Endocrine Abstracts

Among the different functions of bone, the biomechanical one is the most evident. Biomechanical function of bone allows locomotion and protection of essential organs like brain and in a way can be considered as a survival function. Optimal bone strength maintenance through bone remodeling is an active energy consuming process. When a fracture occurs, two sides of the phenomenon should be evaluated: the trauma and the bone resistance including bone mass and bone quality. Bone resistance impairment leads to fragility fractures which is source of pain, local complications, disability, surgery and excess mortality. Performing a diagnostic assessment to understand origin of bone resistance impairment is the first key step for the physician. Etiologies are numerous including osteoporosis, osteomalacia, bone metastases, chronic kidney diseases, genetic disorders, endocrine diseases such as hyperparathyroidism. The second key step is fracture risk evaluation to advise patients on bone targeted treatments and lifestyle. The available tools are not the same in a benign bone fragility context and in bone metastases. In benign bone fragility, physicians will use bone densitometry (DXA), clinical risk factors, FRAX® score tool, TBS, or bone remodeling markers. Some device like HR-pQCT, MRI and qCT may also be useful. For bone metastases, some scores like the Mirels, the SINS, or the Tokuashi’s scores, have been developed. These scores have limitations and we will point out the difficulty to assess fracture risk and the need for new tools.