Cortical Bone
Dense and compact Runs the length of the long bones, forming a hollow cylinder
Has a light, honeycomb structure Trabeculae are arranged in the directions of tension and compression Occurs in the heads of the long bones Also makes up most of the bone in the vertebrae
Trabecular bone
Osteons
Haversian canal place for the nerve blood and lymphatic vessels Lamellae collagen deposition pattern Lacunae holes for osteocytes Canaliculi place of communication between osteocytes
Bone cells
Osteoblasts Osteoclasts
Osteocytes
Trapped osteoblasts
In lacunae
Keep bone matrix in good condition and can release calcium ions from bone matrix when calcium demands increase
Osteocytic osteolysis
Osteoblasts
Make collagen Activate nucleation of hydroxyapatite crystallization onto the collagen matrix, forming new bone As they become enveloped by the collagenous matrix they produce, they transform into osteocytes Stimulate osteoclast resorptive activity
Osteoclasts
Resorbe bone matrix from sites where it is deteriorating or not needed Digest bone matrix components Focal decalcification and extracellular digestion by acid hydrolases and uptake of digested material Disappear after resorption Assist with mineral homeostasis
Matrix Mineral
Matrix - osteoid
Collagen type I and IV Layers of various orientations (add to the strength of the matrix) Other proteins 10% of the bone protein
Mineral
A calcium phosphate/carbonate compound resembling the mineral hydroxyapatite Ca10(PO4)6(OH)2 Hydroxyapatite crystals
Trapping of calcium and phosphate ions in concentrations that would initiate deposition of calcium phosphate in the solid phase, followed by its conversion to crystalline hydroxyapatite
Phase I
Signal from osteoblasts Stimulation of osteoblastic precursor cells to become osteoclasts Process takes 10 days
Phase II
Osteoclast resorb bone creating cavity Macrophages clean up
Phase III
Hormonal Influence
Vitamin D Parathyroid Hormone Calcitonin Estrogen Androgen
Vitamin D
Osteoblast have receptors for (1,25-(OH)2-D) Increases activity of both osteoblasts and osteoclasts Increases osteocytic osteolysis (remodeling) Increases mineralization through increased intestinal calcium absorption Feedback action of (1,25-(OH)2-D) represses gene for PTH synthesis
Parathyroid Hormone
Accelerates removal of calcium from bone to increase Ca levels in blood PTH receptors present on both osteoblasts and osteoclasts Osteoblasts respond to PTH by
Change of shape and cytoskeletal arrangement Inhibition of collagen synthesis Stimulation of IL-6, macrophage colony-stimulating factor secretion
Chronic stimulation of the PTH causes hypocalcemia and leads to resorptive effects of PTH on bone
Calcitonin
C cells of thyroid gland secrete calcitonin Straight chain peptide - 32 aa Synthesized from a large preprohormone Rise in plasma calcium is major stimulus of calcitonin secretion Plasma concentration is 10-20 pg/ml and half life is 5 min
Actions of Calcitonin
Osteoclasts are target cells for calcitonin Major effect of clacitonin is rapid fall of plasma calcium concentration caused by inhibition of bone resorption Magnitude of decrease is proportional to the baseline rate of bone turnover
Estrogens
Androgens
Growth hormone
Glucocorticoids
Thyroid hormones
Increase bone resorption Increase bone formation
Cytokines
IL-6 IL-1
IGF-I TGF-
Osteoporosis
A disease characterized by:
low bone mass microarchitectural deterioration of the bone tissue
Leading to:
enhanced bone fragility increase in fracture risk
Normal: Not less than 1 SD below the avg. for young adults Osteopenia: -1 to -2.5 SD below the mean Osteoporosis: More than 2.5 SD below the young adult average
70% of women over 80 with no estrogen replacement therapy qualify More than 2.5 SD below with fractures
Severe osteoporosis
Osteoporosis - epidemiology
Disorder of postmenopausal women of northern European descent Increase in the incidence related to decreasing physical activity Over 27 million or 1of 3 women are affected with osteoporosis Over 5 million or 1of 5 men are affected with osteoporosis
Bone Mass
Statistics
Estrogen loss triggers increases in IL1, IL-6, and TNF due to:
Reduced suppression of gene transcription of IL-6 and TNF Increased number of monocytes Increased cytokines lead to increased osteoclast development and lifespan
National Osteoporosis Risk Assessment (NORA): Factors Associated With Increased Risk of Osteoporosis
Osteoporosis
Types of osteoporosis
Type I Type II Secondary
Osteoporosis - types
Secondary osteoporosis
Osteoporotic vertebra
Risk Factors
If result might influence decisions about intervention One or more risk factors History of fracture
Relative Risk
DXA-assessed content is a proven effective method for assessing osteoporosis related fracture risk. Population surveys and research studies demonstrate a decrease in bone density measured by DXA predicts fracture at specific sites. Marshall, D, et al: Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. British Medical Journal. 312:1254-1259, 1996.
BUA
40 30 20 10 0 Fracture No Fracture
Subjects who developed hip fracture showed significantly (p<0.001) lower heel BUA results in a two-year follow-up prospective study of 1,414 subjects. Porter, RW, et al: Prediction of hip fracture in elderly women: a prospective study. British Medical Journal. 301:638-641, 1990.
Schott, AM, et al: Ultrasound discriminates patients with hip fracture equally well as dual energy x-ray absorptiometry and independently of bone mineral density. Journal of Bone and Mineral Research. 10:243-249, 1995.
2.5 2 1.5 1 0.5 0 Hans, et al Bauer, et al Research Study Frost, et al BUA BMD
NORA
NORA
Calcium Supplementation
HOPE Trial
PEPI Trial
BMD
Spine BMD
Forearm BMD
WHI Results
WHI Results
Summary