BIOLOGY 310 ASSIGNMENT OSTEOPOROSIS

8/14/2019 BIOLOGY 310 ASSIGNMENT OSTEOPOROSIS

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BIOLOGY 310

ASSIGNMENT

OSTEOPOROSIS

NAME: MOHD IZWAN IBRAHIM

LECTERURES NAME:

SIR ABDUL RAZAK B ABDUL RAHMAN


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Abstract

Osteoporosis is a common age-related disorder manifested clinically by skeletal fractures,

especially fractures of the vertebrae, hip, and distal forearm. The major cause of these fractures is

low bone mass, although an increase in trauma due to falls in the elderly also contributes. There

are multiple causes for the low bone mass which, in any given individual, may contribute

differently to the development of the osteopenia. The most important groups of causes are failure

to achieve adequate peak bone mass, slow bone loss due to processes relating to aging, the

menopause in women, and a variety of sporadic behavioral, nutritional, and environmental

factors that affect bone mass in some but not in other individuals. The most important approach

is prevention. Drugs and behavioral factors known to cause bone loss should be eliminated and

perimenopausal women should be evaluated for possible preventive administration of estrogen.

For patients with fractures due to established osteoporosis, the only drugs approved by the Food

and Drug Administration are the antiresorptive agents calcium, estrogen, and calcitonin.

Formation-stimulating regimens, however, are being developed and may be available for clinical

use in the foreseeable future. These regimens may be capable of increasing bone mass to above

the fracture threshold, thereby resulting in a clinical cure of the osteoporosis.


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INTRODUCTION


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History of Osteoporosis

Osteoporosis has haunted human since the dawn of history. Egyptian mummies from

4,000 years ago have been found with the telltale dowagers hump. Most young women today

can expect to spend their old age standing as straight and tall as they ever were, thanks to recent

dramatic improvements in the diagnosis, prevention, andtreatment of osteoporosis.

An early medical pioneer, the eighteenth century English surgeon John Hunter discovered

that as new bone is laid down in the body, old bone is destroyed, or resorbed. This process is

now known as remodeling and was later shown to play a critical role in osteoporosis, though it

wasnt even a recognized disease for more than 100 years after his death.

In the 1830s the French pathologist Jean Georges Chretien Frederic Martin Lobstein

noticed that some patients bones were riddled with larger than normal holes, and he coined the

term osteoporosis (porous bone) to describe such deteriorated human bone. In the 1930s Fuller

Albright Fuller Albright of Massachusetts General Hospital couldnt help but ponder what it was

about being postmenopausal that made women particularly susceptible to having frail bones.

Somewhere around 1940 he defines postmenopausal osteoporosis and begins treating

women with the condition with estrogen. Butestrogen therapy can only prevent damage to the

skeleton by stemming bone loss. In the 1940s it was virtually impossible to detect the minimal

bone loss seen in the early stages of the disease.

Fortunately, starting in the 1960s, researchers developed more sensitive devices for

detecting bone loss, including densitometers, which can determine bone density by measuring

changes in the absorption of energy passing through bones in the hand, spine, hip, or other body

part. This technique enables physicians to detect osteoporosis in its early stages, well before

fractures occur.

Also in the 1960s Herbert Fleisch discovered compounds known as bisphosphonates that

inhibit bone resorption. Other researchers discover that compounds known as selective estrogen

receptor modulators (SERMs) can simultaneously block breast tumors and trigger the growth of
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uterine cells. At that time though, limited funding was available and the seriousness of the

disease was not quite recognized or acknowledged.

In 1984, the National Institutes of Health publicized this disease, citing it as a significant

threat to health and emphasizing that bone loss could be reduced by estrogen therapy, calcium,

good nutrition and exercise. In the 80s and 90s Researchers discovered cytokines that influence

the development and activity of osteoclasts.

Such discovery then led to bisphosphonates alendronate and risedronate entering the

market as anti-osteoporosis drugs. The selective estrogen receptor modulator drug Raloxifene

entered the market as a drug to treat and prevent postmenopausal osteoporosis in 1998. Around

this time people were also urged to increase their calcium intake. Despite its long history,

osteoporosis remains a formidable challenge to medicine.


