RESUMEN
Therapeutic advances in oncology have led to longer survival in many forms of cancer, including those complicated by bone metastases. When a bone metastasis is painful or when there is a risk of fracture, interventional radiology procedures can be carried out for pain control and/or stabilisation. All of these techniques can be performed under local anaesthesia. Cementoplasty and vertebroplasty are stabilisation procedures consisting in the percutaneous injection of acrylic cement into a lytic bone lesion. The effect on pain can be explained by the consolidation of weakened, fractured or pre-fractured bone, but also to a lesser extent by the toxic, chemical and thermal effect of the cement. Tumour ablation techniques include alcoholisation or thermal ablation (by heat with radiofrequency and microwave or cold by cryoablation). Percutaneous thermal ablation of bone tumours is most often performed as a palliative measure resulting in a significant and lasting reduction in symptoms. Radiofrequency ablation consists in placing needles through which an electrical current passes. Microwave ablation acts by causing very high frequency vibrations of water molecules. Cryoablation releases argon gas at the tip of the needle, forming an "ice ball" effectively destroying tumour cells. Any of these techniques can be combined to radiation therapy, performed before or after radiation. Finally, tumour embolisation can have a goal of pain control, or preparation of surgery to reduce the risk of peroperative haemorrhage.
Asunto(s)
Neoplasias Óseas/secundario , Neoplasias Óseas/terapia , Dolor en Cáncer/terapia , Fracturas Espontáneas/terapia , Radiología Intervencionista/métodos , Anestesia Local , Cementos para Huesos/uso terapéutico , Ablación por Catéter/métodos , Cementoplastia/métodos , Criocirugía/métodos , Embolización Terapéutica/métodos , Etanol/administración & dosificación , Fracturas Espontáneas/etiología , Fracturas Espontáneas/prevención & control , Hemorragia/prevención & control , Humanos , Microondas/uso terapéutico , Bloqueo Nervioso/métodos , Cuidados Paliativos/métodos , Ablación por Radiofrecuencia/métodos , Solventes/administración & dosificación , Vertebroplastia/métodosRESUMEN
In Fanconi syndrome, hypophosphatemic osteomalacia is caused by proximal renal tubule dysfunction which leads to impaired reabsorption of amino acids, glucose, urate, and phosphate. We present a rare case of a 43-year-old Korean male who was found to have insufficiency stress fracture of the femoral neck secondary to osteomalacia due to Fanconi syndrome. He had been receiving low-dose adefovir dipivoxil (ADV, 10 mg/day) for the treatment of chronic hepatitis B virus infection for 7 years and he subsequently developed severe hypophosphatemia and proximal renal tubule dysfunction. The incomplete femoral neck fracture was fixed with multiple cannulated screws to prevent further displacement of the initial fracture. After cessation of ADV and correction of hypophosphatemia with oral phosphorus supplementation, the patient's clinical symptoms, such as bone pain, muscle weakness, and laboratory findings improved.
Asunto(s)
Adenina/análogos & derivados , Antivirales/efectos adversos , Síndrome de Fanconi , Fracturas del Cuello Femoral , Fracturas Espontáneas , Hepatitis B Crónica/tratamiento farmacológico , Organofosfonatos/efectos adversos , Osteomalacia , Adenina/efectos adversos , Adenina/uso terapéutico , Adulto , Antivirales/uso terapéutico , Síndrome de Fanconi/inducido químicamente , Síndrome de Fanconi/complicaciones , Fracturas del Cuello Femoral/diagnóstico por imagen , Fracturas del Cuello Femoral/etiología , Fracturas del Cuello Femoral/fisiopatología , Fracturas del Cuello Femoral/terapia , Fracturas Espontáneas/diagnóstico por imagen , Fracturas Espontáneas/etiología , Fracturas Espontáneas/fisiopatología , Fracturas Espontáneas/terapia , Humanos , Masculino , Organofosfonatos/uso terapéutico , Osteomalacia/diagnóstico por imagen , Osteomalacia/etiología , Osteomalacia/fisiopatología , Osteomalacia/terapiaRESUMEN
AIMS AND OBJECTIVES: The aim of this integrative literature review is to identify themes associated with improved patient outcomes related to orthogeriatric co-managed inpatient unit models of care for patients who had sustained a hip fracture. APPROACH: An integrative literature review was undertaken from 2002-July 2013 using electronic databases with specific search terms. METHODS: The theoretical framework of Whittemore and Knafl was used to guide the review. This framework was chosen as it allows for the inclusion of varied methodologies and has the capability to increase informed evidence-based nursing practice. RESULTS: Five distinct themes relating to outcomes emerged from the analysis, which were: time from admission to surgery; complications; length of stay; mortality and initiation of osteoporosis treatment. CONCLUSION: The analysis of this integrative literature review clearly indicates the need for national and international sets of agreed outcome measures to be adopted to facilitate the comparison of models of care. This would significantly improve the way in which outcomes and costs are reported, further enhancing international partnerships as the health care team strive to achieve overall improvements in the management of older people presenting to hospital with hip fracture.
