About Us

Doctors Link

Patient Links

     Contact US     Disclaimer




For Advertisements



  About The Author
Preface and introduction






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

Grades of recommendation  :


Level of evidence


Presence of at least one randomized controlled trial recommending the intervention


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


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


Inconsistent results


No benefit demonstrated/no data

 Grades of recommendations for lifestyle intervention  :



Vertebral fracture reduction

Hip fracture reduction





Dietary calcium




Calcium (± vitamin D) supplements




Smoking cessation




Reduced alcohol intake




Hip protectors





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



 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



American academy of orthopaedic surgeons


American association of clinical endocrinologists


American college of rheumatology


American medical association


Foundation for osteoporosis research and education 


International osteoporosis foundation


International society of clinical densitometry


Mayo health oasis women’s health resource


Institute for clinical systems improvement


National osteoporosis foundation


NIH osteoporosis and related bone disease resource center.


North American menopause society

www.menopausejournal .com

North American menopause society


Institute of arthritis care and prevention


Institute of arthritis care and prevention


Medscape from web MD


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) Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy - Independent Expert Panel.  2000 Mar 27-29.  36 pages. 
  1. Osteoporosis.  Singapore Ministry of Health - National Government Agency [Non-U.S.].  2002 Feb.  63 pages. 
  1. ACR Appropriateness Criteria™ for osteoporosis and bone mineral density.  American College of Radiology - Medical Specialty Society.  1998 (revised 2001).  17 pages. 
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update.   American College of Rheumatology - Medical Specialty Society.  1996 Sep 3 (updated 2001).  8 pages. 
  1. AACE medical guidelines for clinical practice for management of menopause.  American Association of Clinical Endocrinologists - Medical Specialty Society.  1999 Nov-Dec.  13 pages. 
  1. Postmenopausal hormone replacement therapy for the primary prevention of chronic conditions: recommendations and rationale.  United States Preventive Services Task Force - Independent Expert Panel.  1996 (revised 2002).  17 pages. 
  1. Behavioral counseling in primary care to promote a healthy diet: recommendations and rationale.  United States Preventive Services Task Force - Independent Expert Panel.  1996 (revised 2002).  20 pages. 
  1. Adult low back pain.  Institute for Clinical Systems Improvement - Private Nonprofit Organization.  1994 Jun (revised 2002 Sep).  61 pages. 


ANNEXURE 7 : RECOMMENDED READINGS                                                        GO-TOP

People say that life is the thing, but I prefer reading.
Logan Pearsall Smith, Afterthoughts



  1. Ensrud KE,Thompson DE,Cauley JA,et al (Fracture Intervention Trial Research Group). Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass.J Am Geriatr Soc.2000; 48:241-249.
  2. Grainge MJ,Coupland CA,Cliffe SJ,Chilvers CE, Hosking DJ (Nottingham EPIC Study Group). Cigarette smoking, alcohol and caffeine consumption, and bone mineral density in postmenopausal women.Osteoporos Int. 1998;8:355-363.
  3. Kado DM,Browner WS,Palermo L,Nevitt MC, Genant HK,Cummings SR (Study of Osteoporotic Fractures Research Group). Vertebral fractures and mortality in older women:a prospective study. Arch Intern Med.1999;159:1215-1220.
  4. Melton LJ III,Egan KS,O ’Fallon WM,Riggs BL . Influence of fracture criteria on the outcome of a randomized trial of therapy. Osteoporos Int.1998;8:184-191.
  5. Ray NF,Chan JK,Thamer M,Melton LJ III. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995:report from the National Osteoporosis Foundation .J Bone Miner Res.1997;12:24-35.

 General Information


  1. Jensen ME,Evans AJ,Mathis JM,Kallmes DF,Cloft HJ,Dion JE. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures:technical aspects. Am J Neuroradiol.1997;18:1897-1904.
  2. Kano K. Relationship between exercise and bone mineral density among over 5,000 women aged 40 years and above. J Epidemiol.1998;8:28-32.
  3. McClung MR.Therapy for fracture prevention. JAMA.  1999;282:687-689.
  4. Meunier PJ.Evidence-based medicine and osteoporosis:a comparison of fracture risk reduction data from osteoporosis randomised clinical trials. Int J Clin Pract.1999;53: 122-129.
  5. Wolff I,van Croonenborg JJ,Kemper HC,Kostense PJ,Twisk JW.The effect of exercise training programs on bone mass:a meta-analysis of published controlled trials in pre-and postmenopausal women.Osteoporos Int.1999;9:1-12.

