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E-mail:rozh@endocrincentr.ru
. .. ... ..
. 016589 10.09.97. 60x90/8. 3000 . 742.
. ISBN 5-7886-0002-5. , . .

. .
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 3/2004

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%) 0,064 /2, () 1 SD
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- NHANES).
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 3/2004

. ,
100%.
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-
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.

SUMMARY
The results of bone tissue study after long duration space flight (614 months) are provided. The decrease of Bone Mineral Density (BMD)
was revealed in lower weight bearing parts of the skeleton (lumbar spine,
femur proximal epiphysis and pelvis) in long-term study of Russian
cosmonauts. BMD was assessed using dual energy X-ray absorptiometry
(DEXA). Simultaneously the tendency of increasing BMD was shown in
upper parts of the skeleton (skull, cervical spine). The direct relationship
was found between BMD in different segments of the skeleton and their
position in the gravitation vector. The BMD mean value was generally
within the normal limits, according to T-score after,space flight. In some
cases changes in the BMD were qualified as a local osteopenia. The
individual BMD level changes and the rate of recovery are found to be
very variable. Therefore, the relationship between the BMD level and
space flight duration can not be established. The situation is considered
to be a bone tissue functional adaptation to the different biomechanical
requirements.

1. .., ..
//
: . . 1. ., 2001. . 20-41.
2. .., B.C., .. . - // , , . 1998. . 32. .
21-25.
3. .. , , . .: , 1971.
152 .
4. B.C. , .;,
2003. 260 .
5. B.C., .., .. . ,
120- // . . . : . 1997. . 63^65.
6. B.C., .., .. . // : . , 1997. . 81,82.
7. B.C., ., ., ..
- // . . , . 1990. . 24, 4. . 20-22.
8. B.C., B.C. // : . . 3. . 1. .: , 1997.
. 421-^60.
9. .., .. : , , . .;.: , , 2000. 560 .
10. . //
. . .: ; : , 1975. . 2, . 1. . 141-176.
11. Cann Ch., Genant H. Precise Measurement of vertebral mineral Content
Using computed tomography // J. . Ass. Tomogr. 1980. V. 4. 4. P. 493
500.
v
12. Carter D.R., Wong M., Orr .. Musculoskeletal ontogeny, phylogeny
and functional adaptation: Proc. of the NASA Symp.on the influence of gravity
and activity on muscle and bone // J. of Biomechanics. 1991. V. 24 (Suppl.l). P.
3-16.
13. Kanis J.A. and WHO Study Group. Assessment of fracture risk and its
application to screening for postmenopausal osteoporosis: synopsis of WHO report
// Osteoporosis int. 1994. 4. P. 368-381.
14. Oganov VS., Bakulin A.V., Novikov V.E. et al. Result of human bone
densitometry after prolonged space flight // Intern. Scientific Cooperation onboard
MIR. Proc. Symp. Intern. Lyon. France. 2001. P. 183-188.
15. Tilton F.E., Degioanni J.J., Schneider V.S. Long-term follow-up of
Skylab bone demineralization // Aviat. Space Environ. Med. 1980. V. 51. P. 12091213.
16. Vico L., Collet Ph., Guignandon A. et al. Effect of long-term
microgravity exposure on cancellous and cortical weight-bearing bones of
cosmonauts // The Lancet. 2000. V. 335. P. 1607-1611.

 3/2004

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5 ) 71,4% 30 (6 , 9
). .
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. , , -

 3/2004
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=147
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0

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35
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<0,0001 .
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50

1.

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70,
(67 333 ).
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.) 8 (12,1%)
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, <0,0001.

(=24),
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, , , ,

 3/2004

, ,
, .

, [11, 19]. , :
, .
, ,
[8]. () .
, , .
[6,16] ,
, - .
(DEXA) (/2) [12].
.
, [21, 24, 25] [26].
[21, 25] , [26] - 4-9-
[24]. , ,
. ,
[5],
. , ,
.
,
- , .
3-7- . 55
2,2 , 37% 62%
.
- 16-18% -
(=7217, 53 ) - 18% [20]. [17].
,
, Bravenboer N. et al.,
1997 [10] .
Seeman E. [22,23]
( - ),
, [13].

, ,
, . , , , .

