Exercise in the prevention and treatment of osteoporosis: the role of physical therapy and nursing.

Exercise plays an important role in the prevention and treatment of osteoporosis. This article cites several scientific studies that support exercise as a means of increasing bone mass and strength for the prevention of osteoporosis. The ultimate goal of intervention for individuals with osteoporosis is fracture prevention. A comprehensive approach, including exercise, is outlined in this article, and the roles of the physical therapist and nurse are discussed.

Estimation of wet, dry and bulk deposition of atmospheric nitrogen in Connecticut.

Atmospheric nitrogen species including NO3-, NH4+ and total nitrogen in air and precipitation samples were collected with low-volume filter packs and wet deposition collectors from March 1999 through the end of December 2000 in seven sampling locations in Connecticut. Three sampling locations were chosen along the shores of Long Island Sound and four were chosen in interior sections of Connecticut. Sampling sites were chosen to represent both rural and urban sectors. Wet deposition flux of nitrogen species was calculated using wet concentrations, the volume of collected precipitation and the opening surface area of the Aerochemetrics wet deposition collector. The dry deposition flux of nitrogen species was estimated with the application of the dry deposition inferential model (DDIM). Bulk deposition of nitrogen was collected with the aid of a device based on the Swedish IVL Sampler. The dry deposition fluxes of NO3-, NH4+ and total nitrogen were found to be significantly higher in urban areas than the rural sampling locations. There was, however, no significant difference between the wet deposition fluxes of different nitrogen species in rural and urban sampling locations. When inland and coastal sites were compared, the dry deposition fluxes of NH4+ and total nitrogen were significantly higher in inland locations and there was no significant difference between coastal and inland sampling locations for wet deposition fluxes of nitrogen species. No significant difference was observed between the bulk deposition and the sum of the wet and dry deposition fluxes of total nitrogen at rural sampling locations. In urban sampling locations, the bulk deposition flux of total nitrogen was significantly lower than the sum of dry and wet deposition fluxes. There appears to be a similar seasonal trend in wet and dry deposition fluxes of total nitrogen in Connecticut with high and low deposition fluxes occurring in summer and winter periods, respectively.

Short-term risedronate treatment in postmenopausal women: effects on biochemical markers of bone turnover.

The development of new biochemical markers has made it possible to assess the effects of therapeutic agents on bone turnover more rapidly and precisely. In this early phase II study, we analyzed the effects of short-term, high-dose treatment with risedronate, a potent pyridinyl bisphosphonate, on markers of bone resorption and formation. Resorption markers included urinary free deoxypyridinoline (D-Pyr) crosslinks, N-terminal telopeptide (NTx) and C-terminal telopeptide (CTx) type I collagen crosslinks. Bone formation markers included osteocalcin (OC), bone-specific alkaline phosphatase (BSAP) and the C-terminal peptide of type I procollagen (PICP). All three resorption markers showed rapid, significant (p<0.05) decreases from baseline following daily administration of 30 mg risedronate for 2 weeks. The mean decreases at 2 weeks were 28% for D-Pyr, 61% for NTx and 73% for CTx, respectively. Over the next 10 weeks after treatment, D-Pyr approached baseline while NTx and CTx remained well below baseline values. The markers of bone formation showed little change during therapy but decreased significantly at 4-10 weeks after therapy - an expected outcome of bisphosphonate therapy. Moreover, there was a significant correlation between the early effects on bone resorption markers and the delayed effects on formation markers. This study demonstrates that the approved dose of risedonate (30 mg/day) for Paget's disease is effective at decreasing bone turnover after 2 weeks of treatment, as observed by the sensitive response of bone turnover markers.

Comparison of the effects of estrogen alone and estrogen plus androgen on biochemical markers of bone formation and resorption in postmenopausal women.

The present study was undertaken to determine whether the addition of an androgen to estrogen therapy in postmenopausal women would alter the skeletal response as determined by measurements of markers of bone formation and resorption. Postmenopausal women were treated for 9 weeks with either a combination of 1.25 mg esterified estrogen and 2.5 mg methyltestosterone (E+A) or 1.25 mg conjugated equine estrogen (CEE). Both groups showed a similar decrease in urinary excretion of the bone resorption markers, deoxypyridinoline, pyridinoline, and hydroxyproline. Patients treated with CEE showed decreases in the serum markers of bone formation, bone-specific alkaline phosphatase, osteocalcin, and C-terminal procollagen peptide. In contrast, subjects treated with E+A showed increases in these markers of bone formation. CEE increased, and E+A decreased serum levels of sex hormone-binding globulin as well as triglycerides and high density lipoprotein levels. Only CEE significantly reduced low density lipoproteins. Both regimens were effective in reducing postmenopausal somatic symptoms, but only E+A had a significant effect on psychological symptoms. We conclude that short term administration of androgen with estrogen may reverse the inhibitory effects of estrogen on bone formation. Long term studies are needed to determine the relative benefits and risks of the combination of estrogen and androgen and whether this results in greater increases in bone mass and strength.