Bone fragility: conceptual framework, therapeutic implications, and COVID-19-related issues

Area of Science:

• Orthopedics and Bone Biology
• Biomechanical Engineering
• Osteoporosis Research

Background:

• Bone fragility is characterized by impaired bone strength, leading to fractures from minimal trauma.
• Osteoporosis involves quantitative and qualitative bone changes, affecting density, geometry, and micro-architecture, increasing fracture susceptibility.
• Bone strength depends on structural (size, shape) and material properties (yield, fatigue).

Purpose of the Study:

• To review the various contributors to bone fragility.
• To examine how anti-osteoporotic drugs influence bone fragility.
• To explore the impact of the COVID-19 pandemic on bone fragility.

Main Methods:

• Literature review of factors affecting bone strength.
• Analysis of bone density measurements (DXA) as a clinical standard.
• Inclusion of non-quantitative parameters like macro-architecture and microcracks.
• Consideration of drug effects and pandemic-related influences.

Main Results:

• Bone fragility is multifactorial, involving structural and material aspects beyond bone density.
• DXA is the gold standard for fracture risk assessment, but other factors are crucial.
• Macro-architecture, material properties, and microcracks significantly impact mechanical strength.
• Anti-osteoporotic drugs and pandemic-related lifestyle changes may influence bone fragility.

Conclusions:

• Bone fragility is a complex trait influenced by multiple factors.
• A comprehensive understanding of bone biomechanics is essential for managing fracture risk.
• Further research is needed to elucidate the impact of external factors like pandemics on bone health and treatment efficacy.