 Bone Density Measurement


  1. Cummings SR,Palermo L,Browner W,et al (Fracture Intervention Trial Research Group).Monitoring osteoporosis therapy with bone densitometry: misleading changes and regression to the mean.JAMA.2000;283:1318-1321.
  2. Garton MJ,Cooper C,Reid D. Perimenopausal bone density screening will it help prevent osteoporosis? Maturitas.1997;26:35-43.
  3. Orwoll ES,Bauer DC,Vogt TM,Fox KM (Osteoporotic Fractures Research Group).Axial bone mass in older women.Ann Intern Med.1996;124:187-196.
  4. Wasnich RD,Miller PD. Antifracture efficacy of antiresorptive agents are related to changes in bone density.J Clin Endocrinol Metab.2000;85:231-236.
  5. Watts NB. Understanding the bone mass measurement act. J Clin Densitom.1999;2:211-217.

 Biochemical Markers of Bone Turnover in Osteoporosis


  1. Garnero P,Delmas PD. Biochemical markers of bone turnover:applications for osteoporosis.Endocrinol Metab Clin North Am.1998;27:303-323.
  2. Hannon R,Blumsohn A,Naylor K,Eastell R. Response of biochemical markers of bone turnover to hormone replacement therapy:impact of biological variability. J Bone Miner Res.1998;13:1124-1133.
  3. Looker AC,Bauer DC,Chesnut CH III,et al. Clinical use of biochemical markers of bone remodeling: current status and future directions. Osteoporos Int.2000;11:467-480.




  1. Black DM,Cummings SR,Karpf DB,et al (Fracture Intervention Trial Research Group). Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures.Lancet.1996;348:1535-1541.
  2. Black DM,Thompson DE,Bauer DC,et al (FIT Research Group). Fracture risk reduction with alendronate in women with osteoporosis:the Fracture Intervention Trial. J Clin Endocrinol Metab.2000;85:4118-4124.
  3. Cummings SR,Black DM,Thompson DE, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial.JAMA.1998;280:2077-2082.
  4. de Groen PC,Lubbe DF,Hirsch LJ, et al. Esophagitis associated with the use of alendronate.N Engl J Med. 1996;335:1016-1021.
  5. Devogelaer JP,Broll H,Correa-Rotter R, et al. Oral alendronate induces progressive increases in bone mass of the spine, hip, and total body over 3 years in postmenopausal women with osteoporosis [erratum in Bone.  1996;19:78 ].Bone.1996;18:141-150.
  6. Downs RW Jr,Bell NH,Ettinger MP, et al. Comparison of alendronate and intranasal calcitonin for treatment of osteoporosis in postmenopausal women. J Clin Endocrinol Metab.2000;85:1783-1788.
  7. Ensrud KE,Black DM,Palermo L, et al. Treatment with alendronate prevents fractures in women at highest risk: results from the Fracture Intervention Trial.Arch Intern Med.1997;157:2617-2624.
  8. Felsenberg D,Alenfeld F,Bock O,Hammermeister C, Gowan W (Fosamax International Trial [FOSIT ]Study Group). Placebo-controlled multicenter study of oral alendronate in postmenopausal osteoporotic women. Maturitas.1998;31:35-44.
  9. Hosking D,Chilvers CE,Christiansen C,et al (Early Postmenopausal Intervention Cohort Study Group). Prevention of bone loss with alendronate in postmenopausal women under 60 years of age. N Engl J Med. 1998;338:485-492.
  10. Karpf DB,Shapiro DR,Seeman E, et al (Alendronate Osteoporosis Treatment Study Groups). Prevention of nonvertebral fractures by alendronate:a meta-analysis. JAMA.1997;277:1159-1164.
  11. Liberman UA,Weiss SR,Broll J, et al (Alendronate Phase III Osteoporosis Treatment Study Group). Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis.N Engl J Med.1995;333:1437-1443.
  12. Lowe CE,Depew WT,Vanner SJ,Paterson WG, Meddings JB. Upper gastrointestinal toxicity of alendronate. Am J Gastroenterol.2000;95:634-640.
  13. Pols HA,Felsenberg D,Hanley DA,et al (Fosamax International Trial Study Group). Multinational, placebo-controlled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results of the FOSIT study. Osteoporos Int.1999;9:461-468.
  14. Ravn P,Weiss SR,Rodriguez-Portales JA, et al (Alendronate Osteoporosis Prevention Study Group). Alendronate in early postmenopausal women:effects on bone mass during long-term treatment and after withdrawal. J Clin Endocrinol Metab.2000;85:1492-1497.
  15. Ribeiro A,DeVault KR,Wolfe JT III,Stark ME. Alendronate-associated esophagitis:endoscopic and pathologic features. Gastrointest Endosc.1998;47:525-528.
  16. Saag KG,Emkey R,Schnitzer TJ,et al (Glucocorticoid Induced Osteoporosis Intervention Study Group). Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis.N Engl J Med.1998;339:292-299.
  17. Schnitzer T,Bone HG,Crepaldi G, et al (Alendronate Once-Weekly Study Group). Therapeutic equivalence of alendronate 70 mg once-weekly and alendronate 10 mg daily in the treatment of osteoporosis.Aging (Milano).2000;12:1-12.
  18. Stock JL,Bell NH,Chesnut CH III, et al. Increments in bone mineral density of the lumbar spine and hip and suppression of bone turnover are maintained after discontinuation of alendronate in postmenopausal women. Am J Med. 1997;103:291-297.
  19. Tonino RP,Meunier PJ,Emkey R,et al (Phase III Osteoporosis Treatment Study Group). Skeletal benefits of alendronate:7-year treatment of postmenopausal osteoporotic women. J Clin Endocrinol Metab.2000;85:3109-3115.
  20. Watts N,Freedholm D,Daifotis A. The clinical tolerability profile of alendronate.Int J Clin Pract Suppl.1999; 101:51-61.