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Definition of Osteoporosis

Osteoporosis was come from Greek words Ostoun meaning bone and Poros

meaning pore. Osteoporosis is a systemic skeletal disease, which can be described as a condition

leading to loss of the required normal density of bones. This disease leads to the bones becoming

fragile which in turn leads to risks of fractures, for the smallest of injuries. is a medical condition

in which there is a break in the continuity of thebone.A bone fracture can be the result of high

forceimpact orstress,or trivial injury as a result of certain medical conditions that weaken the

bones, such asosteoporosis,bone cancer,orosteogenesis imperfecta,where the fracture is then

properly termed apathologic fracture.Patients diagnosed with Osteoporosis, have a disorder in

the skeleton leading to abnormally porous bone structure unlike the normal dense structure of

bones.
http://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Impact_forcehttp://en.wikipedia.org/wiki/Stress_fracturehttp://en.wikipedia.org/wiki/Osteoporosishttp://en.wikipedia.org/wiki/Bone_cancerhttp://en.wikipedia.org/wiki/Osteogenesis_imperfectahttp://en.wikipedia.org/wiki/Pathologic_fracturehttp://en.wikipedia.org/wiki/Pathologic_fracturehttp://en.wikipedia.org/wiki/Osteogenesis_imperfectahttp://en.wikipedia.org/wiki/Bone_cancerhttp://en.wikipedia.org/wiki/Osteoporosishttp://en.wikipedia.org/wiki/Stress_fracturehttp://en.wikipedia.org/wiki/Impact_forcehttp://en.wikipedia.org/wiki/Bone


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CONTENTS


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Condition of Osteoporosis

The osteoporosis can be classified into two classes; the first one is Primary Type 1,

Primary Type 2, or secondary. The primary type of osteoporosis is most common occur among

the women after menopause in range of the ages between 50 and 75. Although it is more likely to

occur in women, postmenopausal osteoporosis also occurs in men with low levels of

testosterone. Primary osteoporosis can be subdivided into Type I is found in the post-menopause

stage. Up to 80% of the women in the United States affected by Osteoporosis in the age group of

50 and 75 are of primary Type I. This is because of the sudden postmenopausal decrease in

estrogen levels, which results in a rapid depletion of calcium from the skeleton. It is associated

with fractures that occur when the vertebrae compress together causing a collapse of the spine,

and with fractures of the hip, wrist, or forearm caused by falls or minor accidents. Primary Type1 osteoporosis accounts for the significantly greater risk for osteoporosis in women than in men.

The type II Primary Osteoporosis is more or less related to age. Type II osteoporosis

(senile osteoporosis) typically happens after the age of 70 and affects women twice as frequently

as men. Type II osteoporosis results when the process of resorption and formation of bone are no

longer coordinated, and bone breakdown overcomes bone building. It may result from age-

related reduction in vitamin D synthesis or resistance to vitamin D activity (possibly mediated by

decreased or unresponsive vitamin D receptors in some patients). he second type of Osteoporosis

is the Secondary type. This type affects both the young and middle age group of people.

Secondary osteoporosis is caused by other conditions, such as hormonal imbalances, certain

diseases, or medications (such as corticosteroids). Details on the many other causes of secondary

disease are included throughout this report. Secondary osteoporosis accounts for < 5% of

osteoporosis cases. Causes include endocrine disease for examples glucocorticoid excess,

hyperparathyroidism, hyperthyroidism, hypogonadism, hyperprolactinemia, diabetes mellitus.


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Symptoms of Osteoporosis

Usually, osteoporosis does not cause any symptoms at first. Osteoporosis is often called

the "silent" disease, because bone loss occurs without symptoms. People often don't know they

have the disease until bone breaks, frequently in a minor fall that wouldn't normally cause a

fracture. Osteoporosis develops very slowly over a period of many years. The condition may

creep up on the patient without any obvious symptoms initially - it can take several months, and

even several years to become noticeable. Early signs of osteoporosis may include:

Joint pains Difficulty standing

Difficulty sitting up straight. The stooping position often seen among elderly people is avisible sign of possible osteoporosis.

As the person's bone density or bone mass continues to go down fractures of the hip,

wrist or bones in the spine become more common. Even a cough or a sneeze may fracture a rib

or cause partial collapse of one of the spinal bones.

Elderly people suffer greatly if they fracture a bone, because the bone cannot repair itself

properly. Bones that do not effectively repair themselves are more likely to triggerarthritis,

eventually leaving the patient seriously disabled. A large percentage of elderly patients who

break a bone are not able to live independently afterwards.

