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Insights into Material and Structural Basis of Bone Fragility from Diseases Associated with Fractures: How Determinants of the Biomechanical Properties of Bone Are Compromised by Disease

Institut National de la Santé et de la Recherche Médicale Research Unit 831 and Université Claude Bernard-Lyon 1 (P.C., P.D.D.), 69372 Lyon Cedex 08, France; and Departments of Medicine and Endocrinology (E.S.), Austin Health, University of Melbourne, Heidelberg 3084, Melbourne, Australia

Correspondence: Address all correspondence and requests for reprints to: Pierre D. Delmas, Institut National de la Santé et de la Recherche Médicale Unit 831, Pavillon F, Hopital E. Herriot, 69437 Lyon Cedex 03, France. E-mail: delmas{at}lyon.inserm.fr

Minimal trauma fractures in bone diseases are the result of bone fragility. Rather than considering bone fragility as being the result of a reduced amount of bone, we recognize that bone fragility is the result of changes in the material and structural properties of bone. A better understanding of the contribution of each component of the material composition and structure and how these interact to maintain whole bone strength is obtained by the study of metabolic bone diseases. Disorders of collagen (osteogenesis imperfecta and Paget’s disease of bone), mineral content, composition and distribution (fluorosis and osteomalacia); diseases of high remodeling (postmenopausal osteoporosis, hyperparathyroidism, and hyperthyroidism) and low remodeling (osteopetrosis, pycnodysostosis); and other diseases (idiopathic male osteoporosis, corticosteroid-induced osteoporosis) produce abnormalities in the material composition and structure that lead to bone fragility. Observations in patients and in animal models provide insights on the biomechanical consequences of these illnesses and the nature of the qualities of bone that determine its strength.

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