Looming changes in the management of “osteoporosis”: A preview for clinicians

Summary

Normally, strong muscles make strong load-bearing bones, and persistently weak muscles make weak ones. We now have a general understanding of how and why that happens. Unexpectedly that understanding also affects our understanding of the nature, pathogenesis and study of disorders currently classified as “osteopaenias” and “osteoporoses”. Such things promise to change how we view, study and manage those disorders. At present, those things incite discussions among authorities that in time should lead to a new accepted “wisdom” about those disorders. Many clinicians who manage patients on a daily basis would probably like to know what issues that process concerns. Because of the importance of those issues to so many millions of this planet's present and future six billion souls, and because of their bearing on the related research, one could argue that clinicians and researchers are entitled to know about those issues. For that reason this article summarizes some of them, of course as I seem them.

It is understood that other times, places and people would resolve any questions about those issues, and that any new accepted wisdom that depends upon their resolution should lie in the future.

Recent recognition of the effects of muscle and biomechanics on the biologic ‘‘machinery” that determines whole-bone strength and bone health incite many changes in formerly accepted views about the nature, diagnosis, pathogenesis, study and management of the group of different disorders that are currently considered as falling under the umbrellas of “osteoporosis” and “osteopaenia”. This article acquaints interested physicians with some of those changes and the reasons for them. It should take time, probably several years, for those changes to gel into an accepted new standard of care for such disorders. Meanwhile currently accepted standards of care could and probably should be followed.

Keywords

Treatment - absorptiometry - biomechanics - diagnosis

• REFERENCES

• 1 Frost HM. Osteoporoses: New Concepts and Some Implications for Future Diagnosis, Treatment and Research (based on insights from the Utah paradigm). Ernst Schering Research Foundation AG; 1998: 7-57.
• 2 Frost HM. Perspective: Changing views about “Osteoporoses” (a 1998 overview). Osteopor Inter 1999; 10: 345-52.
• 3 Martin RB, Burr DB, Sharkey NA. Skeletal Tissue Mechanics. Springer-Verlag; New York: 1998
• 4 Jee WS. Principles in bone physiology. J Musculoskeletal Interactions 2000; 01: 9-11.
• 5 Schonau E, Frost HM. The “muscle strength-bone strength” relationship in humans. A review (A). In: Proceedings, Third International Congress on Osteoporosis; (Xi’an, China): 1999: 84-9.
• 6 Burr DB, Martin RB. Mechanisms of bone adaptation to the mechanical environment. Triangle (Sandoz) 1992; 31: 59-76.
• 7 Burr DB. Muscle strength, bone mass, and age-related bone loss. J Bone Miner Res 1997; 12: 1547-51.
• 8 Currey JD. The Mechanical Adaptations of Bones. Princeton University Press; Princeton: 1984
• 9 Ferretti JL. Peripheral, quantitative computed tomography (pQCT) for evaluating structural and mechanical properties of small bone. In: Practical Guide for Mechanical Testing of Bone. An YH, Draughn RA. (Eds). CRC Press; Boca Raton, FL: 1999: 1-25.
• 10 Jiang Y, Zhao J, Rosen C, Gensens P, Genant H. Perspectives on bone mechanical properties and adaptive response to mechanical loading. J Clin Densitom 1999; 02: 422-33.
• 11 Banu MJ, Orhii PB, Mejia W, McCarter RJM, Mosekilde L, Thomsen JS, Kalu DN. Analysis of the effects of growth hormone, voluntary exercise, and food restriction on diaphyseal bone in female F344 rats. Bone 1999; 25: 479-80.
• 12 Ferretti JL, Capozza RP, Cointry GR, Garcia SL, Plotkin H, Avlarez MLFigueira, Zanchetta JR. Gender-related differences in the relationship between densitometric values of whole-body bone mineral content and lean body mass in humans between 2 and 87 years of age. Bone 1998; 22: 683-90.
• 13 Schiessl H, Willnecker J. Muscle cross sectional area and bone cross sectional area in the lower leg measured with peripheral computed tomography. In: Musculoskeletal Interactions. Vol II. Lyritis GP. (Ed). Hylonome Editions; Athens: 1999: 47-52.
• 14 Schönau E, Westermann F, Mokow E, Scheidhauer K, Werhahn E, Stabrey A, Mtiller-Berghaus J. The functional muscle-bone-unit in health and disease. In: Paediatric Osteology. Prevention of Osteoporosis - a Paediatric Task?. Schönau E, Matkovic V. (Eds). Excerpta Medica; Amsterdam: 1998: 191-202.
• 15 Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporosis Int 1994; 04: 368-81.
• 16 Marcus R, Feldman D, Kelsey J. Osteoporosis (Eds). Academic Press; Orlando, FI: 1996.;
• 17 Runge M. Die multifaktorielle Genese von Gehstörungen, Stürzen und Hüftfrakturen im Alter. Zeits Gerontol Geriat 1997; 30: 267-75.
• 18 Runge M, Rehfeld G, Resnicek E. Balance training and exercise in geriatric patients. J Musculoskeletal Interactions 2000; 01: 54-8.
• 19 The author’s personal observation(s) during 50 years as an orthopaedic surgeon, teacher, researcher and amateur pathologist, of a matter others must have observed too so it need not be original to the author. However it did not previously seem important enough to deserve formal study and publication.
• 20 Schiessl H, Frost HM, Jee WSS. Perspectives: Estrogen and bone-muscle strength and “mass” relationships. Bone 1998; 22: 1-6.