Moving toward a prevention strategy for osteoporosis by giving a voice to a silent disease.
A major unmet challenge in developing preventative treatment programs for osteoporosis is that the optimal timing of treatment remains unknown. In this commentary we make the argument that the menopausal transition (MT) is a critical period in a woman's life for bone health, and that efforts aimed at reducing fracture risk later in life may benefit greatly from strategies that treat women earlier with the intent of keeping bones strong as long as possible. Bone strength is an important parameter to monitor during the MT because engineering principles can be applied to differentiate those women that maintain bone strength from those women that lose bone strength and are in need of early treatment. It is critical to understand the underlying mechanistic causes for reduced strength to inform treatment strategies. Combining measures of strength with data on how bone structure changes during the MT may help differentiate whether a woman is losing strength because of excessive bone resorption, insufficient compensatory bone formation, trabeculae loss, or some combination of these factors. Each of these biomechanical mechanisms may require a different treatment strategy to keep bones strong. The technologies that enable physicians to differentially diagnose and treat women in a preventive manner, however, have lagged behind the development of prophylactic treatments for osteoporosis. To take advantage of these treatment options, advances in preventive treatment strategies for osteoporosis may require developing new technologies with imaging resolutions that match the pace by which bone changes during the MT and supplementing a woman's bone mineral density (BMD)-status with information from engineering-based analyses that reveal the structural and material changes responsible for the decline in bone strength during the menopausal transition.
Department of Orthopaedic Surgery, Biomedical Sciences Research Building, 109 Zina Pitcher Place, University of Michigan, Ann Arbor, MI 48109-2200, USA.
Karl J
KJ
Jepsen
Department of Orthopaedic Surgery, Biomedical Sciences Research Building, 109 Zina Pitcher Place, University of Michigan, Ann Arbor, MI 48109-2200, USA.
Erin M R
EM
Bigelow
Department of Orthopaedic Surgery, Biomedical Sciences Research Building, 109 Zina Pitcher Place, University of Michigan, Ann Arbor, MI 48109-2200, USA.
Melissa
M
Ramcharan
Department of Orthopaedic Surgery, Biomedical Sciences Research Building, 109 Zina Pitcher Place, University of Michigan, Ann Arbor, MI 48109-2200, USA.
Stephen H
SH
Schlecht
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA.
Carrie A
CA
Karvonen-Gutierrez
BMD; Biomechanics; Bone; Menopausal transition; Osteoporosis; Strength
Osteoporos Int. 2000;11(11):953-8
11193248
Osteoporos Int. 1997;7(5):426-31
9425499
J Bone Miner Res. 2001 Dec;16(12 ):2260-6
11760840
J Biomech. 1998 Feb;31(2):125-33
9593205
J Bone Miner Res. 2013 Jun;28(6):1308-18
23299863
Osteoporos Int. 2008 Apr;19(4):385-97
18292978
Hum Reprod Update. 2007 Nov-Dec;13(6):559-65
17630397
J Clin Endocrinol Metab. 2013 Jul;98(7):2854-63
23666961
J Bone Miner Res. 2006 Jan;21(1):124-31
16355281
Ann N Y Acad Sci. 2010 Mar;1192:66-71
20392219
Aging (Milano). 2000 Apr;12(2):85-92
10902050
N Engl J Med. 2003 Jul 24;349(4):320-3
12878736
Maturitas. 1995 Feb;21(2):103-13
7752947
Bone. 2003 May;32(5):561-70
12753873
J Bone Miner Res. 2015 Sep;30(9):1539-50
26235703
J Clin Endocrinol Metab. 2007 Jan;92(1):304-13
17062759
Curr Opin Pharmacol. 2014 Jun;16:64-71
24747363
Maturitas. 2008 Feb 20;59(2):149-57
18280066
Calcif Tissue Int. 1991 Aug;49(2):90-4
1913299
Osteoarthritis Cartilage. 2009 Dec;17 (12 ):1609-14
19563924
Osteoporos Int. 2002 May;13(5):358-65
12086345
Bone. 2004 Nov;35(5):1003-12
15542024
Osteoporos Int. 2012 Apr;23(4):1381-90
21927926
Osteoporos Int. 2013 Sep;24(9):2471-81
23436075
Lancet. 2010 May 15;375(9727):1729-36
20472174
J Bone Miner Res. 2010 May;25(5):994-1001
19874201
J Clin Densitom. 2016 Apr-Jun;19(2):174-9
25708121
J Bone Miner Res. 2012 Sep;27(9):1916-26
22532507
Osteoporos Int. 2003 Apr;14(2):141-5
12730775
Menopause. 2010 Jan-Feb;17(1):25-54; quiz 55-6
20061894
J Bone Miner Res. 2015 Jun;30(6):951-66
25917136
Science. 1964 Jul 10;145(3628):156-7
14171549
Bone. 1996 Jan;18(1 Suppl):77S-86S
8717551
Br J Radiol. 1993 May;66(785):435-40
8319065
Ann Lab Med. 2012 Mar;32(2):105-12
22389876
J Bone Miner Res. 2006 Dec;21(12):1856-63
17002580
J Bone Miner Res. 2003 Oct;18(10):1766-74
14584886