Although osteoporosis is not painful in itself, the condition cause bone to break more

easily, and broken bones are very painful. The most common cause of chronic pain linked to the

osteoporosis is a spinal fracture.
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Risk Factors That Can Causes and Link to Osteoporosis

The two major determinants of risk in the development of osteoporosis are peak bone

mass and rate of bone loss. These two determinants are influenced by a number of genetic and

environmental factors. Roughly 70% of cases of osteoporosis are probably the result of genetic

predisposition, including the role of genetics in dictating how an individual will respond to

various exogenous stressors. The remaining 30% of cases are probably triggered by

environmental influences. A risk factor is something that increases a person's chances of

developing a disease or condition. A number of factors can raise the probability of developing

osteoporosis. They include:

1. The patient's sex.Women are twice as likely to develop osteoporosis as men. Experts say there are two

reasons for this:

I. Women start life with a lower bone life than men.II. Women live longer than men.

III. Themenopause causes a sudden drop in estrogen in women which speedsup bone loss.

2. Age.A person's bone mass lowers each year as he/she gets old. The falling bone mass

continues until the person dies.The average loss of bone mass every year after age 50 is 0.5%

in both male and female.

3. Vertigo.Korean scientists found a linkbetween people who suffer from vertigo and osteoporosis.

This is a study of vertigo (Dizziness) among people who have Osteoporosis. The study

analyzes the Osteoporosis patients by their gender and age, drugs used, and common

conditions other than Osteoporosis. In total 87,013 Osteoporosis patients are studied. The

study is created by eHealthMe based on reports from Food and Drug Administration

(FDA) and is updated regularly. On Sep, 12, 2013: 87,013 people who have osteoporosis

are studied. Among them, 6,855 (7.88%) have vertigo.
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4. Human immunodeficiency virus (HIV).People with HIV/AIDS have a significantly higher risk of developing osteoporosis, as

this study found. Studies have documented that osteopenia and osteoporosis are more

common among HIV-positive patients, compared to HIV-negative individuals of the

same sex and age. HIV infection can increase certain proteins in the body including

interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-a)that

may also be responsible for accelerated bone loss. It's also possible that the constant level

of T-cell activation in the body may have an effect on bones. Some researchers have also

speculated that HIV's ability to infect cells in the bone marrow may be to blame.

5. Ethnicity.People who are Caucasian, or of South Asian descent are more likely to develop

osteoporosis than people of African or North/South American Indian descent. However,

the risk is still significant for everybody.

6. Family history.People who have a close relative which meant parent or sibling who has or had

osteoporosis are much more likely to develop it themselves. This is especially the case if

the close relative had fractures.A study found that a gene called Duffy Antigen Receptor

for Chemokines (DARC) negatively regulates bone density in mice.

7. People with small frames.People who have small body frames, as well as people who are very thin tend to have a

higher risk of developing osteoporosis when they get older. This is because their bone

mass is lower than other people's when they start to age and bone density begins to fall.

8. Estrogen exposure.Women who have a late menopause, when estrogen levels drop significantly, have a

lower risk of developing osteoporosis compared to women whose menopause arrives

early or at an average age. Conversely, women whose menopause arrived early are at a

higher risk.
http://www.medicalnewstoday.com/articles/108685.phphttp://www.medicalnewstoday.com/articles/108685.phphttp://www.medicalnewstoday.com/articles/65843.phphttp://www.medicalnewstoday.com/articles/65843.phphttp://www.medicalnewstoday.com/articles/108685.phphttp://www.medicalnewstoday.com/articles/108685.php


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9. Anorexia and/or bulimia.People of both sexes who have, or have had eating disorders have a higher risk of

developing osteoporosis. International Osteoporosis Foundation warns of bone damage

from anorexia.
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Treatment For Osteoporosis

Hormone Replacement Therapy (HRT)

For women going through the menopauseHRT helps prevent bone density loss, thusreducing the risk of fractures during treatment. In many cases, though, HRT is not recommended

as the first osteoporosis treatment, because it can raise her risk of having astroke,heart

disease and breast cancer. It is important that the patient discuss this option with a doctor.

Testosterone Treatment

When a man has osteoporosis because of low testosterone production, testosterone

treatment may be recommended. However, as with breast cancer, testosterone may accelerate the

growth of prostate cancer as well as increasing the risk of prostate cancer recurrence.

