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The aging spine: new technologies and therapeutics for the osteoporotic spine

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Abstract

Osteoporosis results in low-energy fractures of the spine. The load necessary to cause a vertebral fracture is determined by the characteristics related to the vertebral body structure, mineral content, and quality of bone. Radiographic techniques centered on dual X-ray absorptiometry (DXA) permit a determination of bone mass and fracture risk. Current medical therapies principally using bisphosphonate and pulsatile PTH profoundly decrease the risk of fracture (50+%). Fall prevention strategies can further decrease the possibility of fracture. A comprehensive approach to osteoporosis can favorably alter the disease.

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References

  1. Adami S, Prizzi R, Colapietro F (2001). Alendronate for the treatment of osteoporosis in men. Calcif Tissue Int 69:239–241

    Article  CAS  PubMed  Google Scholar 

  2. Arnaud CD (1996) Osteoporosis: using ‘bone markers’ for diagnosis and monitoring. Geriatrics 51:24–30

    CAS  Google Scholar 

  3. Bagur A, Solis F, Di Gregorio S, Mautalen C (2000) Reference data of vertebral morphometry by X-ray absorptiometry (MXA) in Argentine women. Calcif Tissue Int 66:259–262

    Article  CAS  PubMed  Google Scholar 

  4. Baylink DJ (2000) The diagnosis and management of osteoporosis. J Rheumatol 59 [Suppl 1]:42–44

    Google Scholar 

  5. Bianco AC, Malvestiti LF, Gouveia CH, Wehba S, Lewin S, Marone MM (1999) Morphometric dual-energy X-ray absorptiometry of the spine: report of a large series and correlation with axial bone mineral density. J Bone Miner Res 14:1605–1613

    CAS  PubMed  Google Scholar 

  6. Bidwell J, Feister H, Swartz D, Onyia J, Holden J, Hock J (1996) Parathyroid hormone regulates the expression of rat osteoblast and osteosarcoma nuclear matrix proteins. J Cell Biochem 63:374–383

    CAS  PubMed  Google Scholar 

  7. Black DM, Cummings SR, Karpf DB, et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541

    CAS  PubMed  Google Scholar 

  8. Body JJ, Gaich GA, Scheele WH, et al (2002) A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1–34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 87:4528–4535

    Article  CAS  PubMed  Google Scholar 

  9. Carter DR, Hayes WC (1977) The compressive behavior of bone as a two-phase porous structure J Bone Joint Surg Am 59:954–962

    Google Scholar 

  10. Carter DR, Bouxsein ML, Marcus R (1992) New approaches for interpreting projected bone densitometry data. J Bone Miner Res 7:137–145

    CAS  PubMed  Google Scholar 

  11. Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561

    Article  CAS  PubMed  Google Scholar 

  12. Cauley JA, Norton L, Lippman ME, et al (2001) Continued breast cancer risk reduction in postmenopausal women treated with raloxifene: 4-year results from the MORE trial. Multiple outcomes of raloxifene evaluation. Breast Cancer Res Treat 65:125–134

    Article  CAS  PubMed  Google Scholar 

  13. Chausmer AB (2001) Bone density measurement techniques in the diagnosis and management of osteoporosi. J S C Med Assoc 97:106–110

    PubMed  Google Scholar 

  14. Chavassieux PM, Arlot ME, Roux JP, et al (2000) Effects of alendronate on bone quality and remodeling in glucocorticoid-induced osteoporosis: a histomorphometric analysis of transiliac biopsies. J Bone Miner Res 15:754–762

    CAS  PubMed  Google Scholar 

  15. Chestnut CH 3rd, Silverman S, Adriano K, Genant H (2002) A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the Prevent Recurrence of Osteoporotic Fractures Study. PROOF Study Group. Am J Med 109:267–276

    Article  Google Scholar 

  16. Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S-17S; discussion 17S-19S

