30 - Osteoporosis: Basic and Clinical Aspects

Abstract

The functional significance of bone has been reassessed in light of recent discoveries. In addition to the well-known mechanical support and storage of mineral, mineralized mesenchymal tissue also exports peptides critical for regulation of circulating phosphate and whole-body energy metabolism. We now have a more complete picture of the skeleton and its role in maintaining mineral and metabolic homeostasis. Osteoporosis has a great impact on quality of life and mortality because of its negative impact on bone strength. In the past three decades, risk factors for fractures have been exhaustively scrutinized. Online algorithms are available to help predict long-term fracture risk and are a readily available and important tool for evaluating patients. In parallel, biochemical markers of bone remodeling and imaging techniques to evaluate bone metabolism and structure, respectively, are employed for early recognition of fracture susceptibility. Advances in our knowledge of mechanisms driving bone loss have accelerated development of cost-effective drugs for the prevention of fractures. Moreover, ongoing studies point to additional and more effective drugs for osteoporosis. Curiously, clinical awareness for diagnosing and treating osteoporosis remains underdeveloped; unfortunately, few individuals benefit from the level of knowledge and technology available to diagnose and manage the disorder. Unlike available therapeutic options for other chronic disorders, osteoporosis therapy is unique in that weekly, monthly, biannual, or even annual dosing may be sufficient to accomplish successful treatment.