Or Pui Ching. / Thesis submitted in: December 1999. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaves 174-201). / Abstracts in English and Chinese. / acknowledgement --- p.i / abstract (english version) --- p.ii / abstract (chinese version) --- p.vii / table of contents --- p.xi / abbreviations --- p.xvi / list of tables --- p.xviii / list of figures --- p.xxii / Chapter chapter 1. --- introduction --- p.1 / Chapter chapter 2. --- literature review --- p.3 / Chapter 2.1. --- Bone structure --- p.3 / Chapter 2.1.1. --- Composition --- p.3 / Chapter 2.1.2. --- Cortical and Trabecular bone --- p.3 / Chapter 2.2. --- Bone Remodeling --- p.4 / Chapter 2.3. --- Bone Mass --- p.5 / Chapter 2.3.1. --- Peak Bone Mass --- p.5 / Chapter 2.3.1.1. --- Racial and Genetic Factors --- p.5 / Chapter 2.3.1.2. --- Gonadal Factors --- p.6 / Chapter 2.3.1.3. --- Nutrition Factors --- p.6 / Chapter 2.3.1.4. --- Exercise and Physical Activity --- p.7 / Chapter 2.3.2. --- Bone Loss --- p.7 / Chapter 2.3.2.1. --- Determinants of Osteoporotic Bone Loss --- p.7 / Chapter 2.3.2.2. --- Estrogen Deficiency --- p.8 / Chapter 2.3.2.3. --- Dietary Calcium deficiency and Vitamin D deficiency --- p.8 / Chapter 2.3.2.4. --- Physical Activity --- p.9 / Chapter 2.3.2.5. --- Alcoholism and Smoking --- p.9 / Chapter 2.3.2.6. --- Disease-specific Osteoporosis --- p.9 / Chapter 2.3.2.7. --- Drug-induced Osteoporosis --- p.10 / Chapter 2.3.3. --- Bone Mass and Fracture Risk --- p.11 / Chapter 2.4. --- Clinical Presentation of Osteoporosis --- p.12 / Chapter 2.4.1. --- Vertebral Fractures --- p.12 / Chapter 2.4.1.1. --- Radiological Aspects of Vertebral Fracture --- p.13 / Chapter 2.4.1.1.1. --- Changes in Trabecular Pattern --- p.13 / Chapter 2.4.1.1.2. --- Changes in Shape of the Vertebral bodies --- p.13 / Chapter 2.4.1.1.3. --- Changes of Intervertebral Discs --- p.14 / Chapter 2.4.1.2. --- Back Pain --- p.15 / Chapter 2.4.2. --- Hip Fractures --- p.15 / Chapter 2.4.3. --- Quality of Life --- p.16 / Chapter 2.5. --- Treatment of Established Osteoporosis --- p.18 / Chapter 2.5.1. --- Pain Relief --- p.18 / Chapter 2.5.2. --- Drug Therapy --- p.19 / Chapter 2.5.2.1. --- Calcium Supplement --- p.19 / Chapter 2.5.2.2. --- Vitamin D --- p.20 / Chapter 2.5.2.3. --- Estrogen --- p.21 / Chapter 2.5.2.4. --- Fluorides --- p.22 / Chapter 2.5.2.5. --- Calcitonin --- p.23 / Chapter 2.5.2.6. --- Bisphosphonates --- p.24 / Chapter 2.5.2.6.1. --- Physicochemical effects --- p.27 / Chapter 2.5.2.6.2. --- Mechanisms --- p.27 / Chapter 2.5.2.6.3. --- Therapeutic Use --- p.27 / Chapter 2.5.2.6.4. --- Side effects --- p.29 / Chapter 2.5.2.6.5. --- Alendronate --- p.30 / Chapter 2.5.2.7. --- Summary of drug treatment --- p.33 / Chapter 2.6. --- Diagnostic Methods of Osteoporosis --- p.40 / Chapter 2.6.1. --- Biochemical Markers of Bone Metabolism in Osteoporosis --- p.40 / Chapter 2.6.1.1. --- Bone Formation Markers --- p.41 / Chapter 2.6.1.1.1. --- Bone-specific Alkaline Phosphatase (bALP) --- p.41 / Chapter 2.6.1.2. --- Bone Resorption Markers --- p.42 / Chapter 2.6.1.2.1. --- Deoxypyridinoline (Dpd) --- p.43 / Chapter 2.6.2. --- Bone Densitometry --- p.45 / Chapter 2.6.2.1. --- Dual Energy X-ray Absorptiometry (DEXA) --- p.45 / Chapter 2.6.2.2. --- Peripheral Quatitative Computed Tomography (pQCT) --- p.47 / Chapter 2.6.2.3. --- Quantitative Ultrasound (QUS) --- p.48 / Chapter 2.6.3. --- Summary of Diagnostic Methods --- p.49 / Chapter chapter 3. --- methodology --- p.50 / Chapter 3.1. --- Study on Vertebral Structures --- p.51 / Chapter 3.1.1. --- Procedures --- p.51 / Chapter 3.1.2. --- Data analysis --- p.53 / Chapter 3.2. --- Alendronate Treatment --- p.54 / Chapter 3.2.1. --- Subject Selection --- p.54 / Chapter 3.2.2. --- Study design and drug administration --- p.55 / Chapter 3.2.3. --- Bone Densitometry --- p.56 / Chapter 3.2.3.1. --- Dual Energy X-ray absorptiometry --- p.56 / Chapter 3.2.3.2. --- Peripheral Quantitative Computed Tomography (pQCT) --- p.58 / Chapter 3.2.4. --- Biochemical Markers --- p.63 / Chapter 3.2.4.1. --- Bone formation marker --- p.63 / Chapter 3.2.4.2. --- Bone resorption marker --- p.64 / Chapter 3.2.5. --- Quality of Life --- p.65 / Chapter 3.2.6. --- New fracture assessment --- p.66 / Chapter 3.2.7. --- Statistical analysis --- p.67 / Chapter 3.3. --- Proximal femur fracture study --- p.68 / Chapter 3.3.1. --- Subject and study design --- p.69 / Chapter 3.3.2. --- Statistical analysis --- p.70 / Chapter chapter 4. --- results of study on vertebral structures --- p.71 / Chapter 4.1. --- Results of morphological change of vertebral bodes in osteoporotic patients --- p.71 / Chapter 4.2. --- Morphological changes of intervertebral discs --- p.71 / Chapter 4.3. --- Correlation between morphological changes of vertebrae and bulging ratio --- p.72 / Chapter chapter 5. --- results of alendronate study --- p.76 / Chapter 5.1. --- Baseline measurement --- p.76 / Chapter 5.1.1. --- Demographic characteristics --- p.76 / Chapter 5.1.2. --- Reasons for admission --- p.77 / Chapter 5.1.3. --- Social support --- p.77 / Chapter 5.1.4. --- Number of vertebral fracture(s) --- p.78 / Chapter 5.1.5. --- BMD measurement (Baseline) --- p.79 / Chapter 5.1.5.1. --- BMD of Lumbar spine and Hip (measured by DEXA) --- p.79 / Chapter 5.1.5.2. --- BMD of distal tibia and radius measured by pQCT --- p.80 / Chapter 5.1.6. --- Biochemical Markers (Bone formation and resorption) --- p.86 / Chapter 5.2. --- After treatment --- p.88 / Chapter 5.2.1. --- Bone mineral density measurement (measured by DEXA) --- p.90 / Chapter 5.2.1.1. --- Lumbar spine --- p.90 / Chapter 5.2.1.2. --- Femoral Neck --- p.93 / Chapter 5.2.1.3. --- Trochanter --- p.95 / Chapter 5.2.1.4. --- Ward's Triangle --- p.98 / Chapter 5.2.1.5. --- Summary --- p.101 / Chapter 5.2.2. --- Bone Mineral Density measured by pQCT --- p.103 / Chapter 5.2.2.1. --- Distal Radius (Program 1) --- p.103 / Chapter 5.2.2.1.1. --- BMD change of D50 --- p.103 / Chapter 5.2.2.1.2. --- BMD changes of D100 --- p.106 / Chapter 5.2.2.1.3. --- BMD change of P100 --- p.108 / Chapter 5.2.2.2. --- Distal Radius (Program 2) --- p.111 / Chapter 5.2.2.2.1. --- BMD change of pure trabecular bone --- p.112 / Chapter 5.2.2.2.2. --- BMD changes of pure cortical bone --- p.114 / Chapter 5.2.2.3. --- Distal Tibia (Program 1) --- p.118 / Chapter 5.2.2.3.1. --- BMD changes of D50 --- p.118 / Chapter 5.2.2.3.2. --- BMD changes of D100 --- p.121 / Chapter 5.2.2.3.3. --- BMD changes of P100 --- p.124 / Chapter 5.2.2.4. --- Distal Tibia (Program 2) --- p.128 / Chapter 5.2.2.4.1. --- BMD changes of pure trabecular bone --- p.128 / Chapter 5.2.2.4.2. --- BMD changes of pure cortical bone --- p.131 / Chapter 5.2.3. --- Bone turnover --- p.135 / Chapter 5.2.3.1. --- Bone Resorption Marker (urinary Deoxypyridinoline) --- p.135 / Chapter 5.2.3.2. --- Bone Formation Marker (Bone Specific Alkaline Phosphatase) --- p.137 / Chapter 5.2.4. --- Quality of Life (QOL) --- p.139 / Chapter 5.2.5. --- Oswestry Disability Index (ODI) --- p.139 / Chapter 5.2.6. --- Pain --- p.141 / Chapter 5.2.6.1. --- Pain frequency --- p.141 / Chapter 5.2.6.2. --- Night Pain --- p.142 / Chapter 5.2.6.3. --- Administration of pain relief drugs --- p.143 / Chapter 5.2.7. --- Activity of daily living --- p.144 / Chapter 5.2.8. --- Prevention of new vertebral fracture(s) --- p.146 / Chapter 5.2.9. --- Safety and Tolerability --- p.147 / Chapter chapter 6. --- results on proximal femoral fractures study --- p.149 / Chapter 6.1. --- Epidemiological study on proximal femoral fractures --- p.149 / Chapter 6.2. --- The role of ultrasound equipment in the assessment osteoporosis in patients with proximal femoral fractures --- p.154 / Chapter 6.3. --- Summary --- p.155 / Chapter chapter 7. --- discussion --- p.156 / Chapter 7.1. --- The study on vertebral structures --- p.156 / Chapter 7.1.1. --- Changes in Shape of Vertebral Bodies --- p.156 / Chapter 7.1.2. --- Changes of Interevertbral Discs --- p.157 / Chapter 7.2. --- Alendronate treatment on Chinese elderly women with Osteoporotic vertebral fracture --- p.158 / Chapter 7.2.1. --- The Effect of Alendronate on BMD of Lumbar Spine --- p.159 / Chapter 7.2.2. --- The Effects of Alendronate on BMD of Proximal Femur --- p.159 / Chapter 7.2.3. --- The Effects of Alendronate on the BMD of Trabecular and Cortical Bone in the Distal Radius and Distal Tibia --- p.160 / Chapter 7.2.4. --- The Effects of Calcium Supplementation in the study --- p.162 / Chapter 7.2.5. --- The Effect of alendronate on Biochemical Turnover --- p.162 / Chapter 7.2.6. --- The Efficacy of Alendronate on Prevention of New Fractures --- p.163 / Chapter 7.2.7. --- The Effect of Alendronate on Quality of Life --- p.164 / Chapter 7.2.8. --- Adverse Effects of Alendronate --- p.165 / Chapter 7.3. --- Proximal Femur Fracture Study --- p.165 / Chapter chapter 8. --- conclusion --- p.168 / bibliography --- p.174 / epilogue --- p.202 / appendix --- p.xxv

by Chan Kwai Foon May. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaves 103-114). / Abstracts in English and Chinese. / Declaration --- p.2 / Abstract --- p.3 / Abstract in Chinese --- p.6 / Acknowledgements --- p.8 / Chapter Chapter 1. --- Introduction --- p.15 / Chapter Chapter 2. --- Osteoporosis : The relationship between aging and skeletal organization between men and women --- p.17 / Chapter 2.1. --- Skeletal organization --- p.17 / Chapter 2.1.1. --- Bone structure --- p.17 / Chapter 2.1.2. --- Bone metabolism --- p.17 / Chapter 2.1.3. --- Peak bone mass --- p.18 / Chapter 2.2. --- Bone loss between men and women --- p.20 / Chapter 2.2.1. --- Aging and bone loss --- p.20 / Chapter 2.2.2. --- Clinical aspects of bone loss in men and women --- p.21 / Chapter Chapter 3. --- Vertebral deformity : Bone Mineral Density and Body Composition --- p.23 / Chapter 3.1. --- Bone mineral density --- p.23 / Chapter 3.1.1. --- Types of vertebral deformity --- p.23 / Chapter 3.1.2. --- Clinical diagnosis in vertebral deformity --- p.24 / Chapter 3.1.3. --- Bone mineral density measurements --- p.25 / Chapter 3.1.4. --- Vertebral deformity and bone mineral density --- p.28 / Chapter 3.2. --- Bone composition --- p.33 / Chapter Chapter 4. --- Literature Review on Health Consequences of Vertebral Deformity --- p.36 / Chapter 4.1. --- Back pain --- p.36 / Chapter 4.1.1. --- Back pain and vertebral deformity --- p.36 / Chapter 4.1.2. --- Back pain in men and women with vertebral