Bone Quality An Empty Term 英文参考文献.docVIP

Essay Bone Quality: An Empty Term Harri Siev?nen, Pekka Kannus, Teppo L. N. J?rvinen * A lthough the concept of “bone quality” is at least 15 years old [1], the term has a solution to the classic paradox of osteoporosis: while low BMD values are associated with increased relative risk of fracture at the population level, the predictive value of BMD in an individual patient remains quite marginal [13–15]. And to further support the concept of bone quality, inclusion of increased bone turnover in fracture-predicting models has somewhat improved the ability to predict fracture risk independently of BMD [8,16–19]. fallacy. Basically, BMD re?ects the bulk of material (bone mass) of which the bone, as an organ, is made [22]. BMD thus denotes a lumped measure of virtually everything within the measured bone site (i.e., bone cross- sectional size and dimensions, cortical thickness and porosity, trabecular thickness and number, mineralization of bone material), but it denotes nothing speci?cally. Thus, there is not much left to be accounted for by subtle architectural and material properties (i.e., factors that allegedly account for bone quality). This simply means that BMD and most bone quality characteristics, measurable in vivo, are intertwined and largely inseparable. Flaws in de?ning bone quality. Third, the de?nition of bone quality is too imprecise, incorporating a pool of “non-BMD” indices of bone fragility (or, even more broadly, the portion of fracture risk that is not predicted by BMD [6]). Neither do we have an established measurement, indicator, or unit for bone quality. We don’t even have criteria for de?ning “good” or “bad” bone quality. recently sparked much discussion and debate among clinicians and clinical researchers [2–5]. At a recent National Institutes of Health conference on bone quality, the term was de?ned as: “The sum total of characteristics of the bone that in?uence the bone’s resistance to fracture” [6]. Where Did the De?ni