SUMMARY
The aim of this study is to estimate the frequency of fractures incidence
in patients with congenital pituitary hormone deficiency (CPHD). A
retrospective cohort study of130 adults with CPHD is performed. Patients

with CPHD were compared to 333 age- and sex-matched healthy

individuals (control group). The incidence of fractures was found in 26.9%
of patients with CPHD and ranged from 13,0% in patients younger than
30 to 59,1% in those who were older than 50. The incidents of long bone
fractures were observed with the highest frequency. The radius fractures
were found in 51,4% among all fracture cases.
The mean number of non-traumatic fractures was threefold higher
(p<0.0001) among patients with multiple pituitary hormone deficiency
(MPHD) who were younger than 30 and tenfold higher (p<0,0001) among
patients who were older than 30 in comparison with the control group.
Thus, MPHD patients had significantly increased fracture prevalence
among patients younger than 30 (Odds ratio 3,0); 0.6fractures per patient
(p<0,0001) among patients older than 30 (Odds ratio 7,4); and 2,2
fractures per patient (p<0,0001) in comparison with control group. In
conclusion, CPHD not only effects lineal growth but also impairs bone
tissue that leads to increased fracture prevalence.

1. .., .., .. .
.: . 1998. 302 .
2. ... .., .., .. . // . 1999. 3. . 2-6.
3. .. :. . .: , 2000, 195 .
4. Attanasio A.F., Howell S., Bates P.C., Frewer P., Chipman J., Blum W.F., Shalet
S.M. Body composition, IGF-I and 1GFBP-3 concentrations as outcome measures in severely
GH-deficient (GHD) patients after childhood GH treatment: a comparison with adult onset
GHD patients. J Clin Endocrinol Metab 2002 87:3368 - 3372.
5. Baroncelli GL, Bertelloni S., Sodini F., Saggese G. Lumbar bone mineral density at
final height and prevalence of fractures in treated children with GH deficiency. J Clin Endocrinol
Metab 2002 87:3624-3631.
6. Bass S., Delmas P.D., Pearce G., Hendrich E., Tabensky A., Seeman E. The differing
tempo of growth in bone size, mass, and density in girls is region-specific. J Clin Invest 1999
104:795-804.
7. Bolanowski M., Wielgus M.. Milewicz A.. Marciniak R. Axial bone mineral density
in patients with acromegaly. Acad Radiol 2000 7:592 - 594.
8. Bouillon R., Koledova K., Bezlepkina O., Chernikhova E., Nagajeva E., Bakulin A..
Nijs J., Peterkova V., Dedov I., Oganov O.. Attanasio A. Lifelong hypopituitarism and growth
hormone deficiency decreases bone size but not volumetric density yet increases prevalence
of fractures. J Bone Miner Res. 2001 16: S224.
9. Bouillon R. Growth hormone and bone. Honri Res 1991 36: Suppl 1:49 - 55.
10. Bravenboer N.. Holzmann P., de Boer H., Roos J.C., Van der Veen E.A., Lips P. The
effect of growth hormone (GH) on histomorphometric indices of bone structure and bone
turnover in GH-deficient men. J Clin Endocrinol Metab 1997 82:1818 - 1822.
11. Boer H de, Blok G.J., Van der Veen E.A. Clinical aspects of growth hormone