Asunto(s)
Fracturas de Cadera/terapia , Anciano , Enfermería Basada en la Evidencia , Fracturas Espontáneas/terapia , Servicios de Salud para Ancianos/organización & administración , Fracturas de Cadera/complicaciones , Fracturas de Cadera/mortalidad , Mortalidad Hospitalaria , Hospitalización , Humanos , Relaciones Interprofesionales , Fracturas Osteoporóticas/terapia , Grupo de Atención al Paciente/organización & administración , Tiempo de TratamientoRESUMEN
Osteoporosis is a common but often silent condition among older adults. The characteristic pathological changes associated with osteoporosis may go unnoticed until a fracture occurs or a bone density test is performed. Although osteoporosis occurs in men and among premenopausal women, it is most prevalent among postmenopausal women who are the focus of this article. Within the subpopulation of postmenopausal women, there are major differences in risk status, disease severity, and response to treatment. Two individual examples are presented to highlight these differences and to illustrate appropriate assessment and treatment strategies in each scenario. In addition, general nonpharmacological recommendations for postmenopausal women across risk status and disease severity are presented.
Asunto(s)
Envejecimiento/fisiología , Suplementos Dietéticos , Fracturas Espontáneas/terapia , Estilo de Vida , Osteoporosis Posmenopáusica/diagnóstico , Osteoporosis Posmenopáusica/terapia , Absorciometría de Fotón/métodos , Accidentes por Caídas/prevención & control , Accidentes por Caídas/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Densidad Ósea/fisiología , Dieta Saludable , Terapia por Ejercicio , Femenino , Fracturas Espontáneas/epidemiología , Fracturas Espontáneas/prevención & control , Humanos , Persona de Mediana Edad , Osteoporosis Posmenopáusica/epidemiología , Calidad de Vida , Índice de Severidad de la EnfermedadAsunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/complicaciones , Osteonecrosis de los Maxilares Asociada a Difosfonatos/cirugía , Diabetes Mellitus Tipo 2/complicaciones , Fracturas Espontáneas/etiología , Fracturas Mandibulares/etiología , Fístula Oroantral/etiología , Adulto , Anciano , Osteonecrosis de los Maxilares Asociada a Difosfonatos/terapia , Desbridamiento , Femenino , Fracturas Espontáneas/cirugía , Fracturas Espontáneas/terapia , Humanos , Oxigenoterapia Hiperbárica , Masculino , Fracturas Mandibulares/cirugía , Fracturas Mandibulares/terapia , Persona de Mediana Edad , Fístula Oroantral/cirugía , Fístula Oroantral/terapia , Osteomielitis/etiología , Osteomielitis/cirugía , Osteomielitis/terapia , Arabia SauditaRESUMEN
OBJECTIVE: To review our experience with late Marx stage III osteoradionecrosis (ORN) of the mandible in patients who present with pathologic fracture. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care center. SUBJECTS AND METHODS: Thirty-seven patients were identified from June 1998 to August 2010 who underwent treatment of Marx grade III osteoradionecrosis with pathologic fracture of the mandible. All patients underwent reconstruction with osteocutaneous free tissue transfer and when possible underwent hyperbaric oxygen therapy Marx protocol. RESULTS: The average time between completion of radiation therapy and presentation of ORN-induced pathologic fracture was 3.2 years. Sixteen patients developed ORN following tooth extraction. Sixteen patients had no previous documented ORN prior to presenting with pathologic fracture. Follow-up after surgery averaged 4.5 years with no recurrence of disease. The overall complication rate was 24% with no total flap loss. Of the patients, 95% returned to prefracture dietary intake. Twenty-six patients underwent a staged protocol, in which after resection and plate reconstruction, they underwent 20 hyperbaric oxygen (HBO) dives. They then underwent free tissue transfer followed by a further 10 HBO dives. There were no flaps lost or nonbony unions. Eleven patients did not receive HBO therapy as part of their surgical treatment plan. Again, there was no total flap loss, but 2 skin paddles were lost and 4 bony nonunions occurred. CONCLUSIONS: Pathologic fracture in conjunction with ORN has a relatively high treatment complication rate. Free tissue transfer and HBO are the treatment of choice for this population.
