The Role of Bone Quality on Bone Loss and Bone Fragility

  • Marc D. Grynpas


Normal bone mass in humans, after growth has ceased, is maintained by the balance between bone formation by osteoblasts and bone resorption by osteoclasts. With age, starting around the third decade of life, after peak bone mass has been reached there is a slow and steady loss of bone. A similar age related loss of bone occurs in all mammalian species. Osteoporosis is a multifactorial, age-related metabolic bone disease characterized by low bone mineral density and the deterioration of the microarchitecture of cancellous bone. The resulting changes in the material properties of bone lead to enhanced bone fragility and to a consequent increase in the risk of fracture (Wasnich, 1996). There are two types of osteoporosis, each with their own characteristics. Type I osteoporosis, also called post-menopausal osteoporosis, is characterized by an increase in bone turnover and an accelerated loss of cancellous bone leading to vertebral fracture. It affects mainly post-menopausal women. Type II osteoporosis, also called age-related osteoporosis, affects older women and men and is not accompanied by increased bone turnover, but leads to hip fracture and has a greater mortality and morbidity than type I osteoporosis. The risk factors for osteoporosis are age, gender, genetic, environmental (nutrition, physical activity, medication, smoking, etc.), hormonal deficiency, reproductive history, chronic diseases, and physical characteristics of bone. While osteoporosis is a complex disease that leads to fracture, there is no way to measure the strength of bone in humans to predict fracture risk. Bone mineral density (BMD) as measured by dual energy x-ray absorptiometry (DEXA) has become the main way to assess the risk of fracture even if it is only a surrogate measure of bone strength. Osteoporosis is diagnosed (by the WHO criteria) when the value for BMD is 2.5 standard deviations or more below the mean of the young adult reference range (Kanis, 1994).


Bone Mineral Density Bone Loss Bone Mass Vertebral Fracture Cortical Bone 
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© Springer Science+Business Media New York 2003

Authors and Affiliations

  • Marc D. Grynpas
    • 1
  1. 1.Department of Laboratory Medicine and PathobiologyUniversity of Toronto, and the SLRI of Mount Sinai HospitalTorontoCanada

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