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  About The Author
  Annexure
  Preface and introduction
  Index
 

 

               ANNEXURE

 


 ANNEXURE 1 :
 ANNEXURE 2 :
 ANNEXURE 3 :
 ANNEXURE 4 :
 ANNEXURE 5 :
 ANNEXURE 6 :
 ANNEXURE 7 :
 ANNEXURE 8 :
 ANNEXURE 9 :

ANNEXURE 1 : GRADES OF RECOMMENDATION FOR LIFESTYLE INTERVENTION

He is the best physician who is the most ingenious inspirer of hope.                                                                                 -  Samule Taylor Coleridge

Grades of recommendation  :

Grade

Level of evidence

4

Presence of at least one randomized controlled trial recommending the intervention

3

Presence of well conducted clinical studies but no randomized clinical trials as regards to the recommendation

2

Evidence from expert committee report or opinions and / or clinical experiments of respected authority but no significant clinical studies of good quality.

1

Inconsistent results

--

No benefit demonstrated/no data

 Grades of recommendations for lifestyle intervention  :

Intervention

BMD

Vertebral fracture reduction

Hip fracture reduction

Exercise

4

3

3

Dietary calcium

3

3

3

Calcium (± vitamin D) supplements

4

4

4

Smoking cessation

3

3

3

Reduced alcohol intake

2

2

3

Hip protectors

--

--

4

 

ANNEXURE 2                                                                                         GO-TOP

Life is not merely living but living in health.                                                                  - Martial

Priority aims and suggested actions for healthcare.

 Institutions  :

  1. In patients presenting with a history of low impact fracture, diagnostic and therapeutic follow-up can be improved by taking following steps  :

·      Stastical analysis and recording of those patients who have had bone densitometry.

·        Stastical data collection and analysis of those patients identified as having low BMD values.

·        Percentage of patients with low impact fracture offered discussion and counseling of osteoporosis risk.  Documentation of steps taken by provider to provide health counseling.

·        Percentage of these patients offered osteoporosis treatment.

2.      Increase follow-up testing on patients on osteoporosis treatment with clinical
 evaluation and BMD measurements.

3.      Encourage adults in middle and late age groups presenting for health checkups for
 evaluation for osteoporosis risk factors.

·        Document percentage of patients presenting for a preventive check-up after
 documentation of risk factors for osteoporosis.

·        Percentage of patients at risk for fracture who have BMD testing done.

4.      Awareness regarding lifestyle factors affecting bone health should be encouraged
 amongst the institutional employees.



Annexure 3 : Abbreviations                                                     GO-TOP

When we ask advice, we are usually looking for an accomplice.                                       -  Marquis De Lagrange.

ALN alendronate

LS lumbar spine

AACE  American Association of clinical endocrinologists

M male

ACR American college of radiology

MCHC microcrystalline hydroxyapatite compound

AGS American Geriatric Society

MFP monofluorophosphate

bd twice daily

MPA medroxyprogesterone acetate

BMD bone mineral density

MR mid-radius

BMC bone mineral content

mo month

btwn between

NOF National osteoporosis foundation

Ca calcium

NA not analysed

CAH chronic active hepatitis

NaF sodium fluoride

CaP calcium phosphate

NM not mentioned

CEE conjugated equine estrogens

NS not significant

COPD chronic obstructive pulmonary disease

NTX N-telopeptide

CT calcitonin

NAMS North American Menopause Society.

CTX C-telopeptide

25OHD 25-hydroxyvitamin D

d day

PBC primary biliary cirrhosis

DHT dihydrotachysterol

PTH parathyroid hormone

DR distal radius

PMR polymyalgia rheumatica

DXA dual energy x-ray absorptiometry

po orally

EOD every other day

PR proximal radius

ESR erythrocyte sedimentation rate

pts patients

F female

QCT quantitative computed tomography

FA forearm

RCP Royal college of physicians

FBC full blood count

R radius

FN femoral neck

RA rheumatoid arthritis

FSH follicle-stimulating hormone

SD standard deviation

g gram

SHGB sex hormone binding globulin

GC glucocorticoid

SLE systemic lupus erythematosus

GCA giant cell arteritis

sc subcutaneous

g GT gamma glutamyltransferase

Tx treatment

HRT hormone replacement therapy

TBBM total body bone mineral

Ht heart

Td transdermal

IBD inflammatory bowel disease

TH total hip

Im intramuscular

Tid/tds three times daily

ICSI Institute for clinical systems improvement

Transpl transplantation

IU international unit

TSH thyroid-stimulating hormone

IOF International osteoporosis foundation

Vasc vasculitis

ISCD International society for clinical densitometry.