Asunto(s)
Fracturas Espontáneas/cirugía , Oxigenoterapia Hiperbárica/métodos , Mandíbula/efectos de la radiación , Osteorradionecrosis/complicaciones , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Adulto , Anciano , Placas Óseas , Estudios de Cohortes , Femenino , Peroné/trasplante , Estudios de Seguimiento , Fijación de Fractura/métodos , Curación de Fractura/fisiología , Fracturas Espontáneas/etiología , Fracturas Espontáneas/terapia , Humanos , Oxigenoterapia Hiperbárica/efectos adversos , Masculino , Mandíbula/cirugía , Persona de Mediana Edad , Osteorradionecrosis/terapia , Procedimientos de Cirugía Plástica/efectos adversos , Estudios Retrospectivos , Medición de Riesgo , Resultado del TratamientoRESUMEN
Cushing's Syndrome (CS) is rare in adolescence but the pathological effects of excessive circulating glucocorticoids concentration on bone during the developmental age still represent a challenge for orthopedists. Only few reports describe the gravity of early developed damages of spine in young affected by CS. A 18-years-old woman suffering from Cushing's Disease presented after many years treatment of the primary disease referring severe back pain and worsening back deformity. Radiological investigations showed vertebral collapses a devastating thoraco-lumbar scoliosis of 80° Cobb. Lumbar dual X-ray absorptiometry Z-score values were very low and consistent with severe osteoporosis. The patient was treated with bracing, antiresorptive therapy, calcium and vitamin D supplementation, and followed-up with imaging investigations to screen for further fractures. The bone mineral density will be monitored until its normalization will allow to plane surgical treatment in case of progression of spinal deformity and collapses. Early diagnosis and treatment of hypercortisolism, periodical clinical and radiographic follow-up, and treatment for the bone damage are mandatory to prevent the devastating sequelae of secondary osteoporosis.
Asunto(s)
Síndrome de Cushing/diagnóstico por imagen , Fracturas Espontáneas/diagnóstico por imagen , Vértebras Lumbares/lesiones , Traumatismo Múltiple/diagnóstico por imagen , Escoliosis/diagnóstico por imagen , Vértebras Torácicas/lesiones , Adolescente , Síndrome de Cushing/terapia , Femenino , Fracturas Espontáneas/terapia , Humanos , Vértebras Lumbares/efectos de la radiación , Traumatismo Múltiple/terapia , Radiografía , Escoliosis/terapia , Vértebras Torácicas/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Bone destruction is a hallmark of multiple myeloma(MM). Almost all MM patients develop osteolytic bone lesions that can cause pathologic fractures and severe bone pain. Osteolytic lesions result from increased bone resorption due to osteoclast stimulation and decreased bone formation due to osteoblast inhibition. Plain radiography, CT, and MRI are established imaging techniques in MM. FDG-PET imaging is promising newer scanning technique under current evaluation. The aggressive features of MM bone lesions have significantly contributed to poor prognosis. Therefore, a systemic approach to analgesia, which includes radiotherapy and orthopedic intervention, must be applied as a part of the comprehensive care plan of MM patient. Bisphosphonates have been shown to reduce vertebral fractures and bone pain.