    CAS  Google Scholar 

  17. Crandall C (2002) Parathyroid hormone for treatment of osteoporosis. Arch Intern Med 162:2297–2309

    Article  CAS  PubMed  Google Scholar 

  18. Cummings SR, Black DM, Thompson DE, et al (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280:2077–2082

    CAS  PubMed  Google Scholar 

  19. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337:670–676

    Google Scholar 

  20. Delmas PD, Ensrud KE, Adachi JD, et al (2002) Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab 87:3609–3617

    Google Scholar 

  21. Dickler MN, Norton L (2001) The MORE trial: multiple outcomes for raloxifene evaluation—breast cancer as a secondary end point: implications for prevention. Ann N Y Acad Sci 949:134–142

    CAS  PubMed  Google Scholar 

  22. Doggrell SA (2002) Zoledronate once-yearly increases bone mineral density — implications for osteoporosis. Expert Opin Pharmacother 3:1007–1009

    CAS  PubMed  Google Scholar 

  23. Ensrud KE, Thompson DE, Cauley JA, et al (2000) Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. Fracture Intervention Trial Research Group. J Am Geriatr Soc 48:241–249

    CAS  PubMed  Google Scholar 

  24. Ettinger B, Black DM, Mitlak BH, et al (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 282:637–645

    CAS  PubMed  Google Scholar 

  25. Ferrar L, Jiang G, Barrington NA, Eastell R (2000) Identification of vertebral deformities in women: comparison of radiological assessment and quantitative morphometry using morphometric radiography and morphometric X-ray absorptiometry. J Bone Miner Res 15:575–585

    CAS  PubMed  Google Scholar 

  26. Ferrar L, Jiang G, Eastell R (2001) Longitudinal evaluation of morphometric X-ray absorptiometry for the identification of vertebral deformities. Osteoporos Int 12:661–671

    Article  CAS  PubMed  Google Scholar 

  27. Finkelstein JS, Klibanski A, Arnold AL, Toth TL, Hornstein MD, Neer RM (1998) Prevention of estrogen deficiency-related bone loss with human parathyroid hormone-(1–34): a randomized controlled trial. JAMA 280:1067–1073

    Article  CAS  PubMed  Google Scholar 

  28. Follin SL, Black JN, McDermott MT (2003) Lack of diagnosis and treatment of osteoporosis in men and women after hip fracture. Pharmacotherapy 23:190–198

    PubMed  Google Scholar 

  29. Fujita T, Inoue T, Morii H, et al (1999) Effect of an intermittent weekly dose of human parathyroid hormone (1–34) on osteoporosis: a randomized double-masked prospective study using three dose levels. Osteoporos Int 9:296–306

    Article  CAS  PubMed  Google Scholar 

  30. Galante J, Rostoker W, Ray RD (1970) Physical properties of trabecular bone. Calcif Tis Res 5:236–246

    CAS  Google Scholar 

  31. Gardner MJ, Flik KR, Mooar P, Lane JM (2002) Improvement in the undertreatment of osteoporosis following hip fracture. J Bone Joint Surg Am 84:1342–1348

    Google Scholar 

  32. Gass R (2001) The early preclinical diagnosis of osteoporosis measuring the pure trabecular bone density. Eur J Med Res 6:228–230

    CAS  PubMed  Google Scholar 

  33. Geusens P, Autier P, Boonen S, Vanhoof J, Declerck K, Raus JN (2002) The relationship among history of falls, osteoporosis, and fractures in postmenopausal women. Arch Phys Med Rehabil 83:903–906

    Article  PubMed  Google Scholar 

  34. Giannoukos G, Williams LJ, Chilco PJ, Abou-Samra AB (1999) Characterization of an element within the rat parathyroid hormone/parathyroid hormone-related peptide receptor gene promoter that enhances expression in osteoblastic osteosarcoma 17/2.8 cells. Biochem Biophys Res Commun 258:336–340

