Pathogenesis of osteoporosis.

There are many pathways that might lead to decreased bone mass, skeletal fragility, and increased fracture risk in osteoporosis. Some of these have been clearly identified, such as estrogen deficiency. Others that were conceived on the basis of experimental findings and recent scientific discoveries such as abnormalities of cytokines, bone growth factors, and osteoblast transcription factors remain interesting but speculative. The recent revolution in genomics and proteomics opens new avenues for pursuing in great depth the pathways leading to osteoporosis. Animal models developed largely in rodents can suggest specific factors that can be further studied in primate models and in osteoporotic patients. Identification of specific pathogenetic mechanisms should lead to new approaches to the diagnosis and management of this disorder.