Osteoporosis International

, 20:1461 | Cite as

Is bone quality associated with collagen age?

  • D. J. Leeming
  • K. Henriksen
  • I. Byrjalsen
  • P. Qvist
  • S. H. Madsen
  • P. Garnero
  • M. A. Karsdal


The World Health Organization defines osteoporosis as a systemic disease characterized by decreased bone tissue mass and microarchitectural deterioration, resulting in increased fracture risk. Since this statement, a significant amount of data has been generated showing that these two factors do not cover all risks for fracture. Other independent clinical factors, such as age, as well as aspects related to qualitative changes in bone tissue, are believed to play an important role. The term “bone quality” encompasses a variety of parameters, including the extent of mineralization, the number and distribution of microfractures, the extent of osteocyte apoptosis, and changes in collagen properties. The major mechanism controlling these qualitative factors is bone remodeling, which is tightly regulated by the osteoclast/osteoblast activity. We focus on the relationship between bone remodeling and changes in collagen properties, especially the extent of one posttranslational modification. In vivo, measurements of the ratio between native and isomerized C-telopeptides of type I collagen provides an index of bone matrix age. Current preclinical and clinical studies suggests that this urinary ratio provides information about bone strength and fracture risk independent of bone mineral density and that it responds differently according to the type of therapy regulating bone turnover.


Antiresorptives Bone quality Isomerization Osteoporosis Type I collagen 



We acknowledge the funding from the Danish “Ministry of Science, Technology and Science”.

Conflicts of interest

Leeming DJ, Henriksen K, Byrjalsen I, Qvist P, Madsen SH, and Karsdal MA are employees of Nordic Bioscience.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • D. J. Leeming
    • 1
  • K. Henriksen
    • 1
  • I. Byrjalsen
    • 1
  • P. Qvist
    • 1
  • S. H. Madsen
    • 1
  • P. Garnero
    • 2
    • 3
  • M. A. Karsdal
    • 1
  1. 1.Nordic BioscienceHerlevDenmark
  2. 2.CCBR-SynarcLyonFrance
  3. 3.INSERMLyonFrance

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