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Fragility Fractures in Men with Idiopathic Osteoporosis Are Associated with Undermineralization of the Bone Matrix without Evidence of Increased Bone Turnover

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Abstract

The pathogenesis of primary osteoporosis in younger individuals is still elusive. An important determinant of the biomechanical competence of bone is its material quality. In this retrospective study we evaluated bone material quality based on quantitative backscattered electron imaging to assess bone mineralization density distribution (BMDD) in bone biopsies of 25 male patients (aged 18–61 years) who sustained fragility fractures but were otherwise healthy. BMDD of cancellous bone was compared with previously established adult reference data. Complementary information was obtained by bone histomorphometry. The histomorphometric results showed a paucity of osteoblasts and osteoclasts on the bone surface in the majority of patients. BMDD revealed a significant shift to lower mineralization densities for cancellous bone values: CaMean (weighted mean Ca content, –5.9%), CaPeak (mode of the BMDD, −5.6%), and CaHigh (portion of fully mineralized bone, −76.8%) were decreased compared to normative reference; CaWidth (heterogeneity in mineralization, +18.5%) and CaLow (portion of low mineralized bone, +68.8; all P < 0.001) were significantly increased. The shift toward lower mineral content in the bone matrix in combination with reduced indices of bone formation and bone resorption suggests an inherent mineralization defect leading to undermineralized bone matrix, which might contribute to the susceptibility to fragility fractures of the patients. The alteration in bone material might be related to osteoblastic dysfunction and seems fundamentally different from that in high bone turnover osteoporosis with a negative bone balance.

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Acknowledgments

We thank Gerda Dinst, Phaedra Messmer, Daniela Gabriel, and Sonja Lueger for careful sample preparations and qBEI measurements. This study was supported by the AUVA (Research funds of the Austrian Workers Compensation Board) and by the WGKK (Viennese Sickness Insurance Funds).

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Author notes

  1. Sarah Pötter-Lang

    Present address: Department of Radiology, Medical University of Vienna, Vienna General Hospital, 1090, Vienna, Austria

Authors and Affiliations

  1. Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, 1140, Vienna, Austria

    Nadja Fratzl-Zelman, Paul Roschger, Barbara M. Misof, Kamilla Nawrot-Wawrzyniak, Klaus Klaushofer & Elisabeth Zwettler

  2. Medical Department II, St. Vincent Hospital Vienna, 1060, Vienna, Austria

    Sarah Pötter-Lang, Christian Muschitz & Heinrich Resch

  3. Ludwig Boltzmann Institute of Osteology, UKH Meidling, Kundratstrasse 37, 1120, Vienna, Austria

    Nadja Fratzl-Zelman

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  1. Nadja Fratzl-Zelman
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Correspondence to Nadja Fratzl-Zelman.

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Fratzl-Zelman, N., Roschger, P., Misof, B.M. et al. Fragility Fractures in Men with Idiopathic Osteoporosis Are Associated with Undermineralization of the Bone Matrix without Evidence of Increased Bone Turnover. Calcif Tissue Int 88, 378–387 (2011). https://doi.org/10.1007/s00223-011-9466-4

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