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Does bone mass equate with bone health? An argument for the negative
1Department of Orthopaedic Surgery, Southern Colorado Clinic, PO Box 9000, Pueblo, CO 81008-9000, USA.
Summary
Bone health and disease diagnosis may need re-evaluation. Current methods using bone mass Z-scores might not fully assess bone strength or health, suggesting a new criterion is needed.
Area of Science:
- Orthopedics and Biomechanics
- Bone Physiology
Background:
- Current diagnosis of osteopenia and osteoporosis relies on bone mass Z-scores.
- This approach assumes Z-scores accurately reflect whole-bone strength and health.
- Bone strength is influenced by mechanical loading and adaptation, not solely mass.
Purpose of the Study:
- To propose a new criterion for bone health assessment.
- To differentiate between statistical abnormality and actual disease in bone conditions.
- To challenge the exclusive reliance on bone mass Z-scores for diagnosing bone disorders.
Main Methods:
- Reviewing the relationship between bone strength, mechanical loads, and fracture incidence.
- Analyzing adaptive bone remodeling in response to voluntary loads.
- Comparing bone health criteria across species with differing bone mass and strength.
Main Results:
- Bone strength is adapted to mechanical loads, indicating health through load-bearing capacity.
- A healthy bone can withstand its typical voluntary loads without fracturing, regardless of mass.
- A new criterion based on strength, load, and fracture is proposed, independent of mass.
Conclusions:
- Bone health should be assessed by its ability to withstand mechanical loads, not just bone mass.
- A bone with a low Z-score may still be healthy if it doesn't fracture under normal loads.
- Rethinking diagnostic criteria is necessary for accurate assessment of bone diseases like osteopenia and osteoporosis.