It is important to understand that the bone-remodeling process and its two agents, bone-destroying osteoclasts and bone-forming osteoblasts, are the answers to your patients' bone health. For different age, gender, and hormonal status, the activities of osteoclasts and osteoblasts are different. Thus, your patients need different bone care as they differ in age, gender, and hormonal status.

("Graphical data of BMD according to age, gender, and hormaonal status")

Individuals are different

Each patient has unique bone remodeling process depending on patient's age, gender, and hormonal status. Here are comprehensive lists of bone remodeling process for each age, gender, and hormonal status group.

Childhood

Both genders need to focus on enhancing the activity of osteoblasts at early age. The osteoblasts should be more active than the osteoclasts. Thus, stimulating bone formation is the priority concern throughout this stage.

Women Before Menopause

Pre-menopausal women need to focus on both stimulating the osteoblasts and inhibiting the osteoclasts throughout the stage. At this stage, bones have become fully-grown and have reached peak bone mass. Maximizing and maintaining the peak bone mass are the most important concerns for women before menopause.

Women After Menopause

Post-menopausal women need to focus on inhibiting the activity of osteoclasts. After menopause, women generally lose as much as 25 to 30 percent of their bone mass during the first five to seven years following menopause. At the onset of menopause, bone destruction is more active than bone formation due to the dramatic fall of estrogen level, which inhibits osteoclast cells. Thus, minimizing rapid bone loss is the main concern during this stage.

Men

Men lose bone mineral density gradually after reaching the peak bone mass. Although men do not experience rapid bone loss as women do, it is crucial to reach the peak bone mass during the early age and maintain the balance between osteoblasts and osteoclasts. The study shows that up to 30 percent of hip fractures occur in men. Notably, men have higher mortality rate from fractures than women because of the misconception and the late diagnosis. (Eastell, R. and others. "Management of Male Osteoporosis: Report of the UK Consensus Group." QJM 91, no. 2 (February 1998): 71-92)

(AGE and BMD)