Osteoporosis: the structural and reparative consequences for the skeleton.

We have discussed the biomechanical and biomaterial properties of bone with emphasis on the microenvironment. The microdensity of bone tissues determines the resistance to compressive forces (strength = density2). The structural orientation of bone determines the ability of bone to withstand torsion and bending forces. Highly remodeled bone is brittle and fractures easily because of the multiple reversal planes within the bone plates. Conversely, augmentation of bone on the periphery by modeling leads to increased material microstrength and structural macrostrength. Consequently, appositional modeling augments whereas remodeling diminishes bone strength. Hip fractures, spinal fractures, Colles' fractures, and pelvic fractures have been discussed in terms of their pathophysiology and treatment. An algorithm (Fig. 4-7) has been presented for the differential diagnosis of patients with recently discovered spinal compression fractures. Lastly, a discussion of exercise demonstrated its beneficial role, especially in the retention of bone mass.