Osteoporosis: Maintenance of Strong Bones as an Adult

How do we avoid osteoporosis?

Written by James Norman MD, FACS, FACE


Once bone formation (the acquisition of bone mineral density "BMD") has stopped (somewhere about 28 years of age) peak bone mass is maintained by a process called "remodeling". Remodeling is a process which occurs 24 hours a day, 7 days a week and involves the continuous breakdown and re-formation of bone. Remember, bone is a live tissue just like the kidneys, heart, and other organs of the body. This live tissue continuously remodels itself to maintain maximal BMD and to repair any small (or large) damage (such as fractures). Remodeling is under the control of a number of hormones.

Remodeling consists of tearing down small parts of the bones, and then re-forming them. The breaking down portion is termed "resorption" and is performed by large cells within the bones called "osteoclasts". Osteoclasts live in the central portion of the bone. They are continually removing small (microscopic) portions of bone at the edge of the bone surface. Nearby, bone forming cells called "osteoblasts" begin to fill in the holes left behind.

Here is the big problem: remodeling does not seem to be a perfect give and take of bone mass. The osteoblasts are less efficient at making bone than the osteoclasts are at removing it. Although the difference is slight, this is what accounts for the gradual loss of bone density (BMD) as a person ages. Any factor which causes a higher rate of bone remodeling will ultimately lead to a more rapid loss of bone mass and thus more fragile bones.

Amount of Strong Bones Formed During Youth

- subtract -

Amount of Bone Lost to Remodeling Over Many Years

- equals -

Level of Bone Mass as an Adult (or degree of osteoporosis)

Factors Involved in Maintenance of Adult Bone Mass

The same factors which encouraged bone formation as a youth and teenager affect the maintenance of bone mass during the adult years. The most important influences are calcium intake, reproductive hormone status, normal parathyroid gland function, and physical activity.