Table 1.

Diseases affecting bone quality

Diseases affecting bone quality	Pathophysiology
Disorders of bone mineral homeostasis
Rickets and osteomalacia [31]	Impairment of mineral deposition
Hyperparathyroidism [38]	Excessive secretion of PTH, leading to increased osteoclastic bone resorption
Hypogonadism [33, 37]	Reduced sex hormones, resulting in increased osteoclastic bone resorption
Hyperthyroidism [85]	Increased bone resorption
Type I diabetes mellitus [83]	Suppression of bone turnover
Cushing’s disease [51, 58, 106]	See Glucocorticoids
Imbalance of bone remodeling
Renal osteodystrophy [98]	Increased osteoclastic bone resorption in high turnover state or decreased bone formation in low turnover state
Paget’s disease [81]	Rapid bone turnover, leading to disorganized mosaic pattern of woven and lamellar bone
Disuse osteoporosis [35, 110]	Uncoupling between bone resorption and formation with increased in bone resorption
Sclerosing bone dysplasias (osteopetrosis) [18, 105]	Defects in osteoclastic bone resorption (retention of primary spongiosa)
Disorders of collagen
Osteogenesis imperfecta [6]	Mutation of Type I collagen genes
Scurvy [78]	Impairment of hydroxylation process during collagen synthesis
Marfan syndrome [40]	Abnormalities of fibrillin-1 glycoprotein
Ehlers-Danlos syndromes [13]	Defects in lysyl hydroxylase and collagen type I, III, and V
Drugs
Glucocorticoids [51, 58, 106]	Increased osteoclastic resorption, impaired maturation of osteoblasts and altered calcium metabolism
Chemotherapeutic agents [49, 79]	Hypogonadism or direct toxic effects on bone
Disease modifying antirheumatic drugs (DMARDs) [26]	Imbalance of bone turnover
Bisphosphonates [76, 96]	Suppression of osteoclastic activity, leading to microdamage accumulation