The adult skeleton is continuously remodeled; removal of existing bone is mediated by osteoclastic bone resorption and replacement with new bone is mediated by osteoblastic bone formation. During skeletal growth, rates of formation exceed resorption resulting in net gain of bone. Resorption rates exceed formation rate later in life, particularly among estrogen-deficient postmenopausal women and all older individuals. Prolonged bone loss leads to low bone mineral density (BMD) and eventually osteoporosis, defined as a condition of skeletal fragility resulting from some combination of bone loss and/or impaired bone quality. Osteoporosis is also defined clinically as radiographically assessed BMD that is at least 2.5 SDs below the BMD observed in a healthy young adult population (T score ≤−2.5).
Bauer DC. Clinical Use of Bone Turnover Markers. JAMA. Published online July 11, 2019322(6):569–570. doi:10.1001/jama.2019.9372
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