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. 2001 Jun;60(6):554–558. doi: 10.1136/ard.60.6.554

Idiopathic osteoporosis: an evolutionary dys-adaptation?

C Alexander 1
PMCID: PMC1753661  PMID: 11350841

Abstract

Osteoporosis is characterised by simultaneous net bone growth and net resorption on different surfaces, suggesting that systemic factors are not the sole explanation for the findings. The main clinical consequence is fracturing in the largely trabecular bones of the spine, hip, and radius, and the key problem in these areas is finding an explanation for the preferential loss of transverse trabeculae. In normal bone, local maintenance depends on a negative feedback response to intermittent compression strain, and it is concluded, from biomechanical analysis of the response required to achieve negative feedback, that a preferential loss of transverse trabeculae is indicative of a selective deficiency of radial compression loading. The only significant source of radial compression in humans is the induced strain produced by axial tension. This is a necessary component of the lifestyles of quadrupeds and arboreal primates, but in humans occurs only on the convex side when the bone is offset loaded. The resulting strain is a function of the range of movement. It is suggested that the asymmetrical pattern of bone loss in cortical and trabecular osteoporosis reflects chronic underuse of movement range, resulting from the adoption of a bipedal lifestyle. Exercise regimens based on using the whole of the available movement range should better prepare the skeleton to adjust to other factors hostile to bone maintenance.



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Figure 1  .

Figure 1  

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Coronal and transverse computed tomographic (CT) scans of dry vertebrae, 1 mm slice thickness, 120 kV, 250 mA. Left, a young adult vertebra, mean (SD) x ray absorption -570 (102) Houndsfield Units (HU). Right, an osteoporotic vertebra, x ray absorption -827 (103) HU. The right hand figures are representative middle third scans from a sample of 61 triplanar CT scans made across three osteoporotic vertebrae. The transverse scan B2 shows substantial loss of radial and annular trabeculae. There is some loss of axial trabeculae with thickening of several unsupported survivors. The pattern of bone loss is not uniform across the transverse section, and differs from that seen in coronal and sagittal sections.

Figure 2  .

Figure 2  

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A transverse 1 mm computed tomographic section of the same vertebra as in fig 1, B2, taken 8 mm more distally. It shows little sign of osteoporosis with no detectable axial thickening. Trabeculae near the tension-resisting end plate are better preserved and show less anisotropy.

Figure 3  .

Figure 3  

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Strain distribution in a bent strut. Both compression and tension strains are maximal at the cortical surface and a function of the degree of bending. The longitudinal tension strain induces a transverse compression strain on the convex side of the neutral zero-strain axis.    

Figure 4  .

Figure 4  

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Transverse strains induced by longitudinal strains on an elastic body.

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