Endocrine causes of age-related bone loss and osteoporosis.

Women have an early postmenopausal phase of rapid bone loss that lasts for 5-10 years after menopause, whereas both ageing women and men have a slow continuous phase of bone loss that lasts indefinitely. In women, the rapid phase is mediated mainly by loss of the direct restraining effect of oestrogen on bone cell function, whereas the slow phase is mediated mainly by the loss of oestrogen action on extraskeletal calcium homeostasis leading to net calcium wasting and secondary hyperparathyroidism. Because elderly men have low serum bioavailable oestrogen and testosterone levels, and because recent data suggest that oestrogen is the main sex steroid regulating bone metabolism in men, oestrogen deficiency may also be the principal cause of bone loss in elderly men. Decreased bone formation contributes to bone loss in both genders and may be caused by a decreased production of growth hormone and IGF1 as well as oestrogen and testosterone deficiency. Other changes in endocrine secretion, although present in the elderly, seem less important in the pathophysiology of age-related bone loss and osteoporosis.