Vit vitamin

Iv intravenous

wk week

kg kilogram

yr year

 
                                                                                                                                   GO-TOP

ANNEXURE 4 : RECOMMENDED BOOKS FOR FURTHER READINGS 

 Books are for nothing but to inspire.
- Ralph Waldo Emerson, The American Scholar

 

  1. Osteoporosis - Edition 1 by Ralston, Stuart H. / Kleerekoper,  Michael MOSBY-YEAR BOOK INC
  2. Osteoporosis Compendium - Edition 1 by Arden, Nigel CURRENT MEDICAL LITERATURE
  3. The Johns Hopkins White Papers: Low Back Pain and Osteoporosis, 2002 - Edition 1 by Margolis, Simeon / Kostuik, John P. REBUS, INC
  4. Clinician's Manual on Male Osteoporosis - Edition 1 by Orwoll                         SCIENCE PRESS INC.
  5. Clinician's Manual on Prevention and Management of Osteoporosis - Edition 1 by Ralston SCIENCE PRESS INC.
  6. Nutritional Aspects of Osteoporosis - Edition 1 by Burckhardt, Peter / Dawson-Hughes, / Heaney, Robert P.  ACADEMIC PRESS INC
  7. Osteoporosis Sourcebook - Edition 1 by Cook, Allan R. OMNIGRAPHICS Bibliography
  8. Osteoporosis (2-Volume Set) - Edition 2 by Marcus, Robert / Feldman, David / Kelsey, Jennifer ACADEMIC PRESS INC
  9. The Osteoporosis Remedy: Designing a Personal Prevention Program - Edition 1 by Schettini, Stephen AVERY PUBLISHING GROUP
  10. The Silent Thief: Osteoporosis, Exercises and Strategies for Prevention and Treatment - Edition 1 by Bohme, Karine / Budden, Frances FIREFLY BOOKS
  11. An Atlas of Osteoporosis - Edition 2 by Stevenson, John C. / Marsh, Michael PARTHENON PUBLISHING
  12. Contemporary Diagnosis and Management of Osteoporosis - Edition 1 by Baran HANDBOOKS IN HEALTH CARE COMPANY
  13. Ernst Schering Research Foundation Workshop, 4: Hormone Replacement Therapy and Osteoporosis supplement 4 - Edition 1 by Kato, J. / Minaguchi, H. / Nichono, Y  SPRINGER VERLAG INC
  14. Everything You Need to Know About Osteoporosis - Edition 1 82by Patrick, Judy Lyn PRIMA HEALTH PUBLISHING
  15. Home Medical Guide to Osteoporosis - Edition 1 by American College of Physicians DK PUBLISHING
  16. Osteoporosis - Edition 1 by Marcus, Robert BLACKWELL PUBLISHERS
  17. Osteoporosis Management - Edition 1 by Reid, I.R. LIPPINCOTT WILLIAMS & WILKINS
  18. Osteoporosis - Edition 1 by Marcus, Robert BLACKWELL PUBLISHERS clearance 04/02
  19. Preventing and Managing Osteoporosis - Edition 1 by Gueldner, Sarah Hall / Burke, M. Susan / Smiciklas-Wright, Helen SPRINGER PUB CO INC
  20. Preventing Osteoporosis with Ipriflavone: the Proven, Safe Alternative to Estrogen Replacement Therapy - Edition 1 by Girman, Andrea M. / Poole, Carol PRIMA HEALTH PUBLISHING
  21. Preventing and Managing Osteoporosis - Edition 1 by Hall-Gueldner, Sarah / Burke, Susan / Smiciklas-Wright, Helen PROMETHEUS BOOKS
  22. Strong Women, Strong Bones: Everything You Need to Know to Prevent, Treat, and Beat Osteoporosis - Edition 1 by Nelson, Miriam E. / Wernick, Sarah PENGUIN PUTNAM INC
  23. The Athletic Woman's Survival Guide: How to Win the Battle Against Eating Disorders, Amenorrhea, Osteoporosis - Edition 1 by Otis, Carol L. / Goldingay, Roger HUMAN KINETICS PUBLISHERS
  24. The Genetics of Osteoporosis and Metabolic Bone Disease - Edition 1 by Econs, Michael J.HUMANA PRESS
  25. The Osteoporosis Primer - Edition 1 by Henderson, Janet E. / Goltzman, David CAMBRIDGE UNIVERSITY PRESS
  26. Tumor Bone Diseases and Osteoporosis in Cancer Patients: Pathophysiology, Diagnosis, and Therapy - Edition 1 by Body, Jean-Jacques MARCEL DEKKER INC
  27. Osteoporosis in Men: the Effects of Gender on Skeletal Health - Edition 1                               by Orwoll, Eric S. PRESS INC
