Abnormal bone microarchitecture and evidence of osteoblast dysfunction in premenopausal women with idiopathic osteoporosis

Adi Cohen, David W. Dempster, Robert R. Recker, Emily M. Stein, Joan M. Lappe, Hua Zhou, Andreas J. Wirth, G. Harry Van Lenthe, Thomas Kohler, Alexander Zwahlen, Ralph Mul̈ler, Clifford J. Rosen, Serge Cremers, Thomas L. Nickolas, Donald J. McMahon, Halley Rogers, Ronald B. Staron, Jeanette LeMaster, Elizabeth Shane

Research output: Contribution to journalArticle

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Abstract

Context: Idiopathic osteoporosis (IOP) in premenopausal women is an uncommon disorder of uncertain pathogenesis in which fragility fractures occur in otherwise healthy women with intact gonadal function. It is unclear whether women with idiopathic low bone mineral density and no history of fragility fractures have osteoporosis. Objective: The objective of the study was to elucidate the microarchitectural and remodeling features of premenopausal women with IOP. Design:Weperformed transiliac biopsies after tetracycline labeling in 104women:45 with fragility fractures (IOP), 19 with idiopathic low bone mineral density (Z score ≤ -2.0) and 40 controls. Biopsies were analyzed by two-dimensional quantitative histomorphometry and three-dimensional microcomputed tomography. Bone stiffness was estimated using finite element analysis. Results: Compared with controls, affected women had thinner cortices; fewer, thinner, more widely separated, and heterogeneously distributed trabeculae; reduced stiffness; and lower osteoid width and mean wall width. All parameters were indistinguishable betweenwomenwith IOP and idiopathic low bone mineral density. Although there were no group differences in dynamic histomorphometric remodeling parameters, serum calciotropic hormones, bone turnover markers, or IGF-I, subjects in the lowest tertile of bone formation rate had significantly lower osteoid and wall width, more severely disrupted microarchitecture, lower stiffness, and higher serum IGF-I than those in the upper two tertiles, suggesting that women with low turnover IOP have osteoblast dysfunction with resistance to IGF-I. Subjects with high bone turnover had significantly higher serum 1,25 dihydroxyvitamin D levels and a nonsignificant trend toward higher serum PTH and urinary calcium excretion. Conclusions: These results suggest that the diagnosis of IOP should not require a history of fracture. Womenwith IOP may have high, normal or low bone turnover; those with low bone turnover have the most marked deficits in microarchitecture and stiffness. These results also suggest that the pathogenesis of idiopathic osteoporosis is heterogeneous and may differ according to remodeling activity.

Original languageEnglish
Pages (from-to)3095-3105
Number of pages11
JournalJournal of Clinical Endocrinology and Metabolism
Volume96
Issue number10
DOIs
StatePublished - Oct 2011

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Osteoblasts
Osteoporosis
Bone
Bone and Bones
Bone Remodeling
Insulin-Like Growth Factor I
Stiffness
Bone Density
Minerals
Biopsy
Serum
X-Ray Microtomography
Finite Element Analysis
Tetracycline
Osteogenesis
Labeling
Tomography
Hormones
Calcium
Finite element method

All Science Journal Classification (ASJC) codes

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Abnormal bone microarchitecture and evidence of osteoblast dysfunction in premenopausal women with idiopathic osteoporosis. / Cohen, Adi; Dempster, David W.; Recker, Robert R.; Stein, Emily M.; Lappe, Joan M.; Zhou, Hua; Wirth, Andreas J.; Van Lenthe, G. Harry; Kohler, Thomas; Zwahlen, Alexander; Mul̈ler, Ralph; Rosen, Clifford J.; Cremers, Serge; Nickolas, Thomas L.; McMahon, Donald J.; Rogers, Halley; Staron, Ronald B.; LeMaster, Jeanette; Shane, Elizabeth.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 96, No. 10, 10.2011, p. 3095-3105.