  1. Cohen S,Levy RM,Keller M, et al. Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo controlled, parallel-group study. Arthritis Rheum.1999;42:2309-2318.
  2. Eastell R,Devogelaer JP,Peel NF, et al. Prevention of bone loss with risedronate in glucocorticoid-treated rheumatoid arthritis patients.Osteoporos Int.2000;11:331-337.
  3. Harris ST,Watts NB,Genant HK, et al (Vertebral Efficacy With Risedronate Therapy [VERT ]Study Group). Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis:a randomized controlled trial.JAMA.1999;282:1344-1352.
  4. McClung MR,Geusens P,Miller PD, et al (Hip Intervention Program Study Group).Effect of risedronate on the risk of hip fracture in elderly women.N Engl J Med.2001;344:333-340.
  5. Reginster J,Minne HW,Sorensen OH, et al (Vertebral Efficacy with Risedronate Therapy [VERT ]Study Group). Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis.Osteoporos Int.2000;11:83-91.
  6. Reid DM,Hughes RA,Laan RF, et al. Efficacy and safety of daily risedronate in the treatment of corticosteroid induced osteoporosis in men and women: a randomized trial;European Corticosteroid-Induced Osteoporosis Treatment Study.J Bone Miner Res.2000;15:1006-1013.
  7. Watts N,Roux C,Genant H, et al. Risedronate reduces vertebral fracture risk after the first year of treatment in postmenopausal women with established osteoporosis.J Bone Miner Res.1999;14:S136.


Other Bisphosphonates


  1. Heikkinen JE,Selander KS,Laitinen K,Arnala I, Vaananen HK. Short-term intravenous bisphosphonates in prevention of postmenopausal bone loss.J Bone Miner Res.1997;12:103-110.
  2. Lees B,Garland SW,Walton C,Ross D,Whitehead MI, Stevenson JC. Role of oral pamidronate in preventing bone loss in postmenopausal women.Osteoporos Int. 1996;6:480-485.
  3. Miller PD,Watts NB,Licata AA, et al. Cyclical etidronate in the treatment of postmenopausal osteoporosis: efficacy and safety after seven years of treatment [erratum in Am J Med.1998;104:608 ].Am J Med.1997;103: 468-476.
  4. Orr-Walker B,Wattie DJ,Evans MC,Reid IR. Effects of prolonged bisphosphonate therapy and its discontinuation on bone mineral density in post-menopausal osteoporosis. Clin Endocrinol (Oxf).1997;46:87-92.
  5. Peretz A,Body JJ,Dumon JC, et al. Cyclical pamidronate infusions in postmenopausal osteoporosis. Maturitas.1996;25:69-75.
  6. Recker RR,Stakkestad JA,Felsenberg D, et al. A new treatment paradigm:quarterly injections of ibandronate reduce the risk of fractures in women with postmenopausal osteoporosis (PMO):results of a 3-year trial.Osteoporos Int.2000;11:S209.
  7. Roux C,Oriente P,Laan R, et al (Ciblos Study Group). Randomized trial of effect of cyclical etidronate in the prevention of corticosteroid-induced bone loss.J Clin Endocrinol Metab.1998;83:1128-1133.
  8. Watts NB. Treatment of osteoporosis with bisphosphonates. Endocrinol Metab Clin North Am.1998;27:419-439.




