Abstract
Although the concept of “bone quality” is at least 15 years old [1], the term has recently sparked much discussion and debate among clinicians and clinical researchers [2–5]. At a recent National Institutes of Health conference on bone quality, the term was defined as: “The sum total of characteristics of the bone that influence the bone's resistance to fracture” [6].
Highlights
The concept of “bone quality” is at least 15 years old [1], the term has recently sparked much discussion and debate among clinicians and clinical researchers [2,3,4,5]
The idea of bone quality, and the explanation for the conflicting results, linked together two important notions: (1) antiresorptive drugs acted by suppressing bone turnover through inhibiting bone resorption, and (2) increased bone turnover compromises the bone strength through deteriorated bone microarchitecture [4]
The concept of bone quality is invoked to explain fracture risk that cannot be attributed to bone mineral density (BMD), but it seems impossible that bone quality could realistically explain 85% of all fractures
Summary
This definition arose from the results of multicenter clinical trials that evaluated the effects of two classes of drugs—antiresorptive bisphosphonate therapy (alendronate and risedronate) and selective estrogen receptor modulator therapy (raloxifene)—on the prevention of osteoporotic fragility fractures [7,8]. While these studies reported consistent reductions in the incidence of fractures, the treatment effects could not be explained by contemporary changes in dual X-ray absorptiometric bone mineral density (BMD), the present clinical standard of bone fragility. To further support the concept of bone quality, inclusion of increased bone turnover in fracture-predicting models has somewhat improved the ability to predict fracture risk independently of BMD [8,16,17,18,19]
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