Research output: Contribution to journalArticle

Cohen, A, Dempster, DW, Recker, RR, Stein, EM, Lappe, JM, Zhou, H, Wirth, AJ, Van Lenthe, GH, Kohler, T, Zwahlen, A, Mul̈ler, R, Rosen, CJ, Cremers, S, Nickolas, TL, McMahon, DJ, Rogers, H, Staron, RB, LeMaster, J & Shane, E 2011, 'Abnormal bone microarchitecture and evidence of osteoblast dysfunction in premenopausal women with idiopathic osteoporosis', Journal of Clinical Endocrinology and Metabolism, vol. 96, no. 10, pp. 3095-3105. https://doi.org/10.1210/jc.2011-1387
Cohen, Adi ; Dempster, David W. ; Recker, Robert R. ; Stein, Emily M. ; Lappe, Joan M. ; Zhou, Hua ; Wirth, Andreas J. ; Van Lenthe, G. Harry ; Kohler, Thomas ; Zwahlen, Alexander ; Mul̈ler, Ralph ; Rosen, Clifford J. ; Cremers, Serge ; Nickolas, Thomas L. ; McMahon, Donald J. ; Rogers, Halley ; Staron, Ronald B. ; LeMaster, Jeanette ; Shane, Elizabeth. / Abnormal bone microarchitecture and evidence of osteoblast dysfunction in premenopausal women with idiopathic osteoporosis. In: Journal of Clinical Endocrinology and Metabolism. 2011 ; Vol. 96, No. 10. pp. 3095-3105.
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abstract = "Context: Idiopathic osteoporosis (IOP) in premenopausal women is an uncommon disorder of uncertain pathogenesis in which fragility fractures occur in otherwise healthy women with intact gonadal function. It is unclear whether women with idiopathic low bone mineral density and no history of fragility fractures have osteoporosis. Objective: The objective of the study was to elucidate the microarchitectural and remodeling features of premenopausal women with IOP. Design:Weperformed transiliac biopsies after tetracycline labeling in 104women:45 with fragility fractures (IOP), 19 with idiopathic low bone mineral density (Z score ≤ -2.0) and 40 controls. Biopsies were analyzed by two-dimensional quantitative histomorphometry and three-dimensional microcomputed tomography. Bone stiffness was estimated using finite element analysis. Results: Compared with controls, affected women had thinner cortices; fewer, thinner, more widely separated, and heterogeneously distributed trabeculae; reduced stiffness; and lower osteoid width and mean wall width. All parameters were indistinguishable betweenwomenwith IOP and idiopathic low bone mineral density. Although there were no group differences in dynamic histomorphometric remodeling parameters, serum calciotropic hormones, bone turnover markers, or IGF-I, subjects in the lowest tertile of bone formation rate had significantly lower osteoid and wall width, more severely disrupted microarchitecture, lower stiffness, and higher serum IGF-I than those in the upper two tertiles, suggesting that women with low turnover IOP have osteoblast dysfunction with resistance to IGF-I. Subjects with high bone turnover had significantly higher serum 1,25 dihydroxyvitamin D levels and a nonsignificant trend toward higher serum PTH and urinary calcium excretion. Conclusions: These results suggest that the diagnosis of IOP should not require a history of fracture. Womenwith IOP may have high, normal or low bone turnover; those with low bone turnover have the most marked deficits in microarchitecture and stiffness. These results also suggest that the pathogenesis of idiopathic osteoporosis is heterogeneous and may differ according to remodeling activity.",
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T1 - Abnormal bone microarchitecture and evidence of osteoblast dysfunction in premenopausal women with idiopathic osteoporosis

AU - Cohen, Adi

AU - Dempster, David W.

AU - Recker, Robert R.

AU - Stein, Emily M.

AU - Lappe, Joan M.

AU - Zhou, Hua

AU - Wirth, Andreas J.

AU - Van Lenthe, G. Harry

AU - Kohler, Thomas

AU - Zwahlen, Alexander

AU - Mul̈ler, Ralph

AU - Rosen, Clifford J.

AU - Cremers, Serge

AU - Nickolas, Thomas L.

AU - McMahon, Donald J.