Asunto(s)
Enfermedades Óseas Metabólicas/etiología , Fracturas Óseas/etiología , Fracturas Espontáneas/etiología , Mieloma Múltiple/complicaciones , Conservadores de la Densidad Ósea/administración & dosificación , Enfermedades Óseas Metabólicas/diagnóstico , Enfermedades Óseas Metabólicas/prevención & control , Enfermedades Óseas Metabólicas/terapia , Terapia Combinada , Diagnóstico por Imagen , Difosfonatos/administración & dosificación , Fracturas Óseas/diagnóstico , Fracturas Óseas/prevención & control , Fracturas Óseas/terapia , Fracturas Espontáneas/diagnóstico , Fracturas Espontáneas/prevención & control , Fracturas Espontáneas/terapia , Humanos , Dolor/etiología , Manejo del Dolor , Radioterapia , Dosificación Radioterapéutica , VertebroplastiaRESUMEN
OBJECTIVE: To develop a cost-effective strategy for improving osteoporosis management in patients admitted to an orthopedic surgery department for low-energy fractures. METHODS: From November 2003 to July 2004, all patients over 50 years admitted to the orthopedics department of the Caen Teaching Hospital (France) for low-energy fractures were identified and evaluated by rheumatology department physicians in the same hospital. RESULTS: During the study period, 313 patients were identified, 257 women (mean age, 79.5+/-10.2 years) and 56 men (mean age, 74.6+/-10.8 years), each with one fracture (proximal femur, 58.9%; wrist, 13%). Among them, 91 (29%) had a previous history of osteoporotic fractures. Mean bone mineral density (BMD) values were lower at the femoral neck than at the total hip or lumbar spine (e.g. in women, -2.3+/-0.9 versus -1.8+/-1.0 and -1.4+/-1.7, respectively). Osteoporosis treatment was given to 88 (28%) patients and consisted of calcium and vitamin D supplements, combined with alendronate in 32 patients. Complete loss of self-sufficiency occurred in 73 patients. Thus, 161 patients (88 with osteoporosis treatment and 73 with loss of self-sufficiency) received optimal treatment. CONCLUSION: Cooperation between the orthopedics and rheumatology departments improved the management of osteoporosis in patients with low-energy fractures. However, appropriate investigation and treatment of osteoporosis proved difficult in the oldest old and in patients with cognitive impairments.
Asunto(s)
Fracturas Espontáneas/terapia , Hospitalización/estadística & datos numéricos , Ortopedia/estadística & datos numéricos , Osteoporosis/diagnóstico , Derivación y Consulta/organización & administración , Reumatología/organización & administración , Absorciometría de Fotón , Anciano , Conservadores de la Densidad Ósea/uso terapéutico , Calcio de la Dieta/administración & dosificación , Suplementos Dietéticos , Femenino , Fracturas Espontáneas/etiología , Francia , Humanos , Masculino , Ortopedia/organización & administración , Osteoporosis/complicaciones , Osteoporosis/terapia , Vitamina D/administración & dosificaciónRESUMEN
BACKGROUND: Fragility fractures resulting from osteoporosis are common injuries. However, the identification and treatment of osteoporosis in these high-risk patients are widely reported to be inadequate. The goals of this study were to determine how many patients receiving inpatient or outpatient treatment for a fragility fracture could be identified and enrolled in a program for osteoporosis education, investigation, and treatment and receive appropriate osteoporosis care within the program. METHODS: An Osteoporosis Exemplary Care Program was implemented to identify, educate, evaluate, refer, and treat patients considered to be at risk for osteoporosis because of a typical fragility fracture. System modifications included coordination among the orthopaedic unit, Metabolic Bone Disease Clinic, and nuclear medicine unit to provide a continuum of care for these patients. Barriers were addressed through ongoing education of physicians, staff, and patients to increase knowledge and awareness of osteoporosis. The percentages of patients previously diagnosed and treated for osteoporosis, referred for investigation of osteoporosis, treated by the orthopaedic team, and receiving appropriate attention for osteoporosis were calculated. Risk factors for osteoporosis were also assessed. RESULTS: Three hundred and forty-nine patients with a fragility fracture (221 outpatients and 128 inpatients) who met the inclusion criteria and an additional eighty-one patients with a fracture (fifty-five outpatients and twenty-six inpatients) who did not meet the inclusion criteria but were suspected by their orthopaedic surgeons of having underlying osteoporosis were enrolled in the Osteoporosis Exemplary Care Program. More than 96% (414) of these 430 patients received appropriate attention for osteoporosis. Approximately one-third (146) of the 430 patients had been diagnosed and treated for osteoporosis before the time of recruitment. Two hundred and twenty-two of the remaining patients were referred to the Metabolic Bone Disease Clinic or to their family physician for further investigation and treatment for osteoporosis. Treatment was initiated by the orthopaedic team for another twenty-three patients. Many patients had risk factors for osteoporosis in addition to the fragility fracture; these included a previous fracture (forty-nine of 187; 26%), a mother who had had a fragility fracture (forty-two of 188; 22%), or a history of smoking (105 of 188; 56%). CONCLUSIONS: In a coordinated post-fracture osteoporosis education and treatment program directed at patients with a fragility fracture and their caregivers, >95% of patients were appropriately diagnosed, treated, or referred for osteoporosis care. To accomplish this, a dedicated coordinator and the full cooperation of orthopaedic surgeons and residents, orthopaedic technologists, allied health-care professionals (nurses, physical and occupational therapists, and social workers), and administrative staff were required.
