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The Genetics of Osteoporosis

Progress in Mice, not Man

  • Chapter
Osteoporosis

Part of the book series: Contemporary Endocrinology ((COE))

  • 343 Accesses

Abstract

Progress in the study of the genetics of osteoporosis is slow for several reasons. For example, the phenotype is poorly defined; fractures are too uncommon to allow credible detection of any association between genes that regulate a structural determinant of bone strength. Areal bone mineral density (aBMD) predicts bone strength, but it has not proven to be clinically useful in the identifying regulators of skeletal growth and aging, in part, because it is a two dimensional projection of a three dimensional structure. This measurement is too ambiguous to allow detection of the cell-, and surface-specific genetic determinants of bone size, geometry, and volumetric bone mineral density (vBMD). Even vBMD, the net result of changes in accrual and changes in bone size during growth and aging, and cortical thickness the net effect of periosteal and endocortical modeling and remodeling, may be too complex for detecting associations with specific genetically determined mechanisms. This complexity, in part, may explain why associations between aBMD and candidate gene polymorphisms are negative, contradictory or, at best, weak. Under 1–3% of the variance in aBMD is accounted for by any polymorphism, excluding their usefulness as a predictor of fracture or bone loss. Bone “loss” is not just resorptive “removal” of bone, it is the net result of the amount of bone resorbed on the endosteal (intracortical, endocortical, trabecular) surfaces and the amount formed on the periosteal surface. The net amount of bone resorbed is a function of the imbalance between the volume of bone resorbed and formed at each BMU and the rate of bone remodeling (activation frequency). Thus, examining the rate of bone loss using densitometry to identify genetic factors accounting for the variance in net bone loss is fraught with problems. No trials have been done stratifying by genotype then randomization to placebo vs treatment within each genotype. Without this design, genotype specific differences in response to drugs, calcium supplementation, or exercise, may be due to covariates unevenly distributed in the genotype groups rather than the genotype.

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  1. Oregon Health & Science University, Portland, OR, USA

    Eric S. Orwoll MD  & Michael Bliziotes MD  & 

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Seeman, E. (2003). The Genetics of Osteoporosis. In: Orwoll, E.S., Bliziotes, M. (eds) Osteoporosis. Contemporary Endocrinology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-278-4_2

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  • DOI: https://doi.org/10.1007/978-1-59259-278-4_2

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