[Daily practice using the guidelines for prevention and treatment of osteoporosis. How do we realize the bone quality in routine practice using Japanese guideline for osteoporosis prevention and treatment?]

Abstract

Bone quality is thought to encompass the structural and material properties of bone that are affected by turnover rate. The concept of bone quality is included in Japanese Guideline for Osteoporosis prevention and treatment. Evidence has accumulated that collagen cross-links play important roles in bone strength. We have demonstrated that the quantitative and qualitative deterioration of lysyl oxidase controlled and non-enzymatic cross-links (Advanced glycation end products, AGEs, Pentosidine) of collagen in patients with osteoporotic femoral neck fracture cases might be affected by hyperhomocysteinemia (Saito M, Calcif Tissue Int, 2006), oxidative stress, vitamin B status (Saito M, Osteoporos Int, 2006) . Recently, Shiraki et al. demonstrated that a functional polymorphism in methylenetetrahydrofolate reductase (MTHFR) polymorphism, T allele (C677T), may be a risk factor for future fracture in addition to the traditional risk factors (Shiraki M, Saito M, et al., J Bone Miner Metab, in press). In addition, we have reported that a higher urinary pentosidine was an independent risk factor, for vertebral fracture in a 5-year prospective study in Japanese women (Shiraki M, Saito M, et al., J Bone Miner Metab, 2008). If confirmed in large, prospective trials, measurement of serum homocysteine and serum or urinary excretion of pentosidine might be characterized as markers reflecting bone collagen deterioration.