A theoretical analysis of the relative influences of peak BMD, age-related bone loss and menopause on the development of osteoporosis


Factors that determine a post-menopausal woman's bone mineral density (BMD) include her mass at the time of skeletal maturity (peak BMD), menopause and the rate of loss she experiences as she ages. Understanding the relative influence of each of these factors may help identify important preventive treatments and provide new ways to identify women at risk for osteoporosis. In this analysis we utilize a computer model of the bone remodeling process to predict the relative influences of peak BMD, menopause and age-related bone loss on the development of osteoporosis. The delay in the onset of osteoporosis (defined as BMD <2.5 SD from the young adult mean) caused by modifying peak BMD, age-related bone loss or the age at menopause is quantified. A 10% increase in peak BMD is predicted to delay the development of osteoporosis by 13 years, while a 10% change in the age at menopause or the rate of non-menopausal bone loss is predicted to delay osteoporosis by approximately 2 years, suggesting that peak BMD may be the single most important factor in the development of osteoporosis.

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  1. 1.

    Rizzoli R, Bonjour JP, Ferrari SL (2001) Osteoporosis, genetics and hormones. J Mol Endocrinol 26:79–94

  2. 2.

    Hernandez CJ, Beaupré GS, Carter DR (2003) A theoretical analysis of the changes in basic multicellular unit activity at menopause. Bone 32:357–363

  3. 3.

    Heaney RP (1996) Pathophysiology of osteoporosis. Am J Med Sci 312:251–256

  4. 4.

    Riggs BL, Khosla S, Melton LJ 3rd (2001) The type I/type II model for involutional osteoporosis. In: Marcus R (ed) Osteoporosis. Academic Press, San Diego, pp 49–58

  5. 5.

    Kimmel DB (1985) A computer simulation of the mature skeleton. Bone 6:369–372

  6. 6.

    Heaney RP (1994) The bone-remodeling transient: implications for the interpretation of clinical studies of bone mass change. J Bone Miner Res 9:1515–1523

  7. 7.

    Hazelwood SJ, Martin RB, Rashid RR et al. (2001) A mechanistic model for internal bone remodeling exhibits different dynamic responses in disuse and overload. J Biomech 34:299–308

  8. 8.

    Hernandez CJ, Beaupré GS, Marcus R et al. (2001) A theoretical analysis of the contributions of remodeling space, mineralization and bone balance to changes in bone mineral density during alendronate treatment. Bone 29:511–516

  9. 9.

    Lips P, Courpron P, Meunier PJ (1978) Mean wall thickness of trabecular bone packets in the human iliac crest: changes with age. Calcif Tissue Res 26:13–17

  10. 10.

    Heaney RP, Abrams S, Dawson-Hughes B et al. (2000) Peak bone mass. Osteoporos Int 11:985–1009

  11. 11.

    Dent CE (1973) Problems in metabolic bone disease. In: Frame B, Parfitt AM (eds) Clinical aspects of metabolic bone disease. Excerpta Medica, Amsterdam, pp 1–7

  12. 12.

    Matkovic V, Jelic T, Wardlaw GM et al. (1994) Timing of peak bone mass in Caucasian females and its implication for the prevention of osteoporosis. Inference from a cross-sectional model. J Clin Invest 93:799–808

  13. 13.

    Recker R, Lappe J, Davies K et al. (2000) Characterization of perimenopausal bone loss: a prospective study. J Bone Miner Res 15:1965–1973

  14. 14.

    Duan Y, Parfitt A, Seeman E (1999) Vertebral bone mass, size, and volumetric density in women with spinal fractures. J Bone Miner Res 14:1796–1802

  15. 15.

    Hui SL, Slemenda CW, Johnston CC Jr (1990) The contribution of bone loss to postmenopausal osteoporosis. Osteoporos Int 1:30–34

  16. 16.

    Ross PD, Wasnich RD, Davis JW (1990) Fracture prediction models for osteoporosis prevention. Bone 11:327–331

  17. 17.

    Han ZH, Palnitkar S, Rao DS et al. (1997) Effects of ethnicity and age or menopause on the remodeling and turnover of iliac bone: implications for mechanisms of bone loss. J Bone Miner Res 12:498–508

  18. 18.

    Hernandez CJ, Beaupré GS, Carter DR (2000) A model of mechanobiologic and metabolic influences on bone adaptation. J Rehabil Res Dev 37:235–244

  19. 19.

    Eriksen EF, Gundersen HJ, Melsen F et al. (1984) Reconstruction of the formative site in iliac trabecular bone in 20 normal individuals employing a kinetic model for matrix and mineral apposition. Metab Bone Dis Relat Res 5:243–252

  20. 20.

    Parfitt AM, Mundy GR, Roodman GD et al. (1996) A new model for the regulation of bone resorption, with particular reference to the effects of bisphosphonates. J Bone Miner Res 11:150–159

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The authors thank Robert Marcus for his helpful comments and Mitchell Schaffler and Tony Keaveny for their encouragement. This work was supported in part by the Department of Veterans Affairs, VA Merit Review Grant 2424P and a fellowship from the Ford Foundation.

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Presented in part as a poster at the 24rd Annual Meeting of the American Society for Bone and Mineral Research, September 20–24, 2002 San Antonio, Tex., USA

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Hernandez, C.J., Beaupré, G.S. & Carter, D.R. A theoretical analysis of the relative influences of peak BMD, age-related bone loss and menopause on the development of osteoporosis. Osteoporos Int 14, 843–847 (2003) doi:10.1007/s00198-003-1454-8

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  • Aging
  • Bone mineral density (BMD)
  • Computer simulation
  • Menopause
  • Osteoporosis