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Fragility fractures, particularly those of the hip, vertebrae, and distal forearm, constitute a major public health problem. The two ultimate determinants of fracture are bone strength and propensity to trauma. Bone strength depends not only upon bone mass but also upon a variety of qualitative aspects of bone structure. These include its architecture, the amount of fatigue damage it has sustained, and changes in its bulk material properties, indices that are collectively subsumed into the term "bone quality." Fragility fractures show differences in their patterns of incidence by age, sex, ethnic group, geographic area, and season. Many of these differences are currently unexplained, and disorders of bone quality might contribute to them. There are two fracture sites at which evidence implicates bone quality more directly--the spine and proximal femur. Many vertebral compression fractures follow minimal trauma, and controlled studies suggest that vertebral microarchitecture contributes to fracture risk independently of vertebral bone mass. At the hip, observational studies have pointed to a role for disordered trabecular architecture, accumulation of microfractures (fatigue damage), and the accumulation of osteoid. The extent to which these phenomena act independently of bone mass, however, remains uncertain.

Original publication

DOI

10.1007/bf01673397

Type

Journal article

Journal

Calcified tissue international

Publication Date

01/1993

Volume

53 Suppl 1

Pages

S23 - S26

Addresses

MRC Environmental Epidemiology Unit, Southampton General Hospital, England.

Keywords

Humans, Wounds and Injuries, Spinal Fractures, Hip Fractures, Colles' Fracture, Incidence, Risk Factors, Seasons, Bone Density, Adult, Aged, Middle Aged, Ethnic Groups, Female, Male