New research challenges current views on bone fractures, arguing for more drugs targeting cortical rather than trabecular bone decay.
A report in The Lancet claims treatment for age-related bone loss should shift focus as most age-related fractures occur at cortical sites after the age of 65, rather than the vertebrae.
The study found that 80% of age-related fractures are cortical and non-vertebral, yet osteoporosis research has traditionally focused on trabecular bone loss and fractures of back bones.
The team of researchers from the University of Melbourne used high-tech X-ray and microscopy methods to examine bone mineral density and cortical porosity in old age.
They conclude that age-related cortical porosity is currently underestimated in fracture risk assessment. Trabecularisation of the cortex can mean cortical remnants that appear similar to trabeculae are mistakenly viewed and recorded as trabecular bone loss, they fear.
"Accurate assessment of bone structure, especially porosity producing cortical remnants, could improve identification of individuals at high and low risk of fracture and therefore assist targeting of treatment", the scientists say.