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Bone remodeling is a continuous and balanced process of bone resorption by osteoclasts and bone formation by osteoblasts. In adults, it helps maintain bone mass and calcium homeostasis. While mechanical stress can stimulate turnover as part of the normal maintenance and reparative process, several hormones also regulate bone remodeling.
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Osteoclasts are cells responsible for bone resorption and remodeling. They originate from hematopoietic progenitor cells present in the bone marrow. Numerous progenitor cells fuse to form multinucleated cells, each with 10-20 nuclei. A single osteoclast has a diameter of 150 to 200 µM. These cells have ruffled borders that break down the underlying bone tissue and release minerals such as calcium into the blood in bone resorption. Osteoclasts cling to bones with their ruffled edges during...
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Aging and its effect on bone remodeling is the most common cause of bone disorders. In young and healthy people, bone deposition and resorption happen at an equal rate to maintain optimal bone health.
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Related Experiment Video

Updated: Jun 5, 2025

Quantitative [18F]-Naf-PET-MRI Analysis for the Evaluation of Dynamic Bone Turnover in a Patient with Facetogenic Low Back Pain
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Estimating Net Bone Formation Relative to Resorption Using Reference Bone Turnover Markers.

Albert Shieh1, Arun S Karlamangla1, Fatma Gossiel2

  • 1Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, USA.

The Journal of Clinical Endocrinology and Metabolism
|December 10, 2024
PubMed
Summary
This summary is machine-generated.

A new bone balance index (BBI), combining resorption (CTX) and formation (PINP) markers, predicts bone mineral density (BMD) loss. A less favorable BBI indicates faster BMD decline, crucial for understanding menopausal bone health.

Keywords:
bone turnoverbone turnover markerscohortepidemiologylongitudinalmenopause

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Area of Science:

  • Bone biology and metabolism
  • Endocrinology and metabolic disorders
  • Gerontology and geriatric medicine

Background:

  • Bone remodeling involves resorption and formation, but individual markers do not fully