Asunto(s)
Fracturas Espontáneas/diagnóstico , Osteoporosis/diagnóstico , Absorciometría de Fotón , Adulto , Anciano , Anciano de 80 o más Años , Conservadores de la Densidad Ósea/uso terapéutico , Calcio/uso terapéutico , Estudios de Cohortes , Continuidad de la Atención al Paciente , Suplementos Dietéticos , Femenino , Estudios de Seguimiento , Fracturas Espontáneas/terapia , Humanos , Masculino , Persona de Mediana Edad , Ortopedia , Osteoporosis/terapia , Grupo de Atención al Paciente , Cooperación del Paciente , Educación del Paciente como Asunto , Desarrollo de Programa , Derivación y Consulta , Factores de Riesgo , Vitamina D/uso terapéuticoAsunto(s)
Cementos para Huesos , Fracturas Espontáneas/terapia , Procedimientos Ortopédicos/métodos , Osteoporosis/complicaciones , Manejo del Dolor , Polimetil Metacrilato/administración & dosificación , Fracturas de la Columna Vertebral/terapia , Neoplasias de la Columna Vertebral/complicaciones , Anestesia Local , Terapia Combinada , Femenino , Fracturas Espontáneas/diagnóstico por imagen , Fracturas Espontáneas/etiología , Fracturas Espontáneas/prevención & control , Humanos , Inyecciones Intralesiones , Masculino , Persona de Mediana Edad , Neuroleptanalgesia , Dolor/etiología , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/prevención & control , Neoplasias de la Columna Vertebral/secundario , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Nonmedical therapies are playing an increasing role in the management of osteoporosis and its complications. They serve as useful adjuncts to medical treatment. Several areas of nonmedical options for the management of osteoporosis include bracing, exercise, and vertebroplasty and kyphoplasty.
Asunto(s)
Terapias Complementarias , Osteoporosis/prevención & control , Osteoporosis/terapia , Tirantes , Técnicas de Ejercicio con Movimientos , Fracturas Espontáneas/etiología , Fracturas Espontáneas/terapia , Humanos , Procedimientos Ortopédicos , Osteoporosis/complicaciones , Equipos de Seguridad , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/terapia , Columna Vertebral/cirugíaRESUMEN
OBJECTIVE: To discuss a case of enchondroma initially appearing as a pathologic fracture in a metacarpal bone. The recommended treatment for a pathologic fracture of an enchondroma in the hand is reviewed. Additionally, a reasonable list of differential considerations is presented with accompanying radiographic and advanced imaging characteristics. CLINICAL FEATURES: A 25-year-old male chiropractic student had a painful, bruised, and swollen thumb following athletic trauma. Radiographs showed a pathologic comminuted fracture of the first metacarpal, with a resultant anterior angulation of the distal fragment. Fracture occurred through a well-defined, geographic, lucent lesion in the proximal metaphysis consistent with enchondroma. INTERVENTION AND OUTCOME: Closed reduction of the fracture and casting were used. No treatment was administered for the enchondroma. Adequate healing of the fracture took place with residual angulation at the fracture site. Size and extent of the enchondroma were unchanged after fracture healing. CONCLUSIONS: Recommended treatment for a pathologic fracture through an enchondroma in the hand is casting, which allows fracture healing. Curettage of the lesion without packing of the resultant cavity is then recommended. In this case, casting and fracture healing took place without any treatment directed at the enchondroma. The patient was advised of the rationale for undergoing the removal of the enchondroma. Removal was recommended to prevent fracture recurrence from structural weakening, which would be likely due to the unusually high level of mechanical stress from the professional demands of manual treatment.