deficiency in adults. Endocr Rev 1995 16:63 - 86.
12. Fors H., Bjarnason R., Worent L., Albertsson-Wikland K., Bosaeust L.. Bengtsson
B. A., Johansson G. Currently used growth-promoting treatment of children results in normal
bone mass and density. A prospective trial of discontinuing growth hormone treatment in
adolescents. Clin Endocrinol.(Oxf) 2001 55:617 - 624.
13. Genant H.K., Gluer C.C., Lotz J.C. Gender differences in bone density, skeletal
geometry, and fracture biomechanics. Radiology 1994 190:636 - 640.
14. Henry Y.M., Eastell R. Ethnic and gender differences in bone mineral density and
bone turnover in young adults: effect of bone size. Osteoporos Int 2000 11:512 - 517.
15. Katzman D.K., Bachrach L.K., Carter D.R., Marcus R. Clinical and anthropometric
correlates of bone mineral acquisition in healthy adolescent girls. J Clin Endocrinol Metab
1991 73:1332-1339.
16. Kelly T.L. Bone mineral reference databases for American men and women. J Bone
Miner Res 1990 5:249.
17. Lucas A.R.. Melton L.J.. Crowson C.S.. O'Fallon W.M. Long-term fracture risk
among women with anorexia nervosa: a population-based cohort study. Mayo Clin Proc 1999
74:972-977.
18. Melton L.J., III, Khosla S., Atkinson E.J., Oconnor M.K.. Ofallon W.M., Riggs B.L.
Cross-sectional versus longitudinal evaluation of bone loss in men and women. Osteoporos
Int 2000 11:592-599.
19. Ohlsson C. Bengtsson B.A., Isaksson O.G.. Andreassen T.T., Slootweg M.C. Growth
hormone and bone, Hndocr Re\ 1998 14:55 79,
20. Randell K.M., Honkanen R.J., Kruger H.S.S., Saarikoski S. Does hormonereplacement therapy prevent fractures in early postmenopausal women? J Bone Miner Res
2002 17:528-533.
21. Rosen ., Wilhelmsen L., Landin-Wilhclmsen K., Lappas G.. Bengtsson B.A.
Increased fracture frequency in adult patients with hypopituitarism and GH deficiency. Eur J
Endocrinol 1997 137:240-245.
22. Seeman E. Perspective. From density to structure: growing up and growing old on
the surface of bone. J Bone Miner Res 1997 12:509 - 521.
23. Seeman E. The structural basis of bone fragility in men. Bone 1999 25:143 - 147.
24. Vestergaard P., Jorgensen J.O., Hagen C, Hoeck H.C., Laurberg P., Rejnmark L,
Brixen K., Weeke J., Andersen M., Conceicao F.L., Nielsen T.L., Mosekilde L. Fracture risk is
increased in patients with GH deficiency or untreated prolactinomas-a case-control study.
Clin Endocrinol.(Oxf) 2002 56:159 - 167.
25. Wbster C, Slenczka E.. Ziegler R. Erhnhte Pr.avalenz von Osteoporose und
Arteriosklerose bei konventionell substituierter Hypophysenvorderlappen-insuffizienz: Bedarf
einer zusfltzlichen Wachstumshormonsubstitution? Klin Wochenschr 1991 69:769 - 773.
26. Wbster C, Abs R., Bengtsson B.A., Bennmarker H., Feldt-Rasmussen U., HernbergStahl E., Monson J.P., Westberg ., Wilton P. The influence of growth hormone deficiency,
growth hormone replacement therapy, and other aspects of hypopituitarism on fracture rate
and bone mineral density. J Bone Miner Res 2001 16:398 - 405.

