A critical review of bone mass and the risk of fractures in osteoporosis

Abstract

The usefulness of various bone mineral measurement techniques is a subject of current controversy. In order to explore whether disparate conclusions may have arisen from differences in analytic methodology, data from published reports of bone mass and nonviolent fractures have been reanalyzed in terms of fracture risk. In the large majority of studies, reduced bone mass was associated with an increased risk of fractures. However, the magnitude of the relationship varied much more among cross-sectional studies than among prospective studies, suggesting that bias related to subject selection and/or postfracture bone loss may have strongly influenced the cross-sectional findings. We conclude that more emphasis should be given to the results of prospective studies, and that more attention should be paid to subject selection in all investigations. Analyzing and presenting results in terms of fracture risk would probably reduce the level of confusion in the field and provide more clinically relevant information. These issues are also applicable to studies of potential fracture risk factors other than bone mass, such as bone structure and bone quality.

Results from bone mineral density scans in twenty-two complete lesion paraplegics

“…Large negative scores are indicative of a low BMD, and this has been shown to be associated with an increased risk of fracture. Results from studies suggest that for a 2 standard deviation dierence in bone mass there is a 2 ± 4-fold increase in fracture risk at non-spine sites 7 and a 4 ± 6-fold increase at vertebral sites. 8 Though it is recognised that these are predominantly from postmenopausal women, we have used the above to describe benchmarks of fracture risk since very few studies have been conducted either on men or on paraplegics.…”

Magnetic resonance imaging and spectroscopy of the intervertebral disc

“…After surgery, contrast-enhanced MR is used to distinguish scar tissue from recurrent herniation (17,18). There has also been some recent interest in the high intensity zone in the posterior annulus seen in T2-weighted images (19,20).…”

Effects of h-PTH on cancellous bone mass, connectivity, and bone strength in ovariectomized rats with and without sciatic-neurectomy

“…Rapid trabecular disconnectivity has been shown to affect the response to compressive stress [18]. Bone mineral density (BMD) has been shown to be one of the most important contributing factors to bone strength and a good predictor of fracture risks in osteoporosis [4,9,19,25,28]. However, many recent studies have shown that BMD alone may not be sufficient to determine the strength of cancellous bone and that the trabecular architecture may also be an important factor in determining bone strength and individual risk of fractures [3,5,11,33,34].…”