AU - Rogers, Halley

AU - Staron, Ronald B.

AU - LeMaster, Jeanette

AU - Shane, Elizabeth

PY - 2011/10

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N2 - Context: Idiopathic osteoporosis (IOP) in premenopausal women is an uncommon disorder of uncertain pathogenesis in which fragility fractures occur in otherwise healthy women with intact gonadal function. It is unclear whether women with idiopathic low bone mineral density and no history of fragility fractures have osteoporosis. Objective: The objective of the study was to elucidate the microarchitectural and remodeling features of premenopausal women with IOP. Design:Weperformed transiliac biopsies after tetracycline labeling in 104women:45 with fragility fractures (IOP), 19 with idiopathic low bone mineral density (Z score ≤ -2.0) and 40 controls. Biopsies were analyzed by two-dimensional quantitative histomorphometry and three-dimensional microcomputed tomography. Bone stiffness was estimated using finite element analysis. Results: Compared with controls, affected women had thinner cortices; fewer, thinner, more widely separated, and heterogeneously distributed trabeculae; reduced stiffness; and lower osteoid width and mean wall width. All parameters were indistinguishable betweenwomenwith IOP and idiopathic low bone mineral density. Although there were no group differences in dynamic histomorphometric remodeling parameters, serum calciotropic hormones, bone turnover markers, or IGF-I, subjects in the lowest tertile of bone formation rate had significantly lower osteoid and wall width, more severely disrupted microarchitecture, lower stiffness, and higher serum IGF-I than those in the upper two tertiles, suggesting that women with low turnover IOP have osteoblast dysfunction with resistance to IGF-I. Subjects with high bone turnover had significantly higher serum 1,25 dihydroxyvitamin D levels and a nonsignificant trend toward higher serum PTH and urinary calcium excretion. Conclusions: These results suggest that the diagnosis of IOP should not require a history of fracture. Womenwith IOP may have high, normal or low bone turnover; those with low bone turnover have the most marked deficits in microarchitecture and stiffness. These results also suggest that the pathogenesis of idiopathic osteoporosis is heterogeneous and may differ according to remodeling activity.

AB - Context: Idiopathic osteoporosis (IOP) in premenopausal women is an uncommon disorder of uncertain pathogenesis in which fragility fractures occur in otherwise healthy women with intact gonadal function. It is unclear whether women with idiopathic low bone mineral density and no history of fragility fractures have osteoporosis. Objective: The objective of the study was to elucidate the microarchitectural and remodeling features of premenopausal women with IOP. Design:Weperformed transiliac biopsies after tetracycline labeling in 104women:45 with fragility fractures (IOP), 19 with idiopathic low bone mineral density (Z score ≤ -2.0) and 40 controls. Biopsies were analyzed by two-dimensional quantitative histomorphometry and three-dimensional microcomputed tomography. Bone stiffness was estimated using finite element analysis. Results: Compared with controls, affected women had thinner cortices; fewer, thinner, more widely separated, and heterogeneously distributed trabeculae; reduced stiffness; and lower osteoid width and mean wall width. All parameters were indistinguishable betweenwomenwith IOP and idiopathic low bone mineral density. Although there were no group differences in dynamic histomorphometric remodeling parameters, serum calciotropic hormones, bone turnover markers, or IGF-I, subjects in the lowest tertile of bone formation rate had significantly lower osteoid and wall width, more severely disrupted microarchitecture, lower stiffness, and higher serum IGF-I than those in the upper two tertiles, suggesting that women with low turnover IOP have osteoblast dysfunction with resistance to IGF-I. Subjects with high bone turnover had significantly higher serum 1,25 dihydroxyvitamin D levels and a nonsignificant trend toward higher serum PTH and urinary calcium excretion. Conclusions: These results suggest that the diagnosis of IOP should not require a history of fracture. Womenwith IOP may have high, normal or low bone turnover; those with low bone turnover have the most marked deficits in microarchitecture and stiffness. These results also suggest that the pathogenesis of idiopathic osteoporosis is heterogeneous and may differ according to remodeling activity.

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