    Article  PubMed  Google Scholar 

  35. Gonnelli S, Cepollaro C, Montagnani A, et al (2003) Alendronate treatment in men with primary osteoporosis: a three-year longitudinal study. Calcif Tissue Int

    Google Scholar 

  36. Grados F, Fardellone P, Benammar M, Muller C, Roux C, Sebert JL (1999) Influence of age and sex on vertebral shape indices assessed by radiographic morphometry. Osteoporos Int 10:450–455

    Article  PubMed  Google Scholar 

  37. Greenspan SL, von Stetten E, Emond SK, Jones L, Parker RA (2001) Instant vertebral assessment: a noninvasive dual X-ray absorptiometry technique to avoid misclassification and clinical mismanagement of osteoporosis. J Clin Densitom 4:373–380

    CAS  PubMed  Google Scholar 

  38. Greenspan SL, Bone G 3rd, Schnitzer TJ, et al (2002) Two-year results of once-weekly administration of alendronate 70 mg for the treatment of postmenopausal osteoporosis. J Bone Miner Res 17:1988–1996

    CAS  PubMed  Google Scholar 

  39. Guermazi A, Mohr A, Grigorian M, Taouli B, Genant HK (2002) Identification of vertebral fractures in osteoporosis. Sem Musculoskeletal Radiol 6:241–252

    Article  Google Scholar 

  40. Harris ST, Watts NB, Genant HK, et al (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 282:1344–1352

    CAS  PubMed  Google Scholar 

  41. Hasserius R, Karlsson MK, Nilsson BE, Redlund-Johnell I, Johnell O (2003) Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int 14:61–68

    CAS  PubMed  Google Scholar 

  42. Hayes WC, Myers ER, Robinovitch SN, van den Kroonenberg A, Courtney A, McMahon T (1996) Etiology and prevention of age-related hip fractures

  43. Heijckmann AC, Juttmann JR, Wolffenbuttel BH (2002) Intravenous pamidronate compared with oral alendronate for the treatment of postmenopausal osteoporosis. Neth J Med 60:315–319

    CAS  PubMed  Google Scholar 

  44. Holzer G, Majeska RJ, Lundy MW, Hartke JR, Einhorn TA (1999) Parathyroid hormone enhances fracture healing. A preliminary report. Clin Orthop 258–263

  45. Horwitz MJ, Tedesco MB, Gundberg C, Garcia-Ocana A, Stewart AF (2003) Short-term, high-dose parathyroid hormone-related protein as a skeletal anabolic agent for the treatment of postmenopausal osteoporosis. J Clin Endocrinol Metab 88:569–575

    Article  CAS  PubMed  Google Scholar 

  46. Ito M, Tsurusaki K, Hayashi K (1997) Peripheral QCT for the diagnosis of osteoporosis. Osteoporos Int 7 [Suppl 3]:120–127

    Google Scholar 

  47. Jahng JS, Kim HW (2000) Effect of intermittent administration of parathyroid hormone on fracture healing in ovariectomized rats. Orthopedics 23:1089–1094

    CAS  PubMed  Google Scholar 

  48. Jalava T, Sarna S, Pylkkanen L, et al (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18:1254–1260

    PubMed  Google Scholar 

  49. Jordan KM, Cooper C (2002) Epidemiology of osteoporosis Best Pract Res Clin Rheumatol 16:795–806

    Article  Google Scholar 

  50. Kado DM, Duong T, Stone KL, Ensrud KE, et al (2003) Incident vertebral fractures and mortality in older women: a prospective study. Osteoporosis Int 14:589–594

    CAS  Google Scholar 

  51. Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936

    Article  PubMed  Google Scholar 

  52. Kelly CM, Wilkins RM, Gitelis S, Hartjen C, Watson JT, Kim PT (2001) The use of a surgical grade calcium sulfate as a bone graft substitute: results of a multicenter trial. Clin Orthop 42–50

