Table Of ContentCurrent Concepts
of Bone Fragility
Edited by Hans K. Uhthoff
Associate Editor Elvira Stahl
With 166 Figures
Springer-Verlag
Berlin Heidelberg NewYork
London Paris Tokyo
Editor:
HANS K. UHTHOFF, M.D., FRCS (C)
Chairman and Professor
Division of Orthopaedic Surgery
University of Ottawa
Ottawa General Hospital
501 Smyth Road
Ottawa, Ontario K1H 8L6, Canada
Associate Editor:
ELVIRA STAHL, BA, FAAAS, FAMWA
2021 Atwater, Suite 1610
Montreal, Que. H3H 2P2, Canada
ISBN -13:978-3-642-70711-7 e-ISBN-13 :978-3-642-70709-4
DOI: 10.1007/978-3-642-70709-4
Library of Congress Cataloging-in-Publication Data. Current concepts of bone fragility. Pro
ceeding ofthe 12th Applied Basic Science Course, held in Ottawa, Ont., in 1985. Includes index.
1. Bones - Diseases - Congresses. 2. Osteoporosis - Congresses. I. Uhthoff, Hans K., 1925-. II.
Stahl, Elvira. III. Applied Basic Science Course (12th: 1985 : Ottawa, Ont.) [DNLM: 1. Bone
Diseases - congresses. WE 225 C976 1985]
RC930.C87 1986 616.7' 16 86-13120
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Preface
"Physiaians have aZways known, though
often they are reZuatant to adrrrit
it, that the quaZity of their daiZy
praatiae depends on the resuZts of
researah •..
Irvine H. Page *
The 1985 App1ied Basic Science Course distinguished itse1f for three impor
tant reasons. First, it showed c1ear1y the extent to which biotechnology
and biomechanics have become an integral part of orthopedics.
Second, it emphasized the increasingly important role the orthopedist will
have to play in the treatment of the aging population. Projected Canadian
statistics estimate that the population aged 65 years and older will in
crease from the current 9.7% to 13% by the year 2000. Based on the current
total population of almost 25 million, the number of hip fractures caused
by age-related bone 1055 will almost double and will reach approximately
28,000 per year in Canada. Extrapolation of these figures according to
populations in other countries is easy. The costs in expenditures and
human suffering are inestimable. This is an area where orthopedic research
will have to redouble its efforts in the hope of finding better preventive
measures. Furthermore , knowledge of the pathogenetic mechanisms of
bone 1055 becomes increasingly important in osteoporosis associated with
weightlessness.
The third impressive insight we derived from the presentations at this sym
posium was the revelations of the latest imaging techniques and monitoring
devices. Nuclear medicine, computer assisted tomography, and nuclear
magnetic resonance are being applied to bone disease. Moreover, bone
specific biochemical markers and quantitative assessments of bone mass and
turnover are elucidating many events that we had formerly based on empiri
cal presumptions. Biomathematics, biomechanics and kinetic studies can now
demqnstrate to us precisely the cellular mechanism underlying bone struc
ture, the dynamic turnover of bone, and adaptation of bone structure to
function. The origins of malfunctions, metabolic deficiencies and ensuing
deformation, disease and pa in are becoming much clearer to uso No doubt,
our therapeutic management can in future be based on much firmer grounds.
Bone is often compared to structural steel and reinforced concrete. Like
architecture, we are experimenting and already using an even wider selection
of materials for repair and replacement of bones and joints. We should never
forget, however, that bone, unlike reinforced concrete, is a living material
which responds to every action by areaction.
VI
Clinieally, we've learned a great deal during this eonferenee about how
varied are the metabolie bone diseases that eause the osteoporoses and
osteopenias. Whether disordered bone tissue synthesis or imbalaneed meta
bolie processes of bone formation and resorption, the result is loss of
bone mass, skeletal rare faction and frequent fraetures. No doubt, the
longer man's life-span the more his museuloskeletal parts will beeome used
up long be fore his death.
