Clinical Orthopaedics and Related Research®

, Volume 469, Issue 8, pp 2194–2206

Diseases Affecting Bone Quality: Beyond Osteoporosis

  • Aasis Unnanuntana
  • Brian J. Rebolledo
  • M. Michael Khair
  • Edward F. DiCarlo
  • Joseph M. Lane
Symposium: Bone Quality: From Bench to Bedside

DOI: 10.1007/s11999-010-1694-9

Cite this article as:
Unnanuntana, A., Rebolledo, B.J., Michael Khair, M. et al. Clin Orthop Relat Res (2011) 469: 2194. doi:10.1007/s11999-010-1694-9

Abstract

Background

Bone quantity, quality, and turnover contribute to whole bone strength. Although bone mineral density, or bone quantity, is associated with increased fracture risk, less is known about bone quality. Various conditions, including disorders of mineral homeostasis, disorders in bone remodeling, collagen disorders, and drugs, affect bone quality.

Questions/purposes

The objectives of this review are to (1) identify the conditions and diseases that could adversely affect bone quality besides osteoporosis, and (2) evaluate how these conditions influence bone quality.

Methods

We searched PubMed using the keywords “causes” combined with “secondary osteoporosis” or “fragility fracture.” After identifying 20 disorders/conditions, we subsequently searched each condition to evaluate its effect on bone quality.

Results

Many disorders or conditions have an effect on bone metabolism, leading to fragility fractures. These disorders include abnormalities that disrupt mineral homeostasis, lead to an alteration of the mineralization process, and ultimately reduce bone strength. The balance between bone formation and resorption is also essential to prevent microdamage accumulation and maintain proper material and structural integrity of the bone. As a result, diseases that alter the bone turnover process lead to a reduction of bone strength. Because Type I collagen is the most abundant protein found in bone, defects in Type I collagen can result in alterations of material property, ultimately leading to fragility fractures. Additionally, some medications can adversely affect bone.

Conclusions

Recognizing these conditions and diseases and understanding their etiology and pathogenesis is crucial for patient care and maintaining overall bone health.

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Aasis Unnanuntana
    • 1
  • Brian J. Rebolledo
    • 2
  • M. Michael Khair
    • 1
  • Edward F. DiCarlo
    • 3
  • Joseph M. Lane
    • 1
  1. 1.Department of Orthopaedic SurgeryHospital for Special SurgeryNew YorkUSA
  2. 2.Weill Cornell Medical CollegeCornell UniversityNew YorkUSA
  3. 3.Department of Pathology and Laboratory MedicineHospital for Special SurgeryNew YorkUSA

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