ReviewImportant Determinants of Bone Strength Beyond Bone Mineral DensityFriedman, Alan W. MD Author Information From the Medical Clinic of Houston, Houston, Texas. Reprints: Alan W. Friedman, MD, Medical Clinic of Houston, 1707 Sunset Blvd., Houston, TX 77005. E-mail: [email protected] JCR: Journal of Clinical Rheumatology: April 2006 - Volume 12 - Issue 2 - p 70-77 doi: 10.1097/01.rhu.0000208612.33819.8c Buy Metrics AbstractIn Brief Osteoporosis is a systemic skeletal disorder characterized by compromised bone strength that predisposes individuals to increased fracture risk. Bone strength is determined by its material and structural properties. Bone mineral density (BMD) is a useful tool for diagnosis; however, this parameter provides information regarding only the quantity of mineral in bone, which is only one component of bone strength. Osteoporosis treatments have been shown to have beneficial effects on bone turnover, microarchitecture, and/or mineralization, all of which can help account for the reductions in fracture risk above and beyond changes in BMD. Newer noninvasive imaging methods are being developed that assess bone strength independent of BMD, and these methods should improve the assessment of fracture risk and response to treatment. These imaging methods are not currently available for routine clinical use, and therefore, clinicians need to continue for now to rely on surrogate markers of bone fragility, including BMD, prevalent fracture, and other important risk factors for fracture. A variety of important factors that have been difficult to assess are likely to be involved in bone strength. Imaging techniques to evaluate features of bone microarchitecture are being developed. © 2006 Lippincott Williams & Wilkins, Inc.
