A History of Pivotal Advances in Clinical Research into Bone and Mineral Diseases

Clinical practice has changed a lot over the past 40 years because of pivotal research advances. Before 1960, osteoporosis was an uncommon clinical diagnosis based mainly on symptomatic vertebral fractures and estrogen was the only available treatment. Today, we have fracture prediction tools that incorporate bone mineral density (BMD) and multiple risk factors. We have a range of treatments that have been shown to reduce fracture risk. Clinical practice has also benefitted from advances in our understanding of bone biology[1] that contributed to development of treatments targeting key regulatory pathways not just for osteoporosis but also for other disorders of bone and mineral metabolism.

We were invited to review the history of pivotal advances in clinical research in bone and mineral metabolism to coincide with the 40th anniversary of the American Society of Bone and Mineral Research (ASBMR). To capture major advances, we wrote to the awardees of the Bartter Award, the ASBMR's award for excellence in clinical research. Twelve individuals named at least three pivotal advances and their recommendations are the starting point for this article. In general we focus on the key developments rather than on the contributors with exceptions for a few from long ago who may have been forgotten. We included and emphasize those that were noted by two or more. Most of the responses focused on advances that have occurred in osteoporosis. This is no surprise because the number of abstracts on this topic has dominated bone and mineral meetings for at least the past 30 years.