  1. Chesnut CH III,Silverman S,Andriano K, et al (PROOF Study Group). A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis:the Prevent Recurrence of Osteoporotic Fractures Study.Am J Med.2000;109:267-276.

 Estrogen and Hormone Replacement Therapy

  1. WHI (Women’s Health Initiative) Writing Group for the Women’s Health Initiative Investigators.  Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002;288:321-333.

2.      HERS (Heart and Estrogen/Progestin Replacement Study) Herrington DM, Vittinghoff E, Lin F, et al, for the HERS Study Group. Statin therapy, cardiovascular events, and total mortality in the Heart and Estrogen/Progestin Replacement Study (HERS). Circulation 2002; 105:2962-2967.

  1. HERS II (Heart and Estrogen/Progestin Replacement Study) Grady D, Herrington D, Bittner V, et al, for the HERS Research Group. Cardiovascular disease out-comes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 2002;288:49-57.
  2. WEST (Women’s Estrogen for Stroke Trial) Viscoli CM, Brass LM, Kernan WN, Sarrel PM, Suissa S, Horwitz RI. A clinical trial of estrogen-replacement therapy after ischemic stroke. N Engl J Med 2001;345:1243-1249.
  3. Nurses’ Health Study Grodstein F, Manson JE, Colditz GA, Willett WC, Speizer FE, Stampfer MJ. A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease. Ann Intern Med 2000;133:933-941.
  4. HOPE (Women’s Health, Osteoporosis, Progestin,Estrogen trial) Archer DF, Dorin M, Lewis V, Schneider DL, Pickar JH. Effects of lower doses of conjugated equine estrogens and medroxyprogesterone acetate on endometrial bleeding. Fertil Steril 2001;75:1080-1087.
  5. ERA (Estrogen Replacement and Atherosclerosis trial) Herrington DM, Reboussin DM, Brosnihan KB, et al. Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med 2000; 343:522-529.
  6. EPAT (Estrogen in the Prevention of Atherosclerosis Trial) Hodis HN, Mack WJ, Lobo RA, et al, for Estrogen in the Prevention of Atherosclerosis Trial Research Group. Estrogen in the prevention of atherosclerosis: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2001;135:939-953.
  7. MORE (Multiple Outcomes of Raloxifene Evaluation) Barrett-Connor E, Grady D, Sashegyi A, et al, for the MORE Investigators (Multiple Outcomes of Raloxifene Evaluation). Raloxifene and cardiovascular events in osteoporotic postmenopausal women: four-year results from the MORE (Multiple Outcomes of Raloxifene Evaluation) randomized trial. JAMA 2002;287: 847-857.
  8. PEPI (Postmenopausal Estrogen/Progestin Interventions study) Barrett-Connor E, Slone S, Greendale G, et al. The Postmenopausal Estrogen/Progestin Interventions Study: primary outcomes in adherent women. Maturitas 1997;27:261-274.
  9. SWAN (Study of Women’s Health Across the Nation) Huang M-H, Schocken M, Block G, et al. Variation in nutrient intakes by ethnicity: results from the Study of Women’s Health Across the Nation (SWAN).Menopause 2002;9:309-319.
  10. FIT (Fracture Intervention Trial) Black DM, Thompson DE, Bauer DC, et al, for the Fracture Intervention Trial. Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial [erratum appears in J Clin Endocrinol Metab 2001;86:938]. J Clin Endocrinol Metab 2000;85:4118-4124.
  11. VERT (Vertebral Efficacy With Risedronate Therapy study group) Harris ST, Watts NB, Genant HK, et al, for the Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 1999;282:1344-1352.
  12. HIP (Hip Intervention Program study group) McClung MR, Geusens P, Miller PD, et al. Effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med 2001;344:333-340.


