50 Years Ago in CORR: Osteomalacia, Osteoporosis, and Calcium Deficiency B.E.C. Nordin, MD, MRCP, PhD 1960;17:235–258

Excerpt

The concept of bone quality has been long known, although perhaps not in the current context. Some of the earliest references to “bone quality” appear to be in the context of animal husbandry. Burdett-Coutts, referring to the purchase of horses, commented at the end of the 19th Century, “And so he sets himself to think how he can supply the dealers who have been round during the past week, wanting something on short legs, with bone quality, and substance…” [4]. The notion that it might apply to disease appears in the mid 20th Century: Bell remarked, “Rickets is the only condition in which alterations of bone quality have been demonstrated in this laboratory…” [2]. The increase in rates of fracture in elderly persons was well established in the late 1800s [7]. However, researchers questioned whether or not this related to bone quality per se. Knowelden and his colleagues, commented in 1964, “There is indeed no mystery about the immediate cause of any fracture – it is, of course, that the stress produced by the forces applied to the bone has exceeded the breaking stress. There is no proof from either animal or human experiments that bone quality, that is breaking stress, decreases in old age. The bone is, of course, decreased in amount - the compact shaft walls and trabeculae becoming thinner and therefore weaker.” Thus, they presumed the quality of bone—if quality is defined as breaking strength—as a material (contrasted to bone as a structure) was similar regardless of age. …