 3/2004

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 3/2004

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 3/2004

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SUMMARY:

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.

29.68
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Clinical densitometry data of a randomized sample (605

children between the ages of 5-16) is discussed. Osteodensitometry
of the distal forearm and lumbar (L2-L4) spine had been carried
out using DEXA technology (DTX-200, DPX-MD+, Lunar USA).
Age-specific regularities in bone mass accrual are established.
It is demonstrated that bone mass indices are interrelated with age
and anthropometrical parameters independently of the Z-score.
It is established that the development of national standards
using pair correlation equation leads to the reducing of overdiagnosis of osteopenia in growing children in normal states as
well as with chronic disease.

1. .., X., .. . : . .: , 1997. 288 .

2. .., .. : // . 2003. . 11, 27 (199). . 15541556.
3. ... .. :
// . 2004. 1. . 4-11.
4. AlfframT.A., Bauer G.Ch. Epidemiology of fractures of the forearm: a biomechanical
investigation of bone strength // J Bone Joint Surg(Am), 1962; 44A: 105-114.
5. Bachrach L.K. Bone mineralisation in childhood and adolescence //Curr Opin Pediatr.
1993. V. 5 (4). P. 4 6 7 ^ 7 3 .
6. Bailey D.A., Martin A.D., McKay H.A. Calcium accretion in girls and boys during
puberty: a longitudinal analysis // Bone Miner. Res. 2000. 11. P. 2245-2250.
7. Brandey M. et al. Heterogeneity in growth of the axial and appendicular skeleton in
boys: implication for the pathogenesis of bone fragility in men III. Bone Miner. Res. 2000. V.
15. . 10. P. 1871-1878.
8. Carrie Fassler A.L., Bongiour L.P. Osteoporosis as pediatric problem // Pediatr. Clin.
North Am. 1995. V. 43, . 4. P. 811-24.
9. Cassidy J.T., Osteopenia and osteoporosis in children.// Clin. Exp. Rheumatol. 1999.
V. 17, . 2. P. 245-50.
10. Coeverden S.C., De Ridder ., Roos J.C. et al. Pubertal maturation characteristics
and the rate of bone mass development longitudinally toward menarche // J. Bon Miner Res.
2001. 16. 4. P. 47481.
11. Dambacher M.A., Kissling R., Neff M. Prevention of osteoporosis. //Ther. Umsch.
1998. V.55,. 11. P. 702-11.
12. Heaney R.P., Abrams S-, Dawson-Hughes B. et al. Peak Bone Mass// Osteoporosis
Int., 2000. s.ll. P. 985-1009.
13. Leonard M.B., Propert K.J., Zemel B.S. et al. Discrepancies in pediatric bone mineral
density zeferece data: protential for misdiagnosis of osteopenia//J.Pediatric. 1999. V. 135. P.
182-188.
14. Lorcnc R.S. Pediatric aspects of osteoporosis // Pediatr. Pol. 1996. V.71, 2. P. 83-92.
15. Molgaard Ch.,Thomsen B.L.,Prentis et al. Whole body bone mineral content in
healthy children and adolescents // Diseases in Childhood. 1997. V. 76, 1. P. 9-15.
16. Saggese G., Baroncelli G.I., Bertelloni S. Osteoporosis in Children and Adolescents:
Diagnosis, Risk Factors and Prevention // J. of Pediatric Endocrinology & Metabolism. 2001.
V. 14. P. 833-859.
17. Sanberg M., Gardsell P., Johnell O. et al. Peripubertal moderate exercis increases
bone mass in boys but nut in girls: a population-based intervention study // Osteoporos Int.
2001. V. 12, 3 . P. 230-238.
18. Sentongo T.A., Haber B. Progress in the prevention and treatment of osteoporosis
in pediatrics // J. Pediatr. Gastroenterol. Nutr. 1999. V. 28, . 3. P. 348-9.
19. Sojka L. A., Fairfield W. P., Klibanski A. Clinical Review 117 Hormonal
Determinants
and
Disorders
of
Peak
Bone
Mass
in
Children
// J. of Clinical Endocrinology & Metabolism. 2002. V. 85, . 11. P. 3951 -3963.
20. Steelman J., Zeiler P. prepubescent children: a randomized controlled trial // J Bone
Miner Res. 2001. V. 16, 1 . P. 148-156.
21. Szathmari M., Tulassay ., Arato A., Bodanszy et al. Bone mineral content and
density in asymotomatic children with coeliac disease on a gluten-free diet // J. Gastroenterol.
Hepatol. 2001. V. 13, 4. P. 419^124.

 3/2004

OST
1

.. ., ..
' , , - 1
- . , () - .
. "OST" ( , ) . , "OST"
, .

.
, .
6 - 30%,
- [1]. . ,
, 85% , [2].
.
(EFFO),
. ,
,
: , [7].
, .
,
, , [4].


(). , , ,
.
(),
.
[9].

, , . , 2-10 [12].

, .

,
, .

[3].
, , , .
. , . Gluer D. Felsenberg [6]
:
1) ; 2) ,
; 3) ,
; 4)
.
, . : SCORE [11], ORAI [5], OST [8], OSTA [10].
. SCORE
: , , , , , . 91% 40% (- < 2). - ORAI, ,
, 97%
41%. , , , .
(L.K.N. Koh et al.)
, :
(OSTA),
, (ORAI). ( - < 2,5) 61%
OSTA, 15% - 3% - -

 3/2004

[10].
A (Asian) (OST).
, , .

, .
, .

.

.

, .

EXCELL NORLAND Medical Systems,
Inc. ().
1000 ,
- 936 (93,6%). - 1:14,6.
. ,
-1,0 -2,5 SD , . , 2,5
SD -, .
-1,0 SD.
, .
- OST,
. : () (),
0,2. OST : - OST < - 3 ;
- OST - -3 1; - OST > 1.

OST : ,
, .

. 1.

(. .).
30
11 (79%),
48%, 18% 5% .

