Top

Published in:

01-10-2003 | Review

Overview of osteoporosis: pathophysiology and determinants of bone strength

Authors: Christopher M. Bono, Thomas A. Einhorn

Published in: European Spine Journal | Special Issue 2/2003

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.

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 30:418–424CrossRef

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 17:2231–2236PubMed

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

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

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

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

Flynn MJ, Cody DD (1993) The assessment of vertebral bone macroarchitecture with X-ray computed tomography. Calcif Tissue Int 53:S170–S175PubMed

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

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 22:194–198CrossRef

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 9:206–213CrossRef

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

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 93:165–176PubMed

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 12:663–675PubMed

15.

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

16.

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

17.

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

18.

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

19.

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

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 62:465–469CrossRef

21.

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

Title: Overview of osteoporosis: pathophysiology and determinants of bone strength
Authors: Christopher M. Bono
Thomas A. Einhorn
Publication date: 01-10-2003
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue Special Issue 2/2003
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-003-0603-2

At a glance: The STEP trials

Springer Medicine

Overview of osteoporosis: pathophysiology and determinants of bone strength

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Special Issue 2/2003

Medical treatment of vertebral osteoporosis

The aging of the population: a growing concern for spine care in the twenty-first century

Natural history of the aging spine

Posterior approach to the degenerative cervical spine

Anterior decompression for cervical spondylotic myelopathy

Principles of management of osteometabolic disorders affecting the aging spine