Fortunately, new diagnosties have eleared up many eonfusing assumptions and
debates about the osteoporoses and their management. Blaek holes remain,
however, and need further intensive exploring.
Finally, this symposium has not only foeused on the great strides we have
made in elinieal and seientifie orthopedies, but it has sought to bridge
and to blend seientifie and elinieal experienee instead of eaeh going its
own way.
I should like to express my gratitude to Dr. Z.F.G. Jaworski who worked
untiringly to organize this meeting and to monitor the program. I also
thank my assoeiate editor and her team and, above all Dr. Götze, Mrs. Kalow,
and the produetion staff of the Springer Verlag in Heidelberg for their in
valuable eooperation in the publieation of these Proeeedings.
Hans K. Uhthoff
University of Ottawa
Ottawa, Canada
* Medieal Research as I See It.
JAMA 194: 13, 1965.
Table of Contents
Skeleton as an Organ of Physical Support
Basie Biomeehanies of the Skeleton
w.c. HAYES (With 10 Figures) •••••••••••••••••••••••••••••••••••••••••• 3
Biomeehanieal Faetors in Adaptation of Bone Strueture to Funetion
L.E. LANYON (With 7 Figures) •••••••••••••••••••••••••••••••••••••••••• 19
Cellular Meehanisms Underlying the Skeleton's SUpportive Funetion
Z.F.G. JAWORSKI (With 8 Figures) •••••••••••••••••••••••••••••••••••••• 35
Diagnostic and Monitoring Tools
Diagnosis and Follow-up of Patients with Osteoporosis
C.C. JOHNSTON, Jr. •••••••••••••••••••••••••••••••••••••••••••••••••••• 61
Modern Imaging of Patients with Metabolie Bone Disease
W. WENZ, T. KRÖPELIN, B. WIMMER, W. D. REINBOLD, and G. RICHTER 67
Nuelear Medieine Applieations to Metabolie Bone Disease
L. RosenTHALL (With 6 Figures) •••••••••••••••••••••••••••••••••••••••• 75
Quantitative Assessment of Bone: Radiologie Methods
T.N. HANGARTNER (With 5 Figures) •••••••••••••••••••••••••••••••••••••• 89
Bone Turnover Assessment Using Bone-Speeifie Biochemieal Markers
K.G. MANN and B.L. RIGGS (With 2 Figures) ••••••••••••••••••••••••••••• 103
The Role of Bone Biopsy in Metabolie Bone Disease
C.-P. ADLER (With 7 Figures) •••••••••••••••••••••••••••••••••••••••••• 111
Bone Mierodamage: Faetors That Impair Its Repair
H.M. FROST............................................................ 123
Loads versus Bone Strength
Impaired Bone Strength and Fraeture Patterns at Different Skeletal
Sites .
L.J. MELTON 111 and B.L. RIGGS (With 2 Figures) ••••••••••••••••••••••• 149
VIII
Fraeture Patterns in Children
J.J. WILEY and W.M. MeINTYRE (With 5 Figures) •..•••..•••.•.••.•••.••.. 159
Cortieal Porosity in Postmenopausal and Adoleseent Wrist Fraetures
A.M. PARFITT (With 1 Figure) ••••.•..•...•.••.•.•...•.•.•.•••.•.••.••.• 167
Pathologie Fraetures and Stress Fraetures: A Review of Pathogenesis
and Assessment
M. FINNEGAN (With 9 Figures) •.....••.•••.•.•.••••.•.•••••••.••.•.•..•. 173
Disuse Osteoporosis: CUrrent status and Problems
Z.F.G. JAWORSKI and H.K. UHTHOFF (With 8 Figures) 181
osteoporosis: Limitations of Strain-Related Bone Remodeling in
Its Prevention
