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The inter-relationship between bone mineral density, turnover and structural properties in determining bisphosphonate efficacy
Bone 41 (2007) S45 www.elsevier.com/locate/bone
Abstract
The inter-relationship between bone mineral density, turnover and structural properties in determining bisphosphonate efficacy Sol Epstein Mt Sinai School of Medicine, New York and Doylestown Hospital, Doylestown, Pennsylvania, USA Osteoporosis is a skeletal disorder characterised by compromised bone strength, leading to an increased risk of fracture. Properties related to bone strength include rate of bone turnover, bone mineral density (BMD), geometry, microarchitecture, and mean degree of mineralisation. These properties (with or without bone density) are sometimes collectively referred to as bone quality. • Bisphosphonates may reduce fracture risk by several separate, but interrelated effects on the individual properties of bone strength. • For example, bisphosphonates have been reported to reduce bone turnover, stabilise or increase BMD, preserve microarchitecture, reduce the number or size of resorption sites, and improve mineralisation.
8756-3282/$ - see front matter © 2007 Elsevier Inc. All rights reserved.
• Although changes in bone architecture and mineralisation are not currently measurable in clinical practice, bone turnover is assessed easily in vivo and affects the other bone properties. • Moreover, bisphosphonates that produce larger decreases in bone turnover markers together with larger increases in BMD are associated with greater reductions in fracture risk, especially at sites primarily composed of cortical bone such as the hip. • Reductions in fracture risk are the most convincing evidence of good bone quality. Data from randomised clinical trials with up to 10 years of continuous therapy have shown that bisphosphonates effectively reduce fracture risk and (together with extensive preclinical data) suggest no deleterious effects on bone quality [1]. Reference [1] Epstein S. The roles of bone mineral density, bone turnover, and other properties in reducing fracture risk during antiresorptive therapy. Mayo Clin Proc 2005 Mar;80(3):379–88. doi:10.1016/j.bone.2007.08.018
Abstract
The inter-relationship between bone mineral density, turnover and structural properties in determining bisphosphonate efficacy Sol Epstein Mt Sinai School of Medicine, New York and Doylestown Hospital, Doylestown, Pennsylvania, USA Osteoporosis is a skeletal disorder characterised by compromised bone strength, leading to an increased risk of fracture. Properties related to bone strength include rate of bone turnover, bone mineral density (BMD), geometry, microarchitecture, and mean degree of mineralisation. These properties (with or without bone density) are sometimes collectively referred to as bone quality. • Bisphosphonates may reduce fracture risk by several separate, but interrelated effects on the individual properties of bone strength. • For example, bisphosphonates have been reported to reduce bone turnover, stabilise or increase BMD, preserve microarchitecture, reduce the number or size of resorption sites, and improve mineralisation.
8756-3282/$ - see front matter © 2007 Elsevier Inc. All rights reserved.
• Although changes in bone architecture and mineralisation are not currently measurable in clinical practice, bone turnover is assessed easily in vivo and affects the other bone properties. • Moreover, bisphosphonates that produce larger decreases in bone turnover markers together with larger increases in BMD are associated with greater reductions in fracture risk, especially at sites primarily composed of cortical bone such as the hip. • Reductions in fracture risk are the most convincing evidence of good bone quality. Data from randomised clinical trials with up to 10 years of continuous therapy have shown that bisphosphonates effectively reduce fracture risk and (together with extensive preclinical data) suggest no deleterious effects on bone quality [1]. Reference [1] Epstein S. The roles of bone mineral density, bone turnover, and other properties in reducing fracture risk during antiresorptive therapy. Mayo Clin Proc 2005 Mar;80(3):379–88. doi:10.1016/j.bone.2007.08.018