The presence of microdamage in bone has been controversial pertly because it is difficult to locate and quantify. New techniques, including acoustic emission, may improve our ability to detect damage in bone and to assess its effect on tissue properties. Microcracks accumulate exponentially with age. Bone from elderly women is more susceptible to damage than bone from younger women, probably accounting for the decreased fracture toughness that accompanies aging. The transient reduction in bone mass caused by accelerated remodeling in response to load or damage can precipitate a positive feedback leading to eventual fracture. Lower bone turnover in black women may help to account for their lower fracture risk, even though damage accumulation occurs at the same rate as in white women. Positive feedback between damage, remodeling, and porosity may also be one factor that precipitates the loosening of prosthetic implants.
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