  28. Osteoporosis: Genetics, Prevention and Treatment - Edition 1                               by Adams, John S. / Lukert, Barbara P. ACADEMIC PUBLISHERS
  29. Osteoporosis: Prevention, Diagnosis and Management - Edition 3                               by Notelovitz, Morris PROFESSIONAL COMMUNICATIONS INC                               new edition pending 03/03
  30. Primer on Corticosteroid-Induced Osteoporosis - Edition 1 by Adachi, Jonathan D. WILLIAMS & WILKINS
  31. Quantitative Ultrasound: Assessment of Osteoporosis and Bone Status - Edition 1 by Njeh, Christopher F. / Hans, Didier / Fuerst, Thomas                                 MARTIN DUNITZ LTD
  32. Soy Smart Health: Discover the Super Food That Fights Breast Cancer, Heart Disease, Osteoporosis, Discomforts, and Estrogen - Edition 1 by Solomon, Neil / Passwater, Richard A. Elkins, Rita WOODLAND PUBLISHING CO
  33. Super Calcium Counter: The Essential Guide to Preventing Osteoporosis and Building Strong Bones - Edition 1 by McIlwain, Harris / Bruce, Debra                               Fulghum KENSINGTON PUBLISHING CORP
  34. Super Calcium Counter: The Essential Guide to Preventing Osteoporosis and Building Strong Bones - Edition 1 by McIlwain, Harris / Bruce, Debra                               Fulghum KENSINGTON PUBLISHING CORP
  35. The Evaluation of Osteoporosis: Dual Energy X-Ray Absorptionmetry and Ultrasound in Clinical Practice - Edition 2 by Blake, Glen M. / Wahner, Heinz W. / Fogelman, Ignac MARTIN DUNITZ LTD
  36. The Osteoporosis Book: A Guide for Patients and Their Families - Edition 1                               by Lane, Nancy E. UNIVERSITY PRESS
  37. Walk Tall! An Exercise Program for the Prevention and Treatment of Osteoporosis - Edition 1 by Meeks, Sara TRIAD PUBLISHING COMPANY INC
  38. Anabolic Treatments for Osteoporosis - Edition 1 by Whitfield, James F. CRC PRESS INC
  39. Clinicians Manual Osteoporosis - Edition 1 by Avioli ©1998 n/a                               SAUNDERS W B CO not yet published, date indef  Orthopedics & Orthopedic Surgery
  40. Novel Approaches to Treatment of Osteoporosis - Edition 1                               by Russell, R.G.G. / Skerry, T.M. / Kollenkirchen, U.                              SPRINGER VERLAG INC
  41. Nutritional Aspects of Osteoporosis - Edition 1 by Burckhardt, Peter / Dawson-Hughes, / Heaney, Robert P. VERLAG INC
  42. Osteoporosis: A Clinical Guide - Edition 2 by Woolf, Anthony D. / Dixon, Allan St. MARTIN DUNITZ LTD
  43. Osteoporosis - Edition 1 by Stevenson, John C. / Lindsay, Robert                                 OXFORD UNIVERSITY PRESS
  44. Osteoporosis in Clinical Practice: A Practical Guide for Diagnosis and Treatment - Edition 1 by Geusens, P. SPRINGER VERLAG INC
  45. Shared Care for Osteoporosis - Edition 1 by Harrison                               MARTIN DUNITZ LTD
  46. Stand Tall! Every Woman's Guide to Preventing and Treating Osteoporosis - Edition 2 by Notelovitz, Morris / Ware, Marsha / Tonnessen, Diana                                 TRIAD PUBLISHING COMPANY INC
  47. The Parathyroid Hormone: An Unexpected Bone Builder for Treating Osteoporosis - Edition 1 by Whitfield, James F. / Morley, Paul / Willick, Gordon E. LANDES BIOSCIENCE PUBLISHERS
  48. Bone Densitometry & Osteoporosis - Edition 1 by Genant                               SPRINGER VERLAG INC
  49. Osteoporosis '96 - Edition 1 by Papapoulos, S.E. SCIENCE.
  50. The Basics of arthritis – Edition 1 2003 by Dr Manoj R Kandoi, National Book Depot India.
  51. Living with arthritis – Edition 1 2003 by Dr Manoj R Kandoi, Institute of Arthritis Care and Prevention, India.

