The bone quality framework: Determinants of bone strength and their interrelationships, and implications for osteoporosis management

The Bone Quality Framework is presented in this paper as a means of summarizing and explaining the determinants of bone strength. In this framework, bone quality can be understood as an umbrella term that describes the set of characteristics that influence bone strength and explains the interrelationships of these characteristics. Bone strength depends on the structural and material properties of bone, both of which are influenced by the rate of bone turnover. Not all determinants of bone strength are well represented by a BMD measurement. The Bone Quality Framework presents an opportunity to examine all the determinants of bone strength. Greater understanding of the concept of bone quality will ultimately help improve the assessment of fracture risk and monitoring of patients receiving treatment for osteoporosis.