L.E. LANYON ..••.•..••••....•••••••••••.•....•.•••••••.•••••••••.••.••• 195
Disorganized Bone Structure
Congenital Osteopetrosis
J. D'ASTOUS and J. CORKAL (With 6 Figures) 199
Osteogenesis Imperfeeta: CUrrent Coneepts
J .R. SHAPIRO and D.W. ROWE ••..•••.•.•.••.••.••••...••.•.•.•.•.••.•..•• 207
setpoint Proposal for Osteogenesis Imperfeeta
H.M. FROST............................................................ 215
osteogenesis Imperfeeta: Orthopedie Aspeets
J_G. BIRCH •••.•.•.•.•.•••••..••.••.••.•.•••.•••••••••••....•.•.•••.••• 221
Paget's Disease of Bone (Osteitis deformans)
J .R. SHAPIRO •••.••..•.••...••.•••••...•••••••••••..•..•.•.•.••.•.••••• 227
paget's Disease of Bone: Orthopedie Management
A.G. HADJIPAVLOU, P.H. LANDER, and I.P. ENKER (With 14 Figures) •••.••• 237
Reversible Osteopenias
Bone Fragility in Osteomalaeia: Meehanism and Consequenees
A.M. PARFITT •••••••••••.••..•.•.••..••••••••••••••••••••••...•..•••••• 265
Drug-Indueed Osteomalaeia
J .A. BRUNET .••••••••••..••••.•..•.••••.•••••••••••.•.•••.••.•••••••••• 271
Aeeeierated cortieal Bone Loss: Primary and Seeondary
Hyperparathyroidism
A.M. PARFITT •••••...•••..•.••••...••.••••.•.•••••••••••••••••••.••.••• 279
Skeletal Problems in Chronie Renal Diseases
M. KAYE (With 6 Figures) ••••••••••••••.••••.•••.••••..•.•••.••••..••.• 287
Glueoeortieoid-Indueed Osteoporosis
C.V. ODVINA, J.E. WERGEDAL, and D.J. BAYLINK (With 8 Figures) ••..••.•. 295
IX
Etiological Spectrum of Avascular Necrosis
L. SOLOMON (Wi th 3 F igures) •••••••.•.•••••••••••••.•••.•...••••••••••• 311
Reversible Osteopenia: Orthopedic Aspects
J.P. MURNAGHAN (With 8 Figures) ..•.•••.•..•.....••••••....•.•.•••.••.• 319
Osteoporosis
Pathogenic Mechanisms of the Osteoporoses
H.M. FROST (With 12 Figures) •••••••...••.••••••••.•••••.••.••••••.•..• 329
Morphology of Bone Tissue Aging
A. DHEM and V. ROBERT (With 5 Figures) 363
Biomechanical Compensatory Mechanisms for Age-Related Changes in
Cortical Bone
W.C. HAYES and C.B. RUFF (With 5 Figures) ••..••.•••••••••••••••.••.•.• 371
Hip Fracture and cortical Bone Density in Aging African and
Caucasian Populations
L. SOLOMON (With 6 Figures) •.••.•••.•••••.••.••.•••••.••.••••••••••••• 379
Hip Fracture: A Disease and an Accident
L.J. MELTON 111 and B.L. RIGGS (With 2 Figures) 385
Economic and Social Burden of Osteoporosis
S. NAROD and R.A. SPASOFF (With 7 Figures) 391
Involutional Osteoporosis. Critical Evaluation of Medical Treatments
C. ANDERSON (Wi th 4 F igures) •.•••..•••.•.•.•••••••••.••••.•••••..••••. 403
Repetitive Loading to Prevent Osteoporosis in the Vertebral Column
D.B. BURR, R.B. MARTIN, S. LEFEVER, N. FRANKLIN, and G. THOMPSON
(With 7 Figures) ••.•••.••••••.•••••.••..•....•.•.••••••••.•.•••.•••••. 415
Orthopedic Management of Osteoporosis: Effects of Nutrition and
Exercise on the Skeleton
J.M. LANE, J.H. HEALEY, V.J. VIGORITA, and J.R. WERNTZ (With 4 Figures) 429
Subj ect Index •••••••••.•..•.••.••••...•.••••••••••.....•••.•.•.•••••.. 449
List of Contributors
ADLER, C.-P. Institute of Pathology, University of Freiburg,
Albertstr. 19, D-7800 Freiburg, West Germany