 Annexure 5  :  Recommended web sites                                                         GO-TOP

Thought is the first faculty of man; to express it is one of his first desires; to spread it, his dearest privilege.
-  Abbe Raynal

Web site address

Organization

www.aaos.org

American academy of orthopaedic surgeons

www.aace.com

American association of clinical endocrinologists

www.rheumatology.org

American college of rheumatology

www.ama-assn.org

American medical association

www.fore.org

Foundation for osteoporosis research and education 

www.osteofound.org

International osteoporosis foundation

www.iscd.org

International society of clinical densitometry

www.mayoclinic.org

Mayo health oasis women’s health resource

www.icsi.org

Institute for clinical systems improvement

www.nof.org

National osteoporosis foundation

www.osteo.org

NIH osteoporosis and related bone disease resource center.

www.menopause.org

North American menopause society

www.menopausejournal .com

North American menopause society

www.osteoporosisindia.org

Institute of arthritis care and prevention

www.arthritisindia.org

Institute of arthritis care and prevention

www.medscape.com

Medscape from web MD

www.rcplondon.ac.uk

Royal college of physicians of London

www.guideline .gov

A collection of guidelines on various subjectes

 

Annexure 6  Recommended guidelines for further readings                         GO-TOP

Reading is to the mind what exercise is to the body.
         - Richard Steele, The Tatler, no.147

