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Diseases Affecting Bone Quality: Beyond Osteoporosis

  • Symposium: Bone Quality: From Bench to Bedside
  • Published:
Clinical Orthopaedics and Related Research®

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.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Aasis Unnanuntana MD, M. Michael Khair MD & Joseph M. Lane MD

  2. Weill Cornell Medical College, Cornell University, New York, NY, USA

    Brian J. Rebolledo BA

  3. Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY, USA

    Edward F. DiCarlo MD

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  1. Aasis Unnanuntana MD
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Correspondence to Aasis Unnanuntana MD.

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Unnanuntana, A., Rebolledo, B.J., Michael Khair, M. et al. Diseases Affecting Bone Quality: Beyond Osteoporosis. Clin Orthop Relat Res 469, 2194–2206 (2011). https://doi.org/10.1007/s11999-010-1694-9

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  • DOI: https://doi.org/10.1007/s11999-010-1694-9

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