Bisphosphonates

These help prevent bone density loss and are non-hormonal drugs. The breakdown rate of

bone by osteoclasts is slowed down while the production of new bone is speeded up. If

bisphosphonates are unsuitable strontium ranelate might be a good alternative. Taking just one

pill per month may help slow down bone loss, this study revealed. Side effects may include

abdominal pain, nausea, inflamed esophagus, esophageal ulcers (especially for patients who have

hadacid reflux) - side effects may be severe.A study revealed that short term use of oral

bisphosphonates may leave the jaw vulnerable to devastating necrosis (death of bone tissue).
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Calcitonin

This inhibits the cells that break down bone. Calcitonin is a hormone made by the thyroid

gland. It may be prescribed for women who are more than 5 years beyond menopause and who

do not tolerate bisphosphonate medicines. Calcitonin can be used in men withosteoporosis who

have normal levels of the male sex hormone testosterone or whose osteoporosis does not get

better with testosterone treatment. Calcitonin may relieve pain caused by spinal compression

fractures. Calcitonin slows thinning of bone, and may help relieve pain from broken bones

caused by osteoporosis.It may also decrease the risk of fractures in the spine.

Calcium and vitamin D supplements

These may help older patients lower their risk of hip fractures. Sunlight is the best source of

vitamin D. If patients do not have access to sunlight, as may be the case during the winter in

some countries, the doctor may recommend a supplement.A Canadian study found that less than

half (43%) of patients in Europe with osteoporosis are claiming to take both calcium and vitamin

D supplementation with their osteoporosis treatment.

Selective Estrogen Receptor M odulators (SERMs)

These drugs help prevent bone density loss. They mimic the beneficial effects of estrogen

on bone density in postmenopausal women - however, without the risk of triggering cancers.

Raloxifene is an example of this type of drug. Patients who have a history of blood clots should

not take this medication. A common side effect is hot flashes. This drug is only approved for

women with osteoporosis, not men.
http://www.webmd.com/menopause/default.htmhttp://www.webmd.com/osteoporosis/default.htmhttp://www.webmd.com/hw-popup/testosteronehttp://men.webmd.com/Men-Medical-Reference/Testosterone-15738http://www.webmd.com/a-to-z-guides/understanding-fractures-basic-informationhttp://www.medicalnewstoday.com/articles/121512.phphttp://www.medicalnewstoday.com/articles/121512.phphttp://www.webmd.com/a-to-z-guides/understanding-fractures-basic-informationhttp://men.webmd.com/Men-Medical-Reference/Testosterone-15738http://www.webmd.com/hw-popup/testosteronehttp://www.webmd.com/osteoporosis/default.htmhttp://www.webmd.com/menopause/default.htm


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Stem Cell Therapy

Stem cell therapy is not a futuristic dream; these therapies are being performed every day

by doctors in facilities across the country. There is no need to suffer with the debilitating effects

of osteoporosis. Stem cell therapy can free you once again to live without fear that a fracture will

cause irreversible damage. Stem cells are the foundation of all other cells in the body. They have

no function other than to heal and regenerate damaged areas. These stem cells can take on the job

of any other cell including the bone cells that are being lost or damaged due to osteoporosis.

Stem cell therapy works by manipulating these stem cells so that they will strengthen and rebuild

bones with greater structural health and significantly decreased risk of fracture due to bone loss.


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Preventations from Osteoporosis Disease

Osteoporosis is more or less preventable for most people. Prevention is very important

because, while treatments are available for osteoporosis, no cure currently exists. Prevention of

osteoporosis involves several aspects, including nutrition,exercise,lifestyle, and others.

Nutrition

Eating the right foods is essential for good nutrition. Our bodies need the right vitamins,

minerals, and other nutrients to stay healthy. Getting enough calcium and vitamin D is important

for strong bones as well as for proper function of the heart, muscles, and nerves. The best way to

get enough calcium and vitamin D is through a balanced diet.

A Diet H igh in Calcium

Not getting enough calcium during a lifetime significantly increases the risk of

developing osteoporosis and is associated with low bone mass, rapid bone loss, and broken

bones. Good sources of calcium include low-fat dairy products, such as milk, yogurt, cheese, and

ice cream; dark green leafy vegetables, such as broccoli, collard greens, and spinach; sardines

and salmon with bones; tofu; almonds; and foods with added calcium, such as orange juice,

cereals, soy products, and breads. Calcium supplements and vitamins are also available.

