BoneKEy Reports | BoneKEy Watch
Osteoporosis treatment should focus on bone mineral density
DOI:10.1038/bonekey.2012.14
In osteoporosis, the mechanical properties of trabecular bone decline as bone mineral density is reduced. This leads to a decrease in the cross-sectional area of the trabeculae, and an increase in the risk of developing microcracks under normal loading.
In order to better understand the interplay between bone mineral density and compressive microdamage, this study examined how bone volume, bone architecture and mechanical damage affect the shear failure properties of bovine trabecular bone. The bone samples were chosen to be as similar as possible to human bone in terms of bone volume fraction.
It was clear that a lower bone volume was more important than induced mechanical damage in determining the shear strength and toughness of bone, and therefore the potential risk of fracture.
The authors suggest that although increasing bone mineral density and repairing microdamage are both legitimate therapeutic objectives in osteoporosis, increasing bone density is likely to have the greatest impact on bone strength.
Editor's comment: Anti-resorptive agents increase bone mass and density, but may also prevent microdamage repair, raising concerns about the eventual effects on bone quality and therefore strength. This experimental model demonstrates the opposite; the strength and toughness of bovine trabecular bone samples were clearly more dependent on bone volume fraction than induced mechanical damage. Bigger is therefore better, even if microdamage is present.
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