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Understanding bone fragility: theoretical explanation to non-physician health professionals
  1. Toshihiro Sugiyama
  1. Department of Orthopaedic Surgery, Saitama Medical University, Saitama 350-0495, Japan
  1. Correspondence to Dr Toshihiro Sugiyama, Department of Orthopaedic Surgery, Saitama Medical University, Saitama 350-0495, Japan; tsugiym{at}

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The European League Against Rheumatism recently established timely and highly important recommendation for non-physician health professionals regarding the prevention and management of bone fractures among older adults.1 To support the health professionals’ understanding of skeletal fragility, I would like to provide a theoretical explanation.2 3

First, non-physician health professionals are expected to play a role in the improvement of patient adherence to pharmacotherapy for osteoporosis.1 Here, it should be paid attention that the effects of osteoporosis drugs except bisphosphonates with mineral binding capacity are lost rapidly after discontinuation,4 which can be reasonably explained by functional adaptation of bone to mechanical loading during physical activity.3 Second, the homeostatic system in the skeleton2 can also explain why the small and transient effect of calcium supplementation on areal bone mineral density, measured by dual-energy X-ray absorptiometry, is lost after discontinuation.5 Finally, although vigorous-intensity exercise would improve bone fragility,6 the effect can be similarly lost after discontinuation, resulting from the skeletal adaptation to mechanical environment.7 Long-term continuation of exercise should be therefore given priority over the intensity; for example, rapid bone loss following stroke8 indicates the significance of even light-intensity physical activity.



  • Contributors TS is the sole author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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