Asunto(s)
Neoplasias Óseas/complicaciones , Condroma/complicaciones , Fracturas Espontáneas/diagnóstico , Metacarpo/lesiones , Adulto , Neoplasias Óseas/diagnóstico , Condroma/diagnóstico , Diagnóstico Diferencial , Fracturas Espontáneas/etiología , Fracturas Espontáneas/terapia , Mano/diagnóstico por imagen , Humanos , Masculino , Radiografía , Resultado del TratamientoRESUMEN
Family physicians will frequently encounter patients with osteoporosis, a condition that is often asymptomatic until a fracture occurs. Treatment of the fracture can be initiated without further diagnostic testing. Thereafter, treatment of osteoporosis includes (1) prevention of further bone loss through weight-bearing exercise, tobacco and alcohol avoidance, hormone replacement therapy in women, and raloxifene and calcium supplementation; (2) treatment of fracture-related pain with analgesics and calcitonin; (3) building bone mass when feasible with alendronate; and (4) modifying behaviors that increase the risk of falls. Patients without fracture who are at risk for osteoporosis can also benefit from these preventive measures. Furthermore, women of all ages should be encouraged to maintain a daily calcium intake of 1,000 to 1,500 mg and to participate in weight-bearing exercise for 30 minutes three times weekly to reduce their risk of falls and fractures. Persons at risk should avoid medications known to compromise bone density, such as glucocorticoids, thyroid hormones and chronic heparin therapy.
Asunto(s)
Fracturas Espontáneas/terapia , Osteoporosis/terapia , Calcitonina/uso terapéutico , Difosfonatos/uso terapéutico , Terapia de Reemplazo de Estrógeno , Ejercicio Físico , Femenino , Fracturas Espontáneas/etiología , Humanos , Masculino , Osteoporosis/etiología , Moduladores Selectivos de los Receptores de Estrógeno/uso terapéuticoRESUMEN
Osteoporosis had long been considered as an unavoidable consequence of aging for which no prevention was possible, whereas it has recently been recognized as a disease that can be prevented and treated. It is of outstanding importance to choose a therapy tailored to the individual patient based on new findings on the pathogenesis of the different types of osteoporosis and the differential diagnosis related to these. During phases of rapid bone loss, usually at the beginning of postmenopause, but sometimes also in older patients, it is useful to use therapeutic drugs to slow down the high bone turnover to a physiological level when osteoporosis is imminent or manifest. The ideal therapy of established osteoporosis should stimulate bone formation and increase bone mass as well as correct changes in the architecture so that the incidence of new fractures will be reduced or even prevented. In case of an increased fragility, it is especially advantageous to increase the cortical bone mass and to stimulate periosteal bone formation in particular. Therapies increasing cortical porosity such as the administration of fluoride in large doses weaken the bones. Therapies reducing bone remodeling in the long term can inhibit bone reparation and compensatory periosteal bone formation, however. Future prospects for the therapy of osteoporosis using drugs are, on the one hand, an improved exploitation of present strategies by means of new galenical types of application, changes in the daily dosage, the introduction of interval therapies, and synergistic effects due to suitable combinations. On the other hand, new developments achieved by varying chemical structures, e.g., the structures of bisphosphonates and vitamin D metabolites and, above all, new strategies leading to increased bone mass while maintaining or even improving bone structure are urgently required. In addition to the vitamin D metabolites, mainly the parathyroid hormone fragments and growth hormones seem to be promising to achieve this aim. The direct use of cytokines (IGF-1, IGF-2, TGF-beta, etc.) is not yet possible because there is no suitable "drug targeting". An increase in bone mass that has been clinically documented does not necessarily indicate an increased mechanical stability. Bone quality results from a complex relationship between bone mass, bone structure, and the strength of the individual structure elements. Its quantitative measurement and influencing by therapies will be a great challenge to future osteoporosis research.