Normal bone, osteoporosis, and the rheumatologist.
Even after growth has stopped, normal bone remodeling continues with a balanced coupling of osteoblast and osteoclast function with deposition and resorption of bone. Many factors including exercise, hormones and genes affect total bone mass. Osteoporosis can result from a variety of factors that disrupt the normal equilibrium, but it most typically presents in an older woman after menopause. Rheumatologists should understand normal bone biology and the pathophysiologic abnormalities of bone. Optimal care will often be given in a multidisciplinary fashion in collaboration with rehabilitative services and nutritionists and often involves helping the patient to apply assistive devices. Patients with osteoporosis as with other rheumatic diseases often suffer chronic pain and need physicians who understand modern methods of alleviating painful syndromes. The practicing rheumatologist also provides opportunities for patients to learn about the diseases so that they can learn to live with them.
Simon
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Department of Medicine, Harvard Medical School and the Beth Israel Deaconess Medical Center, and the Medical Service (Arthritis Unit) Massachusetts General Hospital, Boston, Massachusetts.
Goodman
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