Combination Pharmacologic Therapy


  1. Lindsay R,Cosman F,Lobo RA, et al. Addition of alendronate to ongoing hormone replacement therapy in the treatment of osteoporosis: a randomized, controlled clinical trial.J Clin Endocrinol Metab.1999;84:3076-3081.
  2. Ravn P,Bidstrup M,Wasnich RD, et al. Alendronate and estrogen-progestin in the long-term prevention of bone loss: four-year results from the early postmenopausal intervention cohort study; a randomized, controlled trial. Ann Intern Med.1999;131:935-942.

 Unapproved Pharmacologic Agents


  1. Feskanich D,Willett WC,Stampfer MJ,Colditz GA. A prospective study of thiazide use and fractures in women. Osteoporos Int.1997;7:79-84.
  2. Finkelstein JS,Klibanski A,Arnold AL,Toth TL, Hornstein MD,Neer RM. Prevention of estrogen deficiency-related bone loss with human parathyroid hormone (1-34):a randomized controlled trial.JAMA.1998;280: 1067-1073.
  3. Gambacciani M,Cappagli B,Piaggesi L,Ciaponi M, Genazzani AR. Ipriflavone prevents the loss of bone mass in pharmacological menopause induced by GnRH-agonists. Calcif Tissue Int.1997;61(Suppl 1):S15-S18.
  4. Gambacciani M,Ciaponi M,Cappagli B,Piaggesi L, Genazzani AR. Effects of combined low dose of the isoflavone derivative ipriflavone and estrogen replacement on bone mineral density and metabolism in postmenopausal women.Maturitas.1997;28:75-81.
  5. Gennari C,Agnusdei D,Crepaldi G, et al. Effect of ipriflavone a synthetic derivative of natural isoflavones on bone mass loss in the early years after menopause. Menopause.1998;5:9-15.
  6. Hodsman AB,Fraher LJ,Watson PH, et al. A randomized controlled trial to compare the efficacy of cyclical parathyroid hormone versus cyclical parathyroid hormone and sequential calcitonin to improve bone mass in postmenopausal women with osteoporosis.J Clin Endocrinol Metab.1997;82:620-628.
  7. Ishimi Y,Miyaura C,Ohmura M, et al. Selective effects of genistein,a soybean isoflavone,on B-lymphopoiesis and bone loss caused by estrogen deficiency.Endocrinology.1999;140:1893-1900.
  8. Lindsay R,Nieves J,Formica C, et al. Randomised controlled study of effect of parathyroid hormone on vertebral bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis.Lancet.1997;350: 550-555.
  9. Lippuner K,Haenggi W,Birkhaeuser MH,Casez JP, Jaeger P. Prevention of postmenopausal bone loss using tibolone or conventional peroral or transdermal hormone replacement therapy with 17beta-estradiol and dydrogesterone.J Bone Miner Res.1997;12:806-812.
  10. Meunier PJ,Sebert JL,Reginster JY, et al. Fluoride salts are no better at preventing new vertebral fractures than calcium-vitamin D in postmenopausal osteoporosis: the FAVO Study.Osteoporos Int.1998;8:4-12.
  11. Pak CY,Zerwekh JE,Antich PP,Bell NH,Singer FR. Slow-release sodium fluoride in osteoporosis.J Bone Miner Res.1996;11:561-564.
  12. Pavlov PW,Ginsburg J,Kicovic PM,van der Schaaf DB,Prelevic G,Bennink HJ. Double-blind, placebo-controlled study of the effects of tibolone on bone mineral density in postmenopausal osteoporotic women with and without previous fractures.Gynecol Endocrinol.1999;13:230-237.
  13. Reginster JY,Meurmans L,Zegels B, et al. The effect of sodium monofluorophosphate plus calcium on vertebral fracture rate in postmenopausal women with moderate osteoporosis:a randomized,controlled trial. Ann Intern Med.1998;129:1-8.
  14. Studd J,Arnala I,Kicovic PM,Zamblera D,Kroger H, Holland N.A randomized study of tibolone on bone mineral density in osteoporotic postmenopausal women with previous fractures.Obstet Gynecol.1998;92(4 Pt 1):574-579.


