The population burden of fractures originates in women with osteopenia, not osteoporosis

Pasco, Julie A.; Seeman, Ego; Henry, Margaret J.; Merriman, E. N.; Nicholson, Geoffrey C.; Kotowicz, Mark A.

doi:10.1007/s00198-006-0135-9

Cited by 299 publications

(205 citation statements)

References 20 publications

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“…(11,12) BMD is a good measure of bone density but only a moderate predictor of bone strength. (13) Bone strength is controlled not only by bone density but also by other qualitative factors, such as composition and mineralization. Recent studies have indicated that the increased fracture risk in other metabolic bone diseases such as osteoporosis not only may follow from the low bone mass and distorted bone structure but also may be due to altered composition of the bone tissue.…”

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confidence: 99%

Infrared spectroscopy indicates altered bone turnover and remodeling activity in renal osteodystrophy

Isaksson

Turunen

Rieppo

et al. 2010

Journal of Bone and Mineral Research

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Renal osteodystrophy alters metabolic activity and remodeling rate of bone and also may lead to different bone composition. The objective of this study was to characterize the composition of bone in high-turnover renal osteodystrophy patients by means of Fourier transform infrared spectroscopic imaging (FTIRI). Iliac crest biopsies from healthy bone (n ¼ 11) and patients with renal osteodystrophy (ROD, n ¼ 11) were used in this study. The ROD samples were from patients with hyperparathyroid disease. By using FTIRI, phosphate-toamide I ratio (mineral-to-matrix ratio), carbonate-to-phosphate ratio, and carbonate-to-amide I ratio (turnover rate/remodeling activity), as well as the collagen cross-link ratio (collagen maturity), were quantified. Histomorphometric analyses were conducted for comparison. The ROD samples showed significantly lower carbonate-to-phosphate ( p < .01) and carbonate-to-amide I ( p < .001) ratios. The spatial variation across the trabeculae highlighted a significantly lower degree of mineralization ( p < .05) at the edges of the trabeculae in the ROD samples than in normal bone. Statistically significant linear correlations were found between histomorphometric parameters related to bone-remodeling activity and number of bone cells and FTIRI-calculated parameters based on carbonate-to-phosphate and carbonate-to-amide I ratios. Hence the results suggested that FTIRI parameters related to carbonate may be indicative of turnover and remodeling rate of bone. ß 2010 American Society for Bone and Mineral Research.KEY WORDS: BONE COMPOSITION; HISTOMORPHOMETRY; FOURIER TRANSFORM; INFRARED; RENAL OSTEODYSTROPHY; CARBONATE B one is a composite material consisting of a mineral phase (hydroxyapatite), an organic phase (collagen), noncollagenous proteins, lipids, and water. (1,2) Metabolic bone disease is a common term referring to a number of abnormalities caused by a broad spectrum of disorders. Most disorders lead to weakening of the bone or impaired bone function and are followed most often by altered bone mechanical properties. Renal osteodystrophy (ROD) is a chronic kidney disease that can be accompanied by different types of bone pathologies. ROD can lead to defective mineralization, altered bone morphology, and/or bone turnover. (3,4) Commonly, it is accompanied by hyperparathyroid disease, which is characterized by increased bone turnover. Patients with renal osteodystrophy may exhibit bone and joint pain, bone deformation, and spontaneous bone fractures. Bone biopsies followed by quantitative histomorphometry prevail as the ''gold standard'' for the diagnosis of renal osteodystrophy. (5)(6)(7) Histomorphometric analysis emphasizes increased amounts of osteoid and erosion surface and a larger amount of bone cells than what is present in normal bone. (8) However, the invasive nature of obtaining the biopsies, the required experience of the pathologists to identify the abnormalities, as well as the lack of standardized normal limits remain problematic.ROD also commonly results in lower bone ...

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confidence: 99%

Infrared spectroscopy indicates altered bone turnover and remodeling activity in renal osteodystrophy

Isaksson

Turunen

Rieppo

et al. 2010

Journal of Bone and Mineral Research

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“…As there is discordance in BM-D between skeletal sites, such estimates depend on the site scanned, as well as the reference range used to determine T-scores 6,7 . However, while osteoporosis confers the greatest risk for fracture, fracture risk is not negligible in persons with more moderate deficits in BMD [8][9][10] . Age-standardised 5-year absolute fracture risk derived from total hip BMD at baseline for post-menopausal women in Australia are 30.8% (95%CI 22.0-39.6) for women with osteoporosis, 17.5% (95%CI 13.2-21.7) for women with osteopaenia and 7.2% (95%CI 3.7-10.7) for women with normal BMD 8 .…”

Section: Resultsmentioning

confidence: 99%

“…Based on proximal femur BMD from a population-based cohort study of 616 postmenopausal Australian women followed for 5.6 years, 26.9% of radiologically confirmed fractures arose from women with osteoporosis and 73.1% from women without osteoporosis (56.5% from women with osteopaenia and 16.6% from women with normal BMD measured at the total hip) 8 .…”

Section: Introductionmentioning

confidence: 99%

“…Increasing age contributes independently to the risk of fracture; for the same BMD, the risk of fracture varies by a factor of 8-10 between women aged <45 years and 80 years and older 15 . Even though the majority of individuals who sustain a fragility fracture do not have a prevalent fracture (this proportion is 75% among women with osteopaenia), a prior fracture independently doubles the risk of subsequent fracture; women with osteopaenia and a prevalent fracture are at comparable risk to those with osteoporosis on BMD criteria 8 . Low body mass index is recognised as a risk factor for fracture that is essentially independent of age and sex, but dependent on BMD 16 .…”

Section: Introductionmentioning

confidence: 99%

“…Low body mass index is recognised as a risk factor for fracture that is essentially independent of age and sex, but dependent on BMD 16 . Falls independently increase the risk of fracture 8,17,18 .…”

Section: Introductionmentioning

confidence: 99%

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