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Overview of osteoporosis: pathophysiology and determinants of bone strength

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Abstract

Recent advances in both the pharmacological and surgical treatment of osteoporosis and vertebral compression fractures offer exciting new options for elderly patients. However, these treatments should be considered only with an indepth knowledge of osteoporosis as a metabolic disorder with complex effects on bone, its homeostatic regulation, and vertebral strength. Bone homeostasis is under the influence of both endogenous hormonal changes and external mechanical loads resulting from physical activity. These impart their effects through regulation of the relative activities of bone cells, in particular osteoblasts and osteoclasts, which control bone deposition and resorption, respectively. The strength of a vertebra is directly influenced by the amount and relative proportions of its components, with bone mineral density a useful measure of fracture risk. The purpose of this article is to discuss these issues, among others, in order to offer the reader a better understanding of the pathophysiology of osteoporosis and the determinants of bone strength as they relate to the aging skeleton.

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References

  1. Amling M, Schilling AF, Haberland M, Rueger JM (2001) Leptin: factor in the central nervous system regulation of bone mass. Development of a new understanding of bone remodeling, skeletal reconstruction, skeletal preservation and skeletal repair. Orthopade 30:418–424

    Article  CAS  Google Scholar 

  2. deLaet CE, vanderKlift M, Pols HA (2002) Osteoporosis in men and women: a story about bone mineral density thresholds and hip fracture risk. J Bone Miner Res 17:2231–2236

    PubMed  Google Scholar 

  3. Eastell R, Lambert H (2002) Strategies for skeletal health in the elderly. Proc Nutr Soc 61:173–180

    Article  Google Scholar 

  4. Einhorn TA (1992) Bone strength: the bottom line. Calcif Tissue Int 51:333–339

    CAS  Google Scholar 

  5. Einhorn TA (2000) Vertebroplasty: an opportunity to do something really good for patients. Spine 25:1051–1052

    CAS  PubMed  Google Scholar 

  6. Feskanich D, Willett W, Colditz G (2002) Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA 288:2300–2306

    Article  Google Scholar 

  7. Flynn MJ, Cody DD (1993) The assessment of vertebral bone macroarchitecture with X-ray computed tomography. Calcif Tissue Int 53:S170–S175

    PubMed  Google Scholar 

  8. Garfin SR, Yuan HA, Reiley MA (2001) New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful ostoeporotic compression fractures. Spine 26:1511–1515

    CAS  PubMed  Google Scholar 

  9. Gill SS, Einhorn TA (1998) Bone metabolism and metabolic bone disease. In: JH Beaty (eds) Orthopaedic knowledge update 6. American Academy of Orthopaedic Surgeons, Rosemont, pp 149–165

  10. Gur A, Denli A, Nas K, Cevik R, Karakoc M, Sarac AJ, Erdogan F (2002) Possible pathogenetic role of new cytokines in postmenopausal osteoporosis and changes during calcitonin plus calcium therapy. Rheumatol Int 22:194–198

    Article  CAS  Google Scholar 

  11. Ismail AA, Cooper C, Felsenberg D, Varlow J, Kanis JA, Silman AJ, O'Neill TW (1999) Number and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. European Vertebral Osteoporosis Study Group. Osteoporosis Int 9:206–213

    Article  CAS  Google Scholar 

  12. Kerstetter JE, O'Brien KO, Insogna KL (2003) Low protein intake: the impact on calcium and bone homeostasis in humans. J Nutr 133:855S–861S

    CAS  Google Scholar 

  13. Lacey DL, Timms E, Tan HL, Kelley MJ, Dunstan CR, Burgess T, Elliott R, Colombero A, Elliott G, Scully S, Hsu H, Sullivan J, Hawkins N, Davy E, Capparell iC, Eli A, Qian YX, Kaufman S, Sarosi I, Shalhoub V, Senaldi G, Guo J, Delaney J, Boyle WJ (1998) Osteoprotegerin ligand is a cytokine that regulates osteoclast differentiation and activation. Cell 93:165–176

    PubMed  Google Scholar 

  14. Leidig-Bruckner G, Minne HW, Schlaich C, Wagner G, Scheidt-Nave C, Bruckner T, Gebest HJ, Ziegler R (1997) Clinical grading of spinal osteoporosis: quality of life components and spinal deformity in women with chronic low back pain and women with vertebral osteoporosis. J Bone Miner Res 12:663–675

    CAS  PubMed  Google Scholar 

  15. Norman AW, Roth J, Orci L (1982) The vitamin D endocrine system: steroid metabolism, hormone receptors and biological response. Endocr Rev 3:331–366

    CAS  PubMed  Google Scholar 

  16. Riggs BL, Melton LJ (1983) Evidence for two distinct syndrome of involutional osteoporosis. Am J Med 309:899–901

    Google Scholar 

  17. Riggs BL, Melton LJ (1992) The prevention and treatment of osteoporosis. N Engl J Med 327:620–627

    CAS  Google Scholar 

  18. Silva MJ, Keaveny TM, Hayes WC (1997) Load sharing between the shell and centrum in the lumbar vertebral body. Spine 22:140–150

    Article  CAS  PubMed  Google Scholar 

  19. Silver JJ, Majeska RJ, Einhorn TA (1994) An update on bone cell biology. Curr Opin Orthop 5:50–59

    Google Scholar 

  20. Vega E, Ghiringhelli G, Mautalen C, ReyValzacchi G, Scaglia H, Zylberstein C (1998) Bone mineral density and bone size in men with primary osteoporosis and vertebral fractures. Calcif Tissue Int 62:465–469

    Article  CAS  Google Scholar 

  21. White A, Panjabi M (1990) Clinical biomechanics of the Spine. Lippincott, Philadelphia

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Boston University Medical Center, 850 Harrison Avenue, Dowling 2 North, Boston, MA 02118, USA

    Christopher M. Bono

  2. Department of Orthopaedic Surgery, Boston University Medical Center, 720 Harrison Avenue, Doctors Office Building Suite 808, Boston, MA 02118, USA

    Thomas A. Einhorn

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  1. Christopher M. Bono
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  2. Thomas A. Einhorn
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Correspondence to Christopher M. Bono.

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Bono, C.M., Einhorn, T.A. Overview of osteoporosis: pathophysiology and determinants of bone strength. Eur Spine J 12 (Suppl 2), S90–S96 (2003). https://doi.org/10.1007/s00586-003-0603-2

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  • DOI: https://doi.org/10.1007/s00586-003-0603-2

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