossrefMedlineGoogle Scholar53. SMITH R: Unpublished data. Cited by Nordin (23), personal communication. Google Scholar54. OWENIRVING ECJT: The calcium requirements of the older male subjects with special reference to the genesis of senile osteoporosis. Acta Med. Scand. 103: 235, 1940. CrossrefGoogle Scholar55. AUBFARQUHARSON JCRF: Studies of calcium and phosphorus metabolism. J. Clin. Invest. 11: 235, 1932. CrossrefMedlineGoogle Scholar56. VINTHER-PAULSEN N: Calcium and phosphorus intake in senile osteoporosis. Geriatrics 8: 76, 1953. MedlineGoogle Scholar57. MALMNICOLAYSENSKJELKVALE OJRL: Calcium metabolism in old age as related to aging of the skeleton. Ciba Foundation Colloquia on Aging 1: 109, 1955. Google Scholar58. MALM OJ: Calcium requirements and adaptation in adult men. Scand. J. Clin. Lab. Invest. supp. 36, 1958. Google Scholar59. WALKERFOXIRVING ARFWJP: The effect of bread rich in phytate on the metabolism of certain mineral salts with special reference to calcium. Biochem. J. 42: 452, 1948. CrossrefGoogle Scholar60. HENNEMANBENEDICTFORBESDUDLEY PHPHAPHR: Idiopathic hypercalciuria. New Engl. J. Med. 259: 802, 1958. CrossrefMedlineGoogle Scholar61. JACKSONDANCASTER WPC: A consideration of the hypercalciuria in sarcoidosis, idiopathic hypercalciuria and that produced by vitamin D. J. Clin. Endocr. 19: 658, 1959. CrossrefGoogle Scholar62. WIDDOWSONTHRUSSEL EMLA: The absorption and excretion of nitrogen, calcium, magnesium, phosphorus. Med. Res. Counc. Spec. Rep. (London) series 275, p. 296, 1951. Google Scholar63. HEGSTEDMOSCOSOCOLLAZOS DMTC: A study of the minimum calcium requirements of adult men. J. Nutr. 46: 181, 1952. CrossrefMedlineGoogle Scholar64. MCCANCE RA: The problem of adaptation to low calcium intake, in Conference on Metabolic Interrelations, ed. by Reifenstein, E. C., Jr., sponsored by the Josiah Macy, Jr. Foundation, New York, 1953, vol. 5, p. 166. Google Scholar65. NICOLAYSEN R: The calcium requirement of man as related to disease of the skeleton. Clin. Orthop. 17: 226, 1960. Google Scholar66. ATKINSONNORDINSHERLOCK MBES: Malabsorption and bone disease in prolonged obstructive jaundice. Quart. J. Med. 25: 299, 1956. MedlineGoogle Scholar67. NORDIN BE: Effects of malabsorption syndrome on calcium metabolism. Proc. Roy. Soc. Med. 54: 497, 1961. MedlineGoogle Scholar68. WHEDON GD: Expansion of the concept of altered bone metabolism in osteoporosis; importance of nutritional factors. Acta Endocr. (Kobenhavn) supp. 51: 519, 1960. Google Scholar69. DIETRICKWHEDONSHORR JEGDE: Effects of immobilization upon various metabolic and physiologic functions of normal men. Amer. J. Med. 4: 3, 1948. CrossrefMedlineGoogle Scholar70. WHEDON GD: Osteoporosis: atrophy of disuse, in Bone as a Tissue, ed. by Fourman, P., McGraw-Hill Book Company, Inc., New York, 1960, pp. 67-82. Google Scholar71. ABRAHAMSON SA: Bone disturbance in injuries to the spinal cord and cauda equina. J. Bone Joint Surg. 30: 982, 1948. CrossrefGoogle Scholar72. HEANEY RP: Radiocalcium metabolism in disuse osteoporosis in man. Amer. J. Med. 33: 188, 1962. CrossrefMedlineGoogle Scholar73. PERKINSZILVA HRSS: The influence of scurvy and fall in weight in young guinea pigs on the alkaline phosphatase content of the serum and the zone of provisional calcification. Biochem. J. 47: 306, 1950. CrossrefMedlineGoogle Scholar74. SISSONS HA: The osteoporosis of Cushing's syndrome. J. Bone Joint Surg. 38B: 418, 1956. CrossrefGoogle Scholar75. SISSONS HA: Osteoporosis of Cushing's syndrome, in Bone as a Tissue, ed. by Fourman, P., McGraw-Hill Book Company, Inc., New York, 1960, pp. 3-17. Google Scholar76. FROST HM: A model of endocrine control of bone remodelling. Henry Ford Hosp. Med. Bull. 10: 119, 1962. MedlineGoogle Scholar77. LAAKE H: Osteoporosis in association with thyrotoxicosis. Acta Med. Scand. 151: 229, 1955. CrossrefMedlineGoogle Scholar78. WILLIAMSMORGAN RHHJ: Thyrotoxic osteoporosis. New Int. Clin. 2: 48, 1940. Google Scholar79. KRANEBROWNELLSTANBURYCORRIGAN SMGLJBH: The effect of thyroid disease on calcium metabolism in man. J. Clin. Invest. 35: 874, 1956. CrossrefMedlineGoogle Scholar80. FOLLIS RH: Skeletal changes associated with hyperthyroidism. Bull. Hopkins Hosp. 92: 405, 1953. MedlineGoogle Scholar81. AUBBAUERHEATHROPES JCWCM: Studies of calcium and phosphorus metabolism. III. The effect of the thyroid hormone and thyroid disease. J. Clin. Invest. 7: 97, 1929. CrossrefMedlineGoogle Scholar82. PUPPELGROSSMCCORMICKHERDLE DHTEKE: The rationale in clinical hyperthyroidism. Surg. Gynec. Obstet. 