Osteoporosis at A Crossroads: A 1999 Overview

摘要

This Third International Congress on Osteoporosis offers its participants two "menus". A) Its first three days review and refine accepted ways to study, manage and diagnose "osteoporosis", and accepted ideas of their pathogenesis. B) Its fourth day presents insights from the still evolving Utah paradigm of skeletal physiology. Those insights promise to change the "A" things profoundly, although it should take time, hard work and help from many to transform them into safe and effective procedures that would be suitable for routine clinical use. Some could find two insights of that paradigm novel or even contentious: (i) Neuromuscular anatomy and function dominate control of the tissue-level biologic mechanisms that control changes in our postnatal bone strength and "mass"; (ii) most nonmechanical agents formerly thought to dominate that control (hormones, calcium, vitamin D, genes, cytokines, etc) could help or hinder it but cannot duplicate or replace it. While those ideas cause controversies that must be resolved, the multidisciplinary evidence they stnad on has become too strong to ignore or discount.