Abstract
A large number of cross-sectional studies suggest that rates of bone loss decrease in the elderly, particularly at the spine and radius. For this reason it has been argued that bone mass measurements are unhelpful in assessing fracture risk in the elderly and that drugs affecting bone metabolism are less likely to be of benefit in reducing this risk. This paper reviews the assumptions on which these conclusions are based and argues that in many instances they are flawed. Indeed, studies examining rates of bone loss in the elderly either directly or by biochemical indices of bone turnover suggest that bone loss continues throughout life and may even accelerate after the age of 70 years. This conclusion supports the view that identification of patients at risk and subsequent treatment is of value in all age groups.
Similar content being viewed by others
References
Krolner B, Nielsen SP. Bone mineral content of the lumbar spine in normal and osteoporotic women: cross-sectional and longitudinal studies. Clin Sci 1982;62:329–36.
Riggs BL, Wahner HW, Seeman E, Offord KP, Dunn WL, Mazess RB, et al. Changes in bone mineral density of the proximal femur and spine with aging. J Clin Invest 1982;70:716–23.
Mazess RB, Barden HS, Ettinger M, Johnston CC, Dawson-Hughes B, Baran D, et al. Spine and femur density using dual-photon absorptiometry in US white women. Bone Miner 1987;2:211–9.
Gallacher JC, Goldgar D, Moy A. Total bone calcium in normal women: effect of age and menopause status. J Bone Miner Res 1987;2:491–6.
Gotfredsen A, Podenphant J, Norgaard H, Nilas L, Hers Nielsen VA, Christiansen C. Accuracy of lumbar spine bone mineral content by dual photon absorptiometry. J Nucl Med 1988;28:248–54.
Horsman A. Bone mass. In: Nordin BEC, editor. Calcium, phosphate and magnesium metabolism. Edinburgh: Churchill Livingstone, 1976:357–404.
Cummings SR. Bone mass and bone loss in the elderly: a special case? In: Christiansen C, Riis B, editors. Osteoporosis. Aalborg, Denmark: Handelstrykleriet Aalborg ApS, 1993:499–500.
Haddaway MJ, Davie MWJ, McCall IW. Bone mineral density in healthy normal women and reproducibility of measurements in spine and hip using dual energy X-ray absorptiometry. Br J Radiol 1992;65:213–7.
Johnston CC, Hui SL, Wiske P, Norton JA, Epstein S. Bone mass and subsequent rates of loss as determinants of osteoporosis. In: DeLuca HF, Frost HM, Jee WSS, Johnston CC, Parfitt AM, editors. Osteoporosis: recent advances in pathogenesis and treatment. Baltimore: University Park Press, 1981:285–91.
Kanis JA, Pitt FA. Epidemiology of osteoporosis. Bone 1992;13(Suppl):S7–15.
Melton LJ, O'Fallon WM, Riggs BL. Secular trends in the incidence of hip fractures. Calcif Tissue Int 1987;41:57–64.
Riggs BL, Melton LJ. The prevention and treatment of osteoporosis. N Engl J Med 1992;327:620–7.
Browner WS, Seeley D, Vogt M, Cummings SR. Non-trauma mortality in elderly women with low bone mineral density. Lancet 1991,338:555–8.
Johansson C, Melstrom D, Milsom I. Reproductive factors as predictors of bone density and fractures in women at the age of 70. Maturitas 1993;17:39–50.
Mosekilde L, Mosekilde L. Sex differences in age-related changes in vertebral body size, density and biomechanical competence in normal individuals. Bone 1990;11:67–73.
Davies KM, Recker RR, Stegman MR, Heaney RP. Tallness versus shrinkage: do women shrink with age or grow taller with recent birth date? J Bone Miner Res 1991 ;6:1115–20.
DeBisschop E, Luypaert R, Louis O, Osteux M. Fat fraction of lumbar bone marrow using in vivo proton nuclear magnetic resonance spectroscopy. Bone 1993;14:133–6.
Parfitt AM. The physiological and clinical significance of bone histomorphometric data. In: Recker R, editor. Bone histomorphometry: techniques and interpretation. Boca Raton: CRC Press, 1993:1443–223.
Hansen M, Overgaard K, Riis B, Christiansen C. Role of peak bone mass and bone loss in postmenoapusal osteoporosis: 12 year study. BMJ 1991;303:961–4.
Stepan JJ, Pospichal J, Presl J, Pacovsky V. Bone loss and biochemical indices of bone remodeling in surgically induced postmenopausal women. Bone 1987;8:279–84.
Delmas PD, Gineyts E, Bertholin A, Garnero P, Marchand F. Immunoassay of pyridinoline crosslink excretion in normal adults and in Paget's disease. J Bone Miner Res 1993;8:643–7.
Uebelhart D, Schlemmer A, Johansen J, Gineyts E, Christiansen C, Delmas PD. Effect of menopause and hormone replacement therapy on the urinary excretion of pyridinium crosslinks. J Clin Endocrinol Metab 1991;72:367–73.
Kanis JA. Pathophysiology and treatment of Paget's disease of bone. London: Martin Dunitz, 1991.
Delmas PD, Stenner D, Wahner HW, Mann KG, Riggs BL. Increase in serum bone carboxyglutamic acid protein with aging in women. J Clin Invest 1983;71:1316–21.
