The decrease in ovarian function culminating in the last menstrual period, the menopause, in women in their forties and fifties takes place over a period of 3 to 5 years. There are several immediate clinical consequences of the menopause that are easy to detect and treat, usually with hormone replacement. In contrast, the longer term consequences of the menopause, cardiovascular disease and osteoporosis, are usually clinically silent during these early postmenopausal years. As a result, it has proven difficult to get physicians and their patients to accept this cause-and-effect relationship between the menopause and the development of osteoporosis or heart disease a decade or more later. The details concerning the menopause and osteoporosis are by now so well established that this disease can serve as a model for studies linking the menopause to heart disease. This article, with its focus on osteoporosis, serves as an introduction to the later articles detailing the cardiovascular consequences of the menopause.

Bone Remodeling↗

PubMedDate not supplied

Biochemical studies in the evaluation and management of osteoporosis: current status and future prospects.

OBJECTIVE: To examine the current status of biochemical markers of bone remodeling and to offer a perspective on their future clinical applications. METHODS: We provide a comprehensive overview of the bone remodeling cycle, the hormonal control of bone remodeling, the specific biochemical markers of bone resorption and bone formation, and their current clinical applications. RESULTS: Bone remodeling occurs in discrete packets, known as bone modeling units, on the surfaces of the skeleton. Osteoclasts are responsible for bone resorption, and osteoblasts are responsible for bone formation. Bone resorption and formation are normally coupled, and an imbalance in these processes can lead to metabolic bone diseases such as osteoporosis. Investigators have attempted to measure various biochemical markers of bone resorption (such as urine calcium and hydroxyproline) and formation (such as bone-specific alkaline phosphatase and osteocalcin) as a reflection of response to therapy. Although several markers of bone resorption and formation can be assayed, an ideal marker has yet to be discovered or proved. CONCLUSION: Until a precise, inexpensive assay is developed, currently available biochemical markers, used in conjunction with measurements of bone density, are considered the most reasonable tools for classifying and directing the management of osteoporosis.

Journal Article↗