Recommended Calcium Intake by the National Academy of Sciences (1997)

Age mg/day

Birth-6 months 210

6 months-1 year 270

1-3 years 500

4-8 years 800

9-13 years 1,300

14-18 years 1,300

19-30 years 1,000

31-50 years 1,000

51-70 years 1,200

70 years or older 1,200

Pregnant or lactating See ages above
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A Diet H igh in Vitamin D

Vitamin D is important for the body to absorb calcium from the diet. Without enough

vitamin D, the body is unable to absorb calcium from the foods that are eaten, and the body has

to take calcium from the bones, making them weaker. Vitamin D comes from two sources. It is

made in the skin through direct exposure to sunlight, and it comes from the diet. Many people

get enough vitamin D naturally. Vitamin D is also found in fortified dairy products, egg yolks,

saltwater fish, and liver. However, vitamin D production decreases with age, in people who are

housebound, with the use of sunscreens, and during the winter when sun exposure is decreased.

In these cases, people may need vitamin D supplements to ensure a daily intake of 400-800 IU of

vitamin D.

Exercise

Exercise is important to prevent osteoporosis. Although bones may seem like hard and

lifeless structures, bones are more like muscle; bones are living tissue that respond to exercise by

becoming stronger. Physical activity during childhood and adolescence increases bone density

and strength. This means that children who get exercise are more likely to reach a higher peak

bone density (maximum strength and solidness), which usually occurs by 30 years of age. People

who reach higher peak bone densities are less likely to develop osteoporosis.

The best exercise to prevent osteoporosis is weight-bearing exercise that works against

gravity. Weight-bearing exercises include walking, hiking, jogging, climbing stairs, playing

tennis, jumping rope, and dancing. A second type of exercise is resistance exercise. Resistance

exercises include activities that use muscle strength to build muscle mass, and these also help to

strengthen bone. These activities include weight lifting, such as using free weights and weight

machines found at gyms and health clubs. Exercise has additional benefits in older people as well

because exercising increases muscle strength, coordination, and balance and leads to better

overall health.


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Elderly people, people with osteoporosis, people with heart or lung disease, and people

who have not exercised for most of adulthood should check with their health care professional

before beginning any exercise program.

Quit Smoking

Smoking is bad for the bones as well as for the heart and lungs. In women, nicotine

inhibits the bone protective effect of estrogen. Women who smoke often go through menopause

earlier, which hastens the development of osteoporosis because bone density decreases more

rapidly after menopause. Women who smoke and choose hormone replacement therapy after

menopause may require higher doses of hormones and have more complications. Smokers may

absorb less calcium from their diets. Smokers have a higher lifetime risk of hip fracture than

nonsmokers. Men smokers are at risk of developing osteoporosis.

Limit Alcohol I ntake

Regular consumption of 2-3 ounces of alcohol a day may be damaging to bones, even inyoung women and men. Heavy drinkers are more likely to have bone loss and fractures. This is

related to both poor nutrition and increased risk of falling.

Therapeuti c Medications

Currently, bisphosphonates, such as alendronate (Fosamax), risedronate (Actonel),

ibandronate (Boniva), and zoledronate (Reclast) are approved by the U.S. Food and Drug

Administration (FDA) for the prevention and treatment of postmenopausal osteoporosis in

women. As men age, they are also susceptible to osteoporosis. Alendronate is approved to

increase bone mass in men with age-related osteoporosis. Alendronate and risedronate are
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approved to treat men and women with steroid-induced osteoporosis. Adequate calcium and

vitamin D intake is essential for bisphosphonates to be effective.

Raloxifene (Evista).

This medication approved for the prevention of osteoporosis only in postmenopausal

women who are not taking hormone replacement therapy. Teriparatide is approved for the

treatment of the disease in postmenopausal women and men who are at high risk for fracture.

Estrogen/hormone therapy (ET/HT) is approved for the prevention of postmenopausal

osteoporosis, and calcitonin is approved for treatment. Both alendronate and risedronate are

approved for use by men and women with glucocorticoid-induced osteoporosis. See

UnderstandingOsteoporosis Medications for more information.

Estrogen or Hormone Therapy

After menopause, bone strength and density decreases rapidly in women. Studies show

that estrogen therapy/hormone therapy (ET/HT) reduces bone loss, increases bone density inboth the spine and hip, and reduces the risk of broken bones (especially the hip and spine).

Currently, ET/HT is approved to prevent osteoporosis from developing after menopause. This

therapy is most commonly available in the form of a pill or skin patch. See Hormone

Replacement and Osteoporosis for more information.

When estrogen therapy (ET) is taken alone, it increases a woman's risk of developing

cancer in the uterus (cancer of the uterine lining, called endometrial cancer). Therefore, for

women who have not had their uterus removed (have not had ahysterectomy), doctors prescribe

an additional hormone, either natural progesterone or a synthetic similar substance called

progestin. Progestin or progesterone in combination with estrogen is called hormone therapy

(HT), and it reduces the risk of endometrial cancer in women who have not had a hysterectomy.
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A large study from the National Cancer Institute (NCI) has recently indicated that long-term use

of ET (estrogen alone) may also be associated with an increase in the risk ofovarian cancer.