  1. Behavioral counseling in primary care to promote physical activity: recommendation and rationale.  United States Preventive Services Task Force - Independent Expert Panel.  1996 (revised 2002 Aug 6).  3 pages. 
  1. Management of early rheumatoid arthritis. A national clinical guideline.  Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.].  2000 Dec.  44 pages. 
  1. Pain in osteoarthritis, rheumatoid arthritis, and juvenile chronic arthritis.  American Pain Society - Professional Association.  2002.  179 pages. 
  1. ACR Appropriateness Criteria for stress/insufficiency fractures (excluding vertebral).  American College of Radiology - Medical Specialty Society.  1995 (revised 1999).  8 pages. 
  1. Summary of policy recommendations for periodic health examinations.  American Academy of Family Physicians - Medical Specialty Society.  1996 Nov (revised 2002 Aug).  15 pages. 
  1. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients--2002 update.  American Association of Clinical Endocrinologists - Medical Specialty Society American College of Endocrinology - Medical Specialty Society.  1996 (revised 2002).  18 pages. 
  1. Recommendations to increase physical activity in communities.  Centers for Disease Control and Prevention - Federal Government Agency [U.S.] Task Force on Community Preventive Services - Independent Expert Panel.  2002 May.  6 pages. 
  1. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism.  American Association of Clinical Endocrinologists - Medical Specialty Society
    American College of Endocrinology - Medical Specialty Society.  1996 (revised 2002).  13 pages. 
  1. Falls and fall risk.  American Health Care Association - Professional Association
    American Medical Directors Association - Professional Association.  1998.  16 pages . 
  1. Multiple myeloma (MM).  Finnish Medical Society Duodecim - Professional Association.  2001 Dec 27.  Various pagings. 
  1. Low back pain or sciatica in the primary care setting.  Department of Defense - Federal Government Agency [U.S.] Veterans Health Administration – Federal Government Agency [U.S.].  1999 May.  Various pagings. 
  1. Clinical practice guideline (second edition) for the diagnosis, treatment, and management of reflex sympathetic dystrophy/complex regional pain syndrome (RSD/CRPS).  Reflex Sympathetic Dystrophy Syndrome Association - Private Nonprofit Organization.  2002 Feb.  46 pages. 
  1. American Gastroenterological Association medical position statement on obesity.  American Gastroenterological Association - Medical Specialty Society.  2002 Sep.  3 pages. 
  1. The management of menorrhagia in secondary care.  Royal College of Obstetricians and Gynaecologists - Medical Specialty Society.  1999 Jul.  77 pages. 
  1. Diagnosis and treatment of adult degenerative joint disease (DJD) of the knee.  Institute for Clinical Systems Improvement - Private Nonprofit Organization.  1996 Jun (revised 2002 May).  42 pages. 
  1. Clinical practice guideline for the management of rheumatoid arthritis.  Advanced Research Techniques in the Health Services - Private For Profit Research Organization
    Spanish Society of Rheumatology - Medical Specialty Society.  2001.  170 pages. 
  1. Guideline on the role of bisphosphonates in breast cancer.  American Society of Clinical Oncology - Medical Specialty Society.  2000 Mar.  14 pages.
  1. Preventive services for adults.  Institute for Clinical Systems Improvement - Private Nonprofit Organization.  1995 Jun (revised 2002 Sep).  50 pages. 
  1. Management of postmenopausal osteoporosis: position statement of The North American Menopause Society.  The North American Menopause Society - Private Nonprofit Organization.  2002 Mar.  18 pages. 
  1. Hormone replacement therapy: collaborative decision making and management.  Institute for Clinical Systems Improvement - Private Nonprofit Organization.  1999 Aug (revised 2001 Jul).  64 pages.  [NGC Update Pending]
  1. Amended report from the NAMS Advisory Panel on postmenopausal hormone therapy.  The North American Menopause Society - Private Nonprofit Organization.  2002 Oct 6.  7 pages. 
  1. The role of calcium in peri- and postmenopausal women: consensus opinion of The North American Menopause Society.  The North American Menopause Society - Private Nonprofit Organization.  2001 Mar.  12 pages. 
  1. Clinical challenges of perimenopause: consensus opinion of The North American Menopause Society.  The North American Menopause Society - Private Nonprofit Organization.  2000 Jan.  9 pages. 
  1. Screening for osteoporosis in postmenopausal women: recommendations and rationale.  United States Preventive Services Task Force - Independent Expert Panel.  1996 (revised 2002 Sep 17).  12 pages. 
  1. Physician's guide to prevention and treatment of osteoporosis.  American Academy of Orthopaedic Surgeons - Medical Specialty Society
    American Academy of Physical Medicine and Rehabilitation - Medical Specialty Society
    American Association of Clinical Endocrinologists - Medical Specialty Society
    American College of Obstetricians and Gynecologists - Medical Specialty Society
    American College of Radiology - Medical Specialty Society
    American College of Rheumatology - Medical Specialty Society
    American Geriatrics Society - Medical Specialty Society
    American Society for Bone and Mineral Research - Professional Association
    National Osteoporosis Foundation - Disease Specific Society
    The Endocrine Society - Disease Specific Society.  1999.  28 pages. 
  1. Diagnosis and treatment of osteoporosis.  Institute for Clinical Systems Improvement - Private Nonprofit Organization.  2002 Aug.  67 pages. 
  1. Osteoporosis. Guide to prevention, diagnosis, and treatment.  Brigham and Women's Hospital (Boston) - Hospital/Medical Center.  1999 (revised 2001).  11 pages. 
  1. Osteoporosis: prevention and treatment.  University of Michigan Health System - Academic Institution.  2002 Mar.  12 pages. 
  1. Osteoporosis.  American Health Care Association - Professional Association
    American Medical Directors Association - Professional Association.  1998.  16 pages. 
  1. Preventive counseling and education.  Institute for Clinical Systems Improvement - Private Nonprofit Organization.  1995 May (revised 2002 Jul).  67 pages. 
  1. (1) Best practice evidence-based guideline for the appropriate prescribing of hormone replacement therapy. (2) Guideline update: hormone replacement therapy.  Effective Practice Institute, University of Auckland - Academic Institution
    New Zealand Guidelines Group - National Government Agency [Non-U.S.].  2001 May (revised information released on 2002 Sep 30).  185 pages. 
  1. Guideline for the prevention of falls in older persons.  American Academy of Orthopaedic Surgeons - Medical Specialty Society American Geriatrics Society - Medical Specialty Society British Geriatrics Society - Medical Specialty Society.  2001 May.  9 pages. 
  1. Physical activity in the prevention, treatment and rehabilitation of diseases.  Finnish Medical Society Duodecim - Professional Association.  2002 May 7.  Various pagings. 
  1. Osteoporosis prevention, diagnosis, and therapy.  National Institutes of Health (NIH)