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Osteoporosis and the mechanisms of disease

A metabolic bone disease that, on a cellular level, results from osteoclastic bone resorption not compensated by osteoblastic bone formation.1,2

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The mechanism of disease

Bones are living tissues that play a role in a range of activities, including support, protection, and the facilitation of movement. It has a structure that is optimized for strength.2

The interior of bone is composed of bone marrow, which is surrounded by 2 major types of bone tissue:

Bone remodeling is out of balance in postmenopausal women

Osteoporosis occurs when bone resorption exceeds bone formation. As a result, the bone structure or microarchitecture deteriorates, leading to bone fragility and an increased risk of fractures.2,4

After menopause, lower estrogen disrupts bone remodeling—resorption increases, formation decreases, and the risk of fracture rises2,4

Normal bone remodeling vs, osteoporosis & Bone formation equals bone resorption

In normal bone remodeling,
osteoblast and osteoclast numbers and activity are balanced

Normal bone remodeling vs, osteoporosis & Decreased bone formation does not equal increased bone resorption

In osteoporosis, the number and activity of osteoclasts is 
greater than that of osteoblasts

Images courtesy of David W. Dempster, PhD ©2023; reproduced with permission.

Take a visual journey through the interior of the bone with these tools to learn more

Introduction to Bone Biology video

Intro to Bone Biology

Take a visual journey through the interior of the bone to learn about bone anatomy and physiology.

Bone Modeling and Remodeling video

Bone Remodeling and Modeling

Learn about the dynamic process of bone remodeling and the factors that lead to changes in bone mass.

The Role of Sclerostin in the Regulation of Bone Mass and Strength

The Role of Sclerostin in the Regulation of Bone

See how sclerostin levels can increase with age and lead to a reduction in bone mass and strength.

Pathways in Osteoporosis

Pathways in Osteoporosis

Use this interactive tool to explore osteoporosis from the inside out and access in-depth information about the disease pathways.

References: 1. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359-2381. 2. U.S. Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. US Dept of Health and Human Services, Office of Surgeon General; 2004. 3. Weatherholt AM, Fuchs RK, Warden SJ. Specialized connective tissue: bone, the structural framework of the upper extremity. J Hand Ther. 2012;25(2):123-132. 4. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25:2359–2381.