Diseases Affecting Bone Quality: Beyond Osteoporosis

• Published in: Clinical orthopaedics and related research 2011-08, Vol.469 (8), p.2194-2206
• Main Authors: Unnanuntana, Aasis, Rebolledo, Brian J., Michael Khair, M., DiCarlo, Edward F., Lane, Joseph M.
• Format: Article
• Language: English
• Subjects: Antirheumatic Agents - therapeutic use; Bone and Bones - drug effects; Bone and Bones - metabolism; Bone and Bones - physiopathology; Bone Density; Bone diseases; Bone Diseases - metabolism; Bone Diseases - physiopathology; Bone mineral density; Bone remodelling; Bone Resorption - physiopathology; Bone strength; Bone turnover; Collagen (type I); Collagen Diseases - physiopathology; Conservative Orthopedics; Drugs; Etiology; Fractures; Fractures, Bone - physiopathology; Glucocorticoids - therapeutic use; Homeostasis; Homeostasis - physiology; Humans; Hyperparathyroidism - physiopathology; Medicine; Medicine & Public Health; Mineralization; Orthopedics; Osteogenesis; Osteopetrosis - physiopathology; Osteoporosis; Osteoporosis - physiopathology; Risk assessment; Sports Medicine; Surgery; Surgical Orthopedics; Symposium: Bone Quality: From Bench to Bedside
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-010-1694-9

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.