Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Bone Quality: From Bench to Bedside 16 articles


The Effect of Antiresorptives on Bone Quality

Robert R. Recker MD, Laura Armas MD

Currently, antiresorptive therapy in the treatment and prevention of osteoporosis includes bisphosphonates, estrogen replacement, selective estrogen receptor modulators (raloxifene), and denosumab (a human antibody that inactivates RANKL). The original paradigm driving the development of antiresorptive therapy was that inhibition of bone resorption would allow bone formation to continue and correct the defect. However, it is now clear increases in bone density account for little of the antifracture effect of these treatments.

Surgical Treatment Options in Patients With Impaired Bone Quality

Norman A. Johanson MD, Jody Litrenta MD, Jay M. Zampini MD, Frederic Kleinbart MD, Haviva M. Goldman PhD

Bone quality should play an important role in decision-making for orthopaedic treatment options, implant selection, and affect ultimate surgical outcomes. The development of decision-making tools, currently typified by clinical guidelines, is highly dependent on the precise definition of the term(s) and the appropriate design of basic and clinical studies. This review was performed to determine the extent to which the issue of bone quality has been subjected to this type of process.

Bone Quality: Educational Tools for Patients, Physicians, and Educators

Junaid Shams BA, Allison B. Spitzer BA, Ann M. Kennelly BA, Laura L. Tosi MD

Defining bone quality remains elusive. From a patient perspective bone quality can best be defined as an individual’s likelihood of sustaining a fracture. Fracture risk indicators and performance measures can help clinicians better understand individual fracture risk. Educational resources such as the Web can help clinicians and patients better understand fracture risk, communicate effectively, and make decisions concerning diagnosis and treatment.

Whole Bone Mechanics and Bone Quality

Jacqueline H. Cole PhD, Marjolein C. H. Meulen PhD

The skeleton plays a critical structural role in bearing functional loads, and failure to do so results in fracture. As we evaluate new therapeutics and consider treatments to prevent skeletal fractures, understanding the basic mechanics underlying whole bone testing and the key principles and characteristics contributing to the structural strength of a bone is critical.

Short-term and Long-term Orthopaedic Issues in Patients With Fragility Fractures

Susan V. Bukata MD, Stephen L. Kates MD, Regis J. O’Keefe MD, PhD

Patients with impaired bone quality who suffer a fragility fracture face substantial challenges in both their short- and long-term care. In addition to poor bone quality, many of these patients have multiple medical comorbidities that alter their surgical risk and affect their ultimate functional recovery. Some medical issues can contribute to the altered bone quality and must be addressed to prevent future fractures.

High-resolution Computed Tomography for Clinical Imaging of Bone Microarchitecture

Andrew J. Burghardt BS, Thomas M. Link MD, Sharmila Majumdar PhD

The role of bone structure, one component of bone quality, has emerged as a contributor to bone strength. The application of high-resolution imaging in evaluating bone structure has evolved from an in vitro technology for small specimens to an emerging clinical research tool for in vivo studies in humans. However, many technical and practical challenges remain to translate these techniques into established clinical outcomes.

Infrared Assessment of Bone Quality: A Review

Eleftherios P. Paschalis PhD, Richard Mendelsohn PhD, Adele L. Boskey PhD

Bone strength depends on both bone quantity and quality. The former is routinely estimated in clinical settings through bone mineral density measurements but not the latter. Bone quality encompasses the structural and material properties of bone. Although its importance is appreciated, its contribution in determining bone strength has been difficult to precisely quantify partly because it is multifactorial and requires investigation of all bone hierarchical levels. Fourier transform infrared spectroscopy provides one way to explore these levels.

Anabolic Agents and Bone Quality

Tarek Sibai MD, Elise F. Morgan PhD, Thomas A. Einhorn MD

The definition of bone quality is evolving particularly from the perspective of anabolic agents that can enhance not only bone mineral density but also bone microarchitecture, composition, morphology, amount of microdamage, and remodeling dynamics.

Functional Interactions Among Morphologic and Tissue Quality Traits Define Bone Quality

Karl J. Jepsen PhD

Advances in diagnostic and treatment regimens that aim to reduce fracture incidence will benefit from a better understanding of how bone morphology and tissue quality define whole-bone mechanical properties.

Methods for Assessing Bone Quality: A Review

Eve Donnelly PhD

Bone mass, geometry, and tissue material properties contribute to bone structural integrity. Thus, bone strength arises from both bone quantity and quality. Bone quality encompasses the geometric and material factors that contribute to fracture resistance.

Diseases Affecting Bone Quality: Beyond Osteoporosis

Aasis Unnanuntana MD, Brian J. Rebolledo BA, M. Michael Khair MD, Edward F. DiCarlo MD, Joseph M. Lane MD

Bone quantity, quality, and turnover contribute to whole bone strength. Although bone mineral density, or bone quantity, is associated with increased fracture risk, less is known about bone quality. Various conditions, including disorders of mineral homeostasis, disorders in bone remodeling, collagen disorders, and drugs, affect bone quality.

Raman Assessment of Bone Quality

Michael D. Morris PhD, Gurjit S. Mandair PhD

Progress in the diagnosis and prediction of fragility fractures depends on improvements to the understating of the compositional contributors of bone quality to mechanical competence. Raman spectroscopy has been used to evaluate alterations to bone composition associated with aging, disease, or injury.