deformity --- p.38 / Chapter 4.2. --- Morale and functional limitation and vertebral deformities --- p.39 / Chapter 4.2.1. --- Function evaluation : The Barthel Index --- p.40 / Chapter 4.2.2. --- Philadelphia Geriatric Morale Scale --- p.41 / Chapter Chapter 5. --- Objectives --- p.43 / Chapter Chapter 6. --- "Subjects and methods for phase I: anthropometric measurement, body composition and bone mineral density measurement in vertebral deformity patients and controls" --- p.44 / Chapter 6.1. --- Study subjects --- p.44 / Chapter 6.2. --- Radiology and digitization protocol for diagnosis vertebral deformity --- p.46 / Chapter 6.3. --- Diagnosis of vertebral deformity --- p.48 / Chapter 6.4. --- Body composition and bone mineral density measurements --- p.54 / Chapter 6.4.1. --- Body composition analysis --- p.54 / Chapter 6.4.2. --- Lumbar spine and hip bone mineral analysis --- p.54 / Chapter 6.5. --- Quality control --- p.56 / Chapter 6.5.1. --- Routine quality control of measurements --- p.56 / Chapter 6.5.2. --- Precision on patient repositioning --- p.56 / Chapter Chapter 7. --- Subjects and methods for phase II: health consequences of vertebral deformity patients and controls --- p.57 / Chapter 7.1. --- Questionnaire on health consequences --- p.57 / Chapter 7.1.1 --- Back pain and disability --- p.57 / Chapter 7.1.2 --- Activities of daily living --- p.59 / Chapter 7.1.3 --- Morale --- p.59 / Chapter 7.2. --- Statistical methods --- p.60 / Chapter 7.2.1. --- Bone mineral density and body composition --- p.60 / Chapter 7.2.2. --- Back pain and disability --- p.60 / Chapter 7.2.3. --- Activities of daily living and morale --- p.61 / Chapter Chapter 8. --- "Results for phase I: anthropometric measurement, body composition and bone mineral density measurement in vertebral deformity patients and controls" --- p.62 / Chapter 8.1. --- Demographic characteristics of study population --- p.62 / Chapter 8.2. --- Anthropometric measurements : Body composition and bone mineral density --- p.64 / Chapter Chapter 9. --- Results for phase II: Health Consequences of vertebral deformity patients and control --- p.76 / Chapter 9.1. --- Back pain --- p.76 / Chapter 9.2. --- Disability --- p.78 / Chapter 9.3. --- Activities of daily living --- p.81 / Chapter 9.4. --- Morale --- p.82 / Chapter Chapter 10. --- Discussion I --- p.83 / Chapter 10.1. --- Study Sample --- p.83 / Chapter 10.2. --- Digitization method and definition of vertebral deformity --- p.84 / Chapter 10.3. --- Methods for bone mineral density measurement --- p.87 / Chapter 10.4. --- Questionnaire validity --- p.88 / Chapter 10.4.1. --- Back pain and disability --- p.88 / Chapter 10.4.2. --- Barthel Index --- p.88 / Chapter 10.4.3. --- Philadelphia Geriatric Morale Scale --- p.89 / Chapter Chapter 11. --- Discussion II --- p.92 / Chapter 11.1 . --- Body composition and bone mineral density --- p.92 / Chapter 11.2. --- Differences of vertebral deformity between Chinese men and Caucasian men --- p.93 / Chapter 11.3. --- Health consequences in Chinese men --- p.96 / Chapter 11.4. --- Comparison of health consequences between Chinese men and Caucasian men --- p.98 / Chapter 11.5. --- Variation of health consequences between Chinese men and Chinese women --- p.101 / Chapter 11.5.1. --- Back pain and disability --- p.101 / Chapter 11.5.2. --- Morale --- p.102 / Chapter Chapter 12. --- Conclusion --- p.103 / Reference --- p.104 / Appendix I --- p.115 / Appendix II Publication