ANNEXTURE 8 : DIRECTIONS FOR FURTHER RESEARCH                                            GO-TOP

There is only one corner of the universe you can be certain of improving, and that’s your own self.
- Aldous Huxley

 The following issues need to be addressed:

  1. To identify genetic factors leading to osteoporosis.
  2. To develop pharmacogenetic approaches for targeting the predisposing genetic factors.
  3. To develop strategies to maximize peak bone mass in girls and boys.
  4. More research regarding the impact of various risk factors on bone mass.
  5. To determine mechanism, extent of impact of steroid induced osteoporosis.  To develop steroid with least adverse effects on skeletal system.  To develop new pharmacological approaches to stimulate bone formation in this condition.
  6. Further research on the use of biphosphonates or other drugs in secondary osteoporosis.
  7. Trials of dietary supplements.
  8. Improved detection methods and reporting of BMD and fracture risk.
  9. To determine long term effects of fractures on individuals and society.
  10. To determine the effects of micronutrients on bone health and conduct trials of dietary supplement containing these micronutrients.
  11. To develop most effective tool for community screening of osteoporosis which is cost-effective.
  12. Development  and assessment of agents stimulating bone formation.
  13. To develop health education program for community and health professionals.
  14. To study consequences of osteoporosis related fractures on non-skeletal body systems.
  15. To determine the causes of disease in perimenopausal women.
  16. Development of a combination therapy using antiresorptive and anabolic (bone forming) medications.
  17. Identification of patients for diagnosis and treatment.  To determine which asymptomatic patient should have BMD screening.
  18. To assure accessibility to treatment for people specially in developing countries.
  19. To determine diagnosis and management paradigm for osteoporotic fractures.
  20. Randomized clinical trials of combination therapies comprising of pharmacological, dietary supplement and lifestyle interventions.
  21. To determine optimum duration of pharmacological therapies.
  22. To determine cost effectiveness of recommended strategies on fall preventions.
  23. To determine the effect of restraint removal, coupled with other interventions on falls related injuries.
  24. To determine effective elements of exercise programs and cardiovascular programs for fall prevention.
  25. To determine the effectiveness of assistive devices med alone as a method for preventing falls. 

ANNEXTURE 9 : RESOURCES                                                                                   GO-TOP

The foundation of every state is the education of its youth.
                                                                                               -  Diogenes.

 The following are major sources of health education, information on patient groups, self-help aids and equipment.

  1. National Osteoporosis Foundation : 1150 17th street, NW Suite 500, Washington, DC 20036.
  2. US Arthritis Foundation : 1314 Spring St. New Atlanta, 6A 30309, USA.
  3. Institute Of Arthritis Care And Prevention : Ashirwad Hospital, Almas Mension, SVP Road, New Colony, Ambernath (W), Dist : Thane State : Maharashtra.
  4. Indian Rheumatism Association : Headquarters, PD Hinduja Hospital and Medical Research centre, Mumbai Maharashtra.
  5. Rehabilitation International USA : 1123, Broadway, New York, NY 10010 USA.
  6. American Occupational Therapy Association : 6000 Executive Bldg. Rockville, MD 20852 USA.
  7. Arthritis Society : 920 Yonge St., Stc. 420, Toronto, Ontario M5E, 1E6 Canada.
  8. National Association Of The Physically Handicapped, Inc. : 76 Elm. St. London, Ohio 43140 USA.
  9. National Information Center For The Handicapped : PO Box 1492, Washington DC 20013 USA.
  10. National Safety Council Dept. : H.P.O. Box 11171, Chicago, IL 60611 USA.
  11. Public Affairs Committee, Inc. (pamphlet publishers) : 381 Park Avenue South New York, NY 10016 USA.
  12. British Rheumatism And Arthritis Association : 6, Grosvenor Square, London SW1.
  13. The Arthritis And Rheumatism Council : Fouaday House, 8/10 Charing Cross Road, London WC 2.
  14. Clearinghouse On The Handicapped : Office of special education and rehabilitative services, Room 3106, Switzer Bldg., 330 C St SW, Washington, DC 20202.
  15. Disabled USA : The president’s committee on employment of the handicapped, Washington, DC 20210.
  16. Encore National Library : Service for the blind and physically handicapped, Library of congress, Washington, DC 20540 Bi-monthly recording for talking books, readers of selections for publications for the disabled.
  17. National Rehabilitation Information Center : 4407, Eight Street, NW, Catholic University of America, Washington, DC 20017.    














This website is best viewed in 1024 X 768 resolution