30
3 (21,4%)
11 (78,6%)
14(100%)
30 50
13 (7,4%)
162(92,6%)
175 (100%)
50 70 32 (5,3%) 576 (94,7%)
608(100%)
70
17(8,4%)
186(91,6%)
203 (100%)
...
65 (6,5%) 935 (93,5%)
1000 (100%)
2

2 (2%)
0 (0%)
1 (1%)

2(17%)
1 (10%)
18(17%)

10(83%)
9 (90%)
86(81%)
...
12 (100%)
10 (100%)
106 (100%)
3

(OST >1) (OST> - +1 (OST <-3 )

227 (33%)
13 (5%)
0 (0%)

337 (49%)
78 (28%)
0 (0%)

188 (67%)
30(100%)
127(18%)
...
691 (100%)
279 (100%)
30(100%)

30
21% , : 31-50 51-70 - 47%
46%, 70 30% .
70
(65%), , ,
, .
,
143 (14,3%).
12,8% ; 4,7%, - 13,4% . 1,6% 1,5% .

 3/2004

.
.
- 10,6% , -
1,2% .
(11,2%) ,
, .
. 2 ,
,
. ,
50 ,
61-70 , 30 .

.
, , , . :
, , , .
OST . 3.
30
(3%),
( - -2,5 )
100% ;
. , , 66% (20 ).
279 (27,9%), 67% (188
), - 28% (78 ),
- 5% (13 ).
28% (80 ).
691 (69,1 %), 50 ; 33% - 227 ,
- 18% (127 ), -
49% (337 ). 6% (43 ).
,
, , : , -
, , , , -
.
32% (108 ), 50% (63 ).
OST - 95%, - 32%;
- 52%.

1. ,
- - 95%.
2. OST .
3. (OST <-3) . ,
(OST -3 1), .
(OST > 1) . .
SUMMARY
Osteoporosis is one of the most common diseases which often
leads to bone fractures. The gold standard of osteoporosis
diagnostics is Dual Energy X-ray Absorptiometry (DEXA). But
DEXA can not be used for the scmening of the entire population
due to very high cost. The risk of osteoporosis can be assessed
with different questionnaires. In our study we evaluated the
diagnostic value of the questionnaire OST (body mass, age).
We also estimated this questionnaire as a screening method for
selection of patients for DEXA. The results of our study
demonstrate that the OST questionnaire can evaluate the risk
of osteoporosis development with very high accuracy and it can
be recommended as a method for osteoporosis screening.

1. .. // , 2000;2 (6):240-244.
2. ..
: / . .. .
.: , 2003. . 4 6 9 ^ 8 1 .
3. .., .. ()
- // , 2002, 3, .20-23.
4. .., ..
: / . .. . .:
, 2003. . 320-344.
5. Genant .., Cooper , Poor G., et al. Interim report and
recommendation of the World Health Organization task-force for osteoporosis/
Osteoporosis Int., 1999; 10:259-265.
6. Hailey D., Sampietro-Colom L., Marshall D., Rico R., Grandos A. et al.
The effectiveness of bone density measurement and associated treatments for
prevention of fractures: an international collaborative review. Int. J. Technol. Assess
Health Care. 1998.14. P. 237-254.
7. Walker-Bone K., Read D.V., Cooper Is screening for osteoporosis
worthwhile? Br. Med. Bull. 1998. 54. P. 915-927.
8. Cluer C.-C, Felsenberg D. Kosten und Nutzen unterschiedlicher
Strategien zur Diagnoze von Osteoporose. Radiologe. 1996. 36. P.315-326.
9. Lydick E., Cook K., Turpin J., Melton M., Stine R^ et al. Development
and validation of a simple questionnaire to facilitate identification of women likely
to have low bone density. Am J Manag Care. 1998. 4. P. 37^t8.
10. Cadarette S.M., Jaglal S.B., Kreiger N., Mclssac W.J., Darlington G.A.
et al. Development and validation of the Osteoporosis Risk Assessment Instrument
to facilitate selection of women for bone densitometry. CMAJ. 2000,162. P. 12891294.
11. Koh L.K.H., Ben Serdine W., Torralba T.P., Kung A., Fujiwara S. et al.
A simple tool to identify Asian women at increased risk of osteoporosis.
Osteoporosis Int, 2001,V12, 8. P. 699-705.
12. Geusens P., Pols H., Hochberg M.C., Ross P.D. A simple chart for
evaluating risk of osteoporosis based on the osteoporosis self-assessment tool
(OST). Osteoporosis Int, 2002, 13. S31.