ANDERSON, C. 4034 Health Sciences Centre, University of
Western Ontario, London, Ontario N6A 5Cl,
Canada
BAYLINK, D.J. Department of Medicine, Loma Linda University,
Lama Linda, CA 92357, USA
BIRCH, J.G. Division of Orthopedics, University of Texas
Health Science Center of Dallas, 5323 Harry
Hines Blvd., Dallas, Texas 75235, USA
BRUNET, J.A. Division of Orthopedic Surgery, university of
Ottawa, Ottawa, Ontario, Canada
BURR, D.B. Departments of Anatomy and Orthopedic Surgery,
West Virginia University Medical Center,
Morgantown, WV 26506, USA
CORKAL, J. Department of Surgery, University of Ottawa,
Ottawa, Ontario, Canada
D'ASTOUS, J. Children's Hospital of Eastern Ontario, 401
Smyth Road, Ottawa, Ontario KIH 8Ll, Canada
DHEM, A. Human Anatomy Research Unit, Faculty of Medicine,
University of Louvain, Tour Vesale 5240, Avenue
E. Mounier, 52, B-1200 Brussels, Belgium
ENKER, I.P. Department of Orthopedic Surgery, Sir Mortimer
B. Davis-Jewish General Hospital, 3755 Cöte
Ste. Catherine Road, Montreal, Quebec H3T lE2,
Canada
FINNEGAN, M. Division of Orthopedic Surgery, University of
Ottawa, Ottawa General Hospital, 501 Smyth Road,
Ottawa, Ontario KIH 8L6, Canada
FRANKLIN, N. Department of Orthopedic Surgery, West Virginia
University Medical Center, Morgantown, WV 26506,
USA
XII
FROST, H.M. Southern Colorado Clinic, 2002 Lake Ave.,
Pueblo, CO 81004, USA
HADJIPAVLOU, A.G. Department of Orthopedic Surgery, Sir Mortimer
B. Davis-Jewish General Hospital, 3755 Cöte
Ste. Catherine Road, Montreal, Quebec H3T lE2,
Canada
HANGARTNER, T.N. Department of Applied Sciences in Medicine,
University of Alberta, 10-102 Clinical Sciences
Building, Edmonton, Alberta T6G 2G3, Canada
HAYES, W.C. Department of Orthopedic Surgery, Charles A.
Dana Research Institute, Beth Israel Hospital
and Harvard Medical School, Boston, MA 02215,
USA
HEALEY, J.H. Division of Orthopedic Surgery, Memorial Sloan
Kettering Cancer Center, New York, NY 10021, USA
JAWORSKI, Z.F.G. Department of Medicine, University of Ottawa,
Ottawa General Hospital, 501 Smyth Road, Ottawa,
Ontario KIH 8L6, Canada
JOHNSTON, C.C., Jr. Indiana University School of Medicine, Indiana
polis, Indiana 46223, USA
KAYE, M. Division of Nephrology, Montreal General Hospi
tal, 1650 Cedar Avenue, Montreal, Quebec H3G lA4
Canada
KRÖPELIN, T. Institut für Röntgendiagnostik, Universitäts
klinik, Hugstetterstrasse 55, D-7800 Freiburg,
West Germany
LANDER, P.H. Department of Orthopedic Surgery, Sir Mortimer
B. Davis-Jewish General Hospital, 3755 Cöte
Ste. Catherine Road, Montreal, Quebec H3T lE2,
Canada
LANE, J.M. Division of Orthopedic Surgery, Memorial Sloan
Kettering Cancer Center, New York, NY 10021, USA
LANYON, L.E. Department of Anatomy, Royal Veterinary College,
Royal College Street, London NWI OTU, England
LEFEVER, S. Department of Orthopedic Surgery, West Virginia
university Medical Center, Morgantown, WV 26506,
USA
MANN, K.G. Department of Biochemistry, University of Ver
mont, School of Medicine, Burlington, Vermont
05405, USA
MARTIN, R.B. Department of Orthopedic Surgery, University of
California, Davis, CA 92093, USA
