“Osteoporosis” in 2000 Ad Quo Vadis?

Abstract

Here, we suggest that new ideas and knowledge about osteoporosis reveal necessary new directions for future work. To explain, by 1999, five studies involving a total of 1827 healthy humans from two to over 80 years of age supported this proposal in the Utah paradigm of skeletal physiology: Momentary muscle strength strongly influences and may dominate control of the biologic mechanisms that determine the postnatal strength of load-bearing bones. That italicized proposal differed so much from former views that before 1999, few people thought it deserved testing in humans. The above five studies did finally test it, and they support it. If true, its implications would affect many things. In part, they include (A), genetic effects on bone strength and mass, muscle and osteoporosis; (B) the pathogenesis, diagnosis, classification, prevention and management of osteoporosis; (C) the things osteoporosis-oriented basic, clinical and pharmaceutical research should study; (D) the absorptiometric methods and animal models used to study the disorder; (E) which research projects would receive preferred funding; (F) and the content of future texts, review articles, classroom lectures and many osteoporosis-oriented meetings. Many might find some of those implications dubious. While we will respect such doubts, this article describes some of those implications so others can exploit them and/or help to resolve any disagreements they may cause. Because they depend on the Utah paradigm of skeletal physiology, some of its pertinent features must be summarized.