81: 243, 1945. Google Scholar83. KLEEMANTUTTLEBASSETT CRSSH: Metabolic observations in a case of thyrotoxicosis with hypercalcemia. J. Clin. Endocr. 18: 477, 1958. CrossrefGoogle Scholar84. FROSTSTANISAVLJEVICVILLANUEVAROTH HMSBSH: Effect of thyroxine on chondro-osseous complex resorption in the rat. Henry Ford Hosp. Med. Bull. 10: 199, 1962. MedlineGoogle Scholar85. JACKSON WP: Osteoporosis of unknown cause in young people. J. Bone Joint Surg. 40B: 420, 1958. CrossrefGoogle Scholar86. NORDINROGER BEA: Post-pregnancy osteoporosis. Lancet 1: 431, 1955. CrossrefGoogle Scholar87. BAUERCARLSSONLINDQUIST GCAB: Accretion rate of bone salt in osteoporosis studies by means of P32. Acta Med. Scand. 158: 139, 1947. CrossrefGoogle Scholar88. DENT CE: Idiopathic osteoporosis. Proc. Roy. Soc. Med. 48: 574, 1955. MedlineGoogle Scholar89. MCKUSICK VA: Heritable Disorders of Connective Tissue, The C. V. Mosby Company, St. Louis, 1960. Google Scholar90. ANDERSON J: Idiopathic osteoporosis—symptomatic relief by plasma infusion. Proc. Roy. Soc. Med. 47: 509, 1954. MedlineGoogle Scholar91. LAFFERTYSPENCERPEARSON FWGOH: Effects of androgens, estrogens, and high calcium diets on bone formation and resorption in osteoporosis. Paper presented at the forty-fourth meeting of the Endocrine Society, Chicago, June 21, 1962. Google Scholar92. MACKENZIEJANES DAJM: Postmenopausal osteoporosis. A programme of treatment in 42 cases. Canad. Med. Ass. J. 71: 339, 1954. MedlineGoogle Scholar93. WHEDON D, in Hormones and the Aging Process, ed. by Engle, E. T., and Pincus, G., Academic Press, New York, 1956, pp. 221-237. CrossrefGoogle Scholar94. MASTERSBALLEW WHJW: The third sex. Geriatrics 10: 1, 1955. MedlineGoogle Scholar95. HENNEMANWALLACH PHS: A review of the prolonged use of estrogens and androgens in postmenopausal and senile osteoporosis. Arch. Intern. Med. (Chicago) 100: 715, 1957. CrossrefGoogle Scholar96. BLACKGHORMLEYCAMP JRRKJD: Senile osteoporosis of the spinal column. JAMA 117: 2144, 1941. CrossrefGoogle Scholar97. WHEDON GD: Effects of high calcium intake on bones, blood, and soft tissues, relationship of calcium intake to balance in osteoporosis. Fed. Proc. 18: 1112, 1959. MedlineGoogle Scholar98. ACKERMANTORO PGG: Effects of added vitamin D on the calcium balance in elderly males. J. Geront. 8: 451, 1953. CrossrefMedlineGoogle Scholar99. SHORRCARTER EAC: The value of strontium as an adjuvant to calcium in the remineralization of the skeleton in osteoporosis in man, in Conference on Metabolic Interrelations, ed. by Reifenstein, E. G., Jr., sponsored by the Josiah Macy, Jr. Foundation, New York, 1950, vol. 2, p. 144. Google Scholar100. SHORR E: Treatment of osteoporosis, in Cornell Conferences on Therapy, The Macmillan Company, New York, 1953, vol. 6, p. 192. Google Scholar101. SHORRCARTER EAC: The usefulness of strontium as an adjuvant to calcium in the remineralization of the skeleton in man. Bull. Hosp. Joint Dis. 13: 59, 1952. MedlineGoogle Scholar102. MCCASLINJANES FEJM: The effect of strontium lactate in the treatment of osteoporosis. Proc. Mayo Clin. 34: 329, 1959. Google Scholar103. ARNOLD JS: Quantitation of mineralization of bone as an organ and tissue in osteoporosis. Clin. Orthop. 17: 167, 1960. Google Scholar104. SHERMAN MS: Estrogens and bone formation in the human female. J. Bone Joint Surg. 30A: 915, 1948. CrossrefMedlineGoogle Scholar105. POLISHUKKLEINHAUSS ZEM: Treatment of postmenopausal osteoporosis with estrone micro-crystal precipitates. Gynaecologia (Basel) 133: 1, 1952. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Detroit, MichiganRequests for reprints should be addressed to Boy Frame, M.D., Fifth Medical Division, Henry Ford Hospital, Detroit 2, Michigan. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byRadiological pituitary fossa changes in chronic bronchitis.Cushing's disease with pituitary apoplexy leading to hypopituitarism, empty sella, and spontaneous fracture of the dorsum sellaeInvolutional Osteopenia: Current ConceptsDAVID L. THOMSON, M.D., BOY FRAME, M.D., F.A.C.P.Allgemeine Radiologie und Morphologie der KnochenkrankheitenComparative Physiology of BoneOsteoporotic bone loss in two prehistoric Indian populationsThe Antiquity of Age-Associated Bone Demineralization in ManTHE ONSET OF POSTMENOPAUSAL OSTEOPOROSIS AS STUDIED BY A NEW TECHNIQUEEffects of androgens, estrogens and high calcium intakes on bone formation and resorption in osteoporosis 1 March 1963Volume 58, Issue 3Page: 539-550KeywordsBone densityCalciumEtiologyHormonal therapyHormonesMalnutritionOsteoporosisPathogenesisPathogensProteins Issue Published: 1 March 1963 PDF downloadLoading ...