The Women's Health Initiative (WHI) study recently demonstrated that HT is associated

with increases in the risk ofbreast cancer,ovarian cancer, stroke,and heart attack.No studies

have determined whether ET (estrogen alone) is associated with an increase in the risk of breast

cancer or whether it has an effect on cardiovascular events (like heart attack).

Doctors prescribe any estrogen therapy only for the shortest period of time possible.

ET/HT used to prevent osteoporosis after menopause should only be considered for women with

menopausal symptoms who at significant risk of developing osteoporosis, and other nonestrogen

medications should be considered if osteoporosis is the primary concern.
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CONCLUSION


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Conclusion.

Lastly we can conclude that the osteoporosis will start develope when we take less

calcium on our daily life and also the risk rapidly increases due to age. So we need to have a

healthy lifestyle to prevent this disease from getting us trouble. Besides, we need to avoid taking

alcohol especially for pregnency women. It can cause your baby to have a range of lifelong

health conditions. Drinking alcohol during pregnancy can causemiscarriage,preterm birth and

stillbirth.To get a healthy bone we need to follow the preventation steps as us mention in this

report scuh as quick smoking, exercise, and other. So we can have a goood and healthy day in

our late age time.
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REFRENCES


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Wolters Kluwer Health/Lippincott Williams & Wilkins. pp. 1013.3. Body, JJ (2011 NovDec). "How to manage postmenopausal osteoporosis?". Acta clinica

Belgica66(6): 4437.

4. Background Document for Meeting of Advisory Committee for Reproductive HealthDrugs and Drug Safety and Risk Management Advisory Committee.

5. Neurology;Dizziness Linked to Bone HealthPublished: Mar 23, 2009By Crystal Phend ,Staff Writer, MedPage Today Reviewed byRobert Jasmer, MD; Associate Clinical

Professor of Medicine, University of California, San Francisco.

6. Osteoporosis Treatment Following HipsFracture: How Rate Vary by Servis;SouthernMedical Journal. 103(10):977-981, October 2010.

7. New Guidlines for the Preventation and Treatment of Osteoporosis; Lewiecki, E Michael;Watts, Nelson B. Southern Medical Journal. 102(2):175-179, February 2009.

8. Vitamin D: Important for Prevention of Osteoporosis, Cardiovascular Heart Disease,Type 1 Diabetes, Autoimmune Diseases, and Some Cancers;Holick, Michael F. Southern

Medical Journal. 98(10):1024-1026, October 2005.

9. Recommended Calcium and Vitamin D Intakes;Food and Nutrition Board, Institute ofMedicine, National Academy of Sciences, 2010.

10.Vogel VG, et al. (2006). Effects of tamoxifen vs. raloxifene on the risk of developinginvasive breast cancer and other disease outcomes: The NASBP study of tamoxifen and

raloxifene (STAR) P-2 trial. JAMA, 295(23): 2727-2741.
http://www.medscape.com/viewarticle/410461_3http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM341779.pdfhttp://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM341779.pdfhttp://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM341779.pdfhttp://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM341779.pdfmailto:[email protected]://www.medpagetoday.com/reviewer.cfm?reviewerid=55http://journals.lww.com/smajournalonline/Abstract/2005/10000/Vitamin_D__Important_for_Prevention_of.15.aspxhttp://journals.lww.com/smajournalonline/Abstract/2005/10000/Vitamin_D__Important_for_Prevention_of.15.aspxhttp://journals.lww.com/smajournalonline/Abstract/2005/10000/Vitamin_D__Important_for_Prevention_of.15.aspxhttp://journals.lww.com/smajournalonline/Abstract/2005/10000/Vitamin_D__Important_for_Prevention_of.15.aspxhttp://journals.lww.com/smajournalonline/Abstract/2005/10000/Vitamin_D__Important_for_Prevention_of.15.aspxhttp://journals.lww.com/smajournalonline/Abstract/2005/10000/Vitamin_D__Important_for_Prevention_of.15.aspxhttp://www.medpagetoday.com/reviewer.cfm?reviewerid=55mailto:[email protected]://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM341779.pdfhttp://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM341779.pdfhttp://www.medscape.com/viewarticle/410461_3

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