Schiele F, Heaney J, Hitz J, Petitcleic C, Gueguen R, Siest G. Total bone and liver alkaline phosphate in plasma: biological variations and reference limits. Clin Chem 1983;29:634–41.
Eastell R, Delmas PD, Hodgson SF, Eriksen EF, Mann KG, Riggs BL. Bone formation rate in older normal women: concurrent assessment with bone histomorphometry, calcium kinetics and biochemical markers. J Clin Endocrinol Metab 1988;67:741–8.
Fogelman I, Bessent R. Age-related alterations in skeletal metabolism: 24-h whole body retention of diphosphonate in 250 normal subjects [concise communication]. J Nucl Med 1982;23:296.
Heaney RP, Recker RR, Saville PD. Menopausal changes in bone remodelling. J Lab Clin Med 1978;32:964–70.
Vedi S, Compston JE, Webb A, Tighe JR. Histomorphometric analysis of dynamic parameters of trabecular bone formation in the iliac crest of normal British subjects. Metab Bone Dis Rel Res 1983;5:69–74.
Lips P, Courpron P, Meunier PJ. Mean wall thickness of trabecular bone packets in the human iliac crest: changes with age. Calcif Tissue Res 1978;26:13–7.
Merz WA, Schenk RK. A quantitative histological study on bone formation in human cancellous bone. Acta Anal 1970;76:1–15.
Meunier PJ, Courpron P, Edouard C, Bernard J, Bringuier J, Vignon G. Physiological senile involution and pathological rarefaction of bone. Clin Endocrinol Metab 1973;2:239–56.
Frost HM. Human osteoid seams. J Clin Endocrinol Metab 1962;22:631–40.
Wu K, Joss S, Frost HM. Bone resorption rates in ribs in physiological, senile and postmenopausal osteoporosis. J Lab Clin Med 1967;69:810–8.
Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 1992;327:1637–42.
Orwoll ES, Oviatt SK, McClung MR, Deftos LJ, Sexton G. The rate of bone mineral loss in normal men and the effects of calcium and cholecalciferol supplementation. Ann Intern Med 1990;l 12:29–34.
Greenspan SL, Maitland LA, Krasnow MB, Kido TH. Femoral bone loss progresses with age in elderly women. J Bone Miner Res 1993;8 (Suppl 1):S153.
Davis JW,Ross PD, Wasnich RD, Maclean CJ, Vogel JM. Comparison of cross-sectional and longitudinal measurements of age-related changes in bone mineral content. J Bone Miner Res 1989;4:351–7.
Harris S, Dawson-Hughes B. Rates of change in bone mineral density of the spine, heel, femoral neck and radius in healthy postmenopausal women. Bone Miner 1992;17:87–95.
Law M, Wald N, Meade T. Strategies for the prevention of osteoporosis and hip fracture. BMJ 1991;303:453–9.
Freemantle N. Screening for osteoporosis to prevent fractures. Effective Health Care 1992 (no. 1). (Inquiries to Nick Freemantle, Effective Healthcare, School of Public Health, University of Leeds, 32 Hyde Terrace, Leeds LS2 9LN, UK.)
Kanis JA, Passmore R. Calcium supplementation of the diet. BMJ 1989;298:137–40, 205-8, 673-4.
Dawson-Hughes B, Dallas GE, Krall EA, Sadowski L, Sahyonn N, Tannenbaum SA. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 1990;323:878–83.
Luffkin EG. Treatment of osteoporosis with transdermal estrogen. Ann Intern Med 1992;117:1–9.
Watts NB, Harris ST, Genant HK, Wasnich RD, Miller PD, Jackson RD, et al. Intermittent cyclical etidronate treatment of postmenopausal osteoporosis. N Engl J Med 1990;323:73–9.
Storm T, Thamsborg G, Steiniche T, Genant HK, Sorenson OH. Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in postmenopausal osteoporosis. N Engl J Med 1990;322:1265–71.
Kanis JA, Johnell O, Gullberg B, Allander E, Dilsen G, Gennari C, et al. Evidence for the efficacy of drags affecting bone metabolism in the prevention of hip fracture. BMJ 1992;305:1124–8.
Kanis JA, Beneton MNC, Gennari C, Gullberg B, Johnell O, Mazzuoli GF, Passeri M. Effects of anabolic steroids on cortical bone and fractures. In: Christiansen C, Riis B, editors. Osteoporosis. Aalborg, Denmark: Handelstrykleriert Aalborg ApS, 1993:308–10.
Stevenson JC, Kanis JA, Christiansen C. Bone density measurement. Lancet 1992;339:370–1.
Nevitt MC, Johnell O, Black DM, Genant HK, Cummings SR for the Study of Osteoporotic Fractures Research group. Bone mineral density predicts fractures in very elderly women. J Bone Miner Res 1993;8 (Suppl 1):S133.
World Health Organization. Assessment of osteoporotic fracture risk and its role in screening for postmenopausal osteoporosis. Geneva: WHO, 1994 (in press).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kanis, J.A., Adami, S. Bone loss in the elderly. Osteoporosis Int 4 (Suppl 1), S59–S65 (1994). https://doi.org/10.1007/BF01623438
Issue Date:
DOI: https://doi.org/10.1007/BF01623438