    Google Scholar 

  53. Kessenich CR (1998) Tai Chi as a method of fall prevention in the elderly. Orthop Nurs 17:27–29

    CAS  Google Scholar 

  54. Lane JM (1997) Osteoporosis. Medical prevention and treatment. Spine 22:32S-37S

    Article  PubMed  Google Scholar 

  55. Lane JM, Nydick M (1999) Osteoporosis: current modes of prevention and treatment. J Am Acad Orthop Surg 7:19–31

    PubMed  Google Scholar 

  56. Lieberman JR, Le LQ, Wu L, et al (1998) Regional gene therapy with a BMP-2-producing murine stromal cell line induces heterotopic and orthotopic bone formation in rodents. J Orthop Res 16:330–339

    PubMed  Google Scholar 

  57. Liberman UA, Weiss SR, Broll J, et al (1995) Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med 333:1437–1443

    CAS  PubMed  Google Scholar 

  58. Lin JT, van der Meulen MCH, Myers ER, Lane JM (2003) Fracture evaluation and clinical complications. In: Favus MJ (ed) Primer on the metabolic bone diseases and disorders of mineral metabolism, 5th edn. (in press)

  59. Lin JT, Backus S, Meyers E, Peterson M, Lane JM (2003) Six minute walk test: a new powerful predictor of functional dysfunction in osteoporotic patients with and without vertebral fractures (abstract). J Bone Min Res (in press)

    Google Scholar 

  60. Lindsay R, Hart DM, Forrest C, Baird C (1980) Prevention of spinal osteoporosis in oophorectomised women. Lancet 2:1151–1154

    CAS  PubMed  Google Scholar 

  61. Lindsay R, Silverman SL, Cooper C, Hanley DA, et al (2002) Risk of new vertebral fracture in the year following fracture. JAMA 17:285:320–323

    Google Scholar 

  62. Liu G, Peacock M, Eilam O, Dorulla G, Braunstein E, Johnston CC (1997) Effect of osteoarthritis in the lumbar spine and hip on bone mineral density and diagnosis of osteoporosis in elderly men and women. Osteoporos Int 7:564–569

    PubMed  Google Scholar 

  63. Lofman O, Larsson L, Toss G (2000) Bone mineral density in diagnosis of osteoporosis: reference population, definition of peak bone mass, and measured site determine prevalence. J Clin Densitom 3:177–186

    Google Scholar 

  64. Looker AC, Johnston CC Jr, Wahner HW, et al Prevalence of low femoral bone density in older US women from NHANES III (1995) J Bone Miner Res 10:796–802

    CAS  PubMed  Google Scholar 

  65. Luckey MM, Gilchrist N, Bone HG, et al (2003) Therapeutic equivalence of alendronate 35 milligrams once weekly and 5 milligrams daily in the prevention of postmenopausal osteoporosis. Obstet Gynecol 101:711–721

    Article  PubMed  Google Scholar 

  66. Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259

    CAS  PubMed  Google Scholar 

  67. Matthis C, Weber U, O’Neill TW, Raspe H (1998) Health impact associated with vertebral deformities: results from the European Vertebral Osteoporosis Study (EVOS). Osteoporos Int 8:364–372

    Article  CAS  PubMed  Google Scholar 

  68. Melton LJ 3rd, Chrischilles EA, Cooper C, Lane AW, Riggs BL (1992) Perspective. How many women have osteoporosis? J Bone Miner Res 7:1005–1010

    PubMed  Google Scholar 

  69. Melton LJ 3rd, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221

    Article  PubMed  Google Scholar 

  70. Miller PD (2001) New possibilities for diagnosis and treatment of osteoporosis. Int J Fertil Womens Med 46:215–221

    PubMed  Google Scholar 

  71. Moro M, Hecker AT, Bouxsein ML, Myers ER (1995) Failure load of thoracic vertebrae correlates with lumbar bone mineral density measured by DXA. Calcif Tissue Int 56:206–209

    CAS  PubMed  Google Scholar 

  72. Nakajima A, Shimoji N, Shiomi K, et al (2002) Mechanisms for the enhancement of fracture healing in rats treated with intermittent low-dose human parathyroid hormone (1–34). J Bone Miner Res 17:2038–2047

    CAS  PubMed  Google Scholar 

  73. Neer RM, Arnaud CD, Zanchetta JR, et al (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441

    CAS  PubMed  Google Scholar 

  74. Neuner JM, Zimmer JK, Hamel MB (2003) Diagnosis and treatment of osteoporosis in patients with vertebral compression fractures. J Am Geriatr Soc 51:483–491

    PubMed  Google Scholar 

  75. Nordin BE, Morris HA (1989) The calcium deficiency model for osteoporosis. Nutr Rev 47:65–72

    CAS  PubMed  Google Scholar 

  76. O’Gradaigh D, Debiram I, Love S, Richards HK, Compston JE (2003) A prospective study of discordance in diagnosis of osteoporosis using spine and proximal femur bone densitometry. Osteoporos Int 14:13–18

    CAS  PubMed  Google Scholar 

  77. Okazaki K, Jingushi S, Ikenoue T, Urabe K, Sakai H, Iwamoto Y (2003) Expression of parathyroid hormone-related peptide and insulin-like growth factor I during rat fracture healing. J Orthop Res 21:511–520

    Article  CAS  PubMed  Google Scholar 

  78. Orwoll E, Ettinger M, Weiss S, et al (2000) Alendronate for the treatment of osteoporosis in men. N Engl J Med 343:604–610

    CAS  PubMed  Google Scholar 

  79. Osteoporosis prevention, diagnosis, and therapy (2000) NIH Consensus Statement 17:1–45

    Google Scholar 

  80. Owens JM, Fuller K, Chambers TJ (1997) Osteoclast activation: potent inhibition by the bisphosphonate alendronate through a nonresorptive mechanism. J Cell Physiol 172:79–86

    Article  PubMed  Google Scholar 

  81. Paganini-Hill A, Chao A, Ross RK, Henderson BE (1991) Exercise and other factors in the prevention of hip fracture: the Leisure World study. Epidemiology 2:16–25

    CAS  PubMed  Google Scholar 

  82. Park J, Ries J, Gelse K, et al (2003) Bone regeneration in critical size defects by cell-mediated BMP-2 gene transfer: a comparison of adenoviral vectors and liposomes. Gene Ther 10:1089–1098

    Article  PubMed  Google Scholar 

  83. Pasquini GM, Davey RA, Ho PW, et al (2002) Local secretion of parathyroid hormone-related protein by an osteoblastic osteosarcoma (UMR 106–01) cell line results in growth inhibition. Bone 31:598–605

    Article  PubMed  Google Scholar 

  84. Peter CP, Cook WO, Nunamaker DM, Provost MT, Seedor JG, Rodan GA (1996) Effect of alendronate on fracture healing and bone remodeling in dogs. J Orthop Res 14:74–79

    PubMed  Google Scholar 

  85. Rea JA, Chen MB, Li J, et al (2000) Morphometric X-ray absorptiometry and morphometric radiography of the spine: a comparison of prevalent vertebral deformity identification. J Bone Miner Res 15:564–574

    CAS  PubMed  Google Scholar 

  86. Rea JA, Chen MB, Li J, et al (2001) Vertebral morphometry: a comparison of long-term precision of morphometric X-ray absorptiometry and morphometric radiography in normal and osteoporotic subjects. Osteoporos Int 12:158–166

    Article  CAS  PubMed  Google Scholar 

  87. Recker RR, Hinders S, Davies KM, et al (1996) Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res 11:1961–1966

    CAS  PubMed  Google Scholar 

  88. Riew KD, Wright NM, Cheng S, Avioli LV, Lou J (1998) Induction of bone formation using a recombinant adenoviral vector carrying the human BMP-2 gene in a rabbit spinal fusion model. Calcif Tissue Int 63:357–360

    Google Scholar 

  89. Ross PD (1996) Osteoporosis. Frequency, consequences, and risk factors. Arch Intern Med 156:1399–1411

    CAS  PubMed  Google Scholar 

  90. Saag KG, Emkey R, Schnitzer TJ, et al (1998) Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. Glucocorticoid-Induced Osteoporosis Intervention Study Group. N Engl J Med 339:292–299

    Article  CAS  PubMed  Google Scholar 

  91. Sahota O(2000) Osteoporosis and the role of vitamin D and calcium-vitamin D deficiency, vitamin D insufficiency, and vitamin D sufficiency. Age Ageing 29:301–304

    Article  CAS  PubMed  Google Scholar 

  92. Sarkar S, Mitlak BH, Wong M, Stock JL, Black DM, Harper KD (2002) Relationships between bone mineral density and incident vertebral fracture risk with raloxifene therapy. J Bone Miner Res 17:1–10

    CAS  PubMed  Google Scholar 

  93. Schousboe JT, DeBold CR, Bowles C, Glickstein S, Rubino RK (2002) Prevalence of vertebral compression fracture deformity by X-ray absorptiometry of lateral thoracic and lumbar spines in a population referred for bone densitometry. J Clin Densitom 5:239–246

    PubMed  Google Scholar 

  94. Shields AT, Chesnut CH 3rd (2001) Diagnosis of postmenopausal osteoporosis: reviews in endocrine and metabolic disorders. Rev Endocr Metab Disord 2:23–33

    Article  CAS  PubMed  Google Scholar 

  95. Simkin A, Ayalon J, Leichter I (1987) Increased trabecular bone density due to bone-loading exercises in postmenopausal osteoporotic women. Calcif Tissue Int 40:59–63

    CAS  PubMed  Google Scholar 

  96. Stephenson J (2003) FDA orders estrogen safety warnings: agency offers guidance for HRT use. JAMA 289:537–538

    Article  PubMed  Google Scholar 

  97. Strocchi R, Orsini G, Iezzi G, et al (2002) Bone regeneration with calcium sulfate: evidence for increased angiogenesis in rabbits. J Oral Implantol 28:273–278

    PubMed  Google Scholar 

  98. Tinetti ME, Baker DI, Garrett PA, Gottschalk M, Koch ML, Horwitz RI (1993) Yale FICSIT: risk factor abatement strategy for fall prevention. J Am Geriatr Soc 41:315–320

    CAS  PubMed  Google Scholar 

  99. Varady P, Li JZ, Alden TD, Kallmes DF, Williams MB, Helm GA (2002) CT and radionuclide study of BMP-2 gene therapy-induced bone formation. Acad Radiol 9:632–637

    PubMed  Google Scholar 

  100. Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T (1996) Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and injuries: cooperative studies of intervention techniques. J Am Geriatr Soc 44:489–497

    CAS  PubMed  Google Scholar 

  101. Wu G (2002) Evaluation of the effectiveness of Tai Chi for improving balance and preventing falls in the older population — a review. J Am Geriatr Soc 50:746–754

    Article  PubMed  Google Scholar 

  102. Zerath E, Holy X, Noel B, Malouvier A, Hott M, Marie PJ (1998) Effects of BMP-2 on osteoblastic cells and on skeletal growth and bone formation in unloaded rats. Growth Horm IGF Res 8:141–149

    CAS  Google Scholar 

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Lane, J.M., Gardner, M.J., Lin, J.T. et al. The aging spine: new technologies and therapeutics for the osteoporotic spine. Eur Spine J 12 (Suppl 2), S147–S154 (2003). https://doi.org/10.1007/s00586-003-0636-6

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