 3/2004

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reabsorption of phosphate and C-terminal b-isomerized

telopeptide of type I collagen level in the OGC-group versus the
IGC-group. We also found a decrease in serum osteocalcin level
and a parathyroid hormone hypersecretion in OGC-group as
compared with the control group. An increase in biochemical
markers of bone resorption and a decrease in ionized calcium
serum level as well as an increase in tubular reabsorption of
phosphate were revealed in the IGC-group versus the control
group. The main risk factors for osteoporosis are considered to
be age, duration of menopause, low body weight, and duration of
OGC-therapy in postmenopausal women who have been treated
with OGC. The risk factors for osteoporosis development are
supposed to be age, duration of menopause and daily dose of
IGC in postmenopausal women who have received IGC-therapy
These results demonstrate that long term OGC therapy
increases the risk of osteoporosis and vertebral deformations for
postmenopausal women. IGC does not effect BMD and fracture
risk, but high doses of IGC intake may be an additional risk factor
of osteoporosis for postmenopausal women.

, (, - ),
, , .

1. , ,
.
2.
,
.
3. , , , , , .
4. .
5. , , , .

SUMMARY
The purpose of our study was to assess Bone Mineral Density
(BMD), fracture risk, biochemical parameters of bone metabolism
and risk factors for glucocorticoid-induced osteoporosis in
postmenopausal women with glucocorticoid therapy. We
investigated 81 women between 41-75 who suffered from bronchial
asthma. Among these patients, 55 women received oral
glucocorticoids (OGC-group) and 26 women were treated with
inhaled glucocorticoids (IGC-group). The control group consisted
of 123 healthy women who never received glucocorticoids therapy.
Bone mineral density (BMD) was significantly lower in the
lumbar spine and proximal femur in OGC-group versus the control
group. The OGC group also had lower BMD in the femoral neck,
trochanter and proximal femur versus the IGC-group. The
osteoporosis frequency was higher in spine femoral neck and
forearm in the OGC-group as compared with the control group.
Moreover, the incidences of compressive vertebral deformation
were found more frequently in the OGC-group as compared with
the control group. We did not find an influence of IGC intake on
BMD and fracture risk. Biochemical examination revealed a
marked decrease in phosphorus serum level, renal tubular

1. ., .. : , , // / . .. . ., 2003. . 397^(29.
2. .., .., .. .
// . 2001. 1. . 20-27.
3. .., .. // / . ... , 2003. . 10-53.
4. .. // . 2000. 2. . 12-17.
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8. Dykman T.R., Gluck O.S., Murphy W.A. et al. Evaluation of factors associated
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9. Eastell R., Reid D.M., Compston J. et al. A UK Consensus Group on management
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on mineral metabolism and parathyroid hormone activity in humans // Calcif. Tissue Int.
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prevention. Revised. National Institutes of Health, 2002; 176 p.
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postmenopausal women is a major determinant of osteoporosis // J. Bone miner. Res. 1996.
V. I I . P. 337-349.
13. Gulko P.S., Mulloy A.L. Glucocorticoid-induced osteoporosis: pathogenesis,
prevention and treatment // Clin. Exp. Rheumatol., 1996; 14(2): 199-206.
14. Hofbauer L.C., Gori F., Riggs B.L. et al. Stimulation of osteoprotegerin ligand
and inhibition of osteoprotegerin production by glucocorticoids in human osteoblastic
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Endocrinology, 1999; 140: 4382^1389.
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 3/2004

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SUMMARY
The objective of this review is to summarize our knowledge
about the recently introduced anabolic agent teriparatide.
Teriparatide is the recombinant human 1-34 amino acid sequences
of parathyroid hormone, which has been approved in USA, Europe
and Russia for the treatment of osteoporosis. Different agents used
for the prevention and treatment of osteoporosis slow bone loss
by decreasing both bone resorption and formation. While oncedaily injection of teriparatide increases bone mass by stimulating

formation of new bone resulting in the restoration of bone

architecture.
The international clinical trials data of teriparatide usage
are provided. We also include our experience in using teriparatide
and its influences on biochemical markers of bone metabolism.
We suppose that measurements of biochemical bone markers may
be used for early therapeutic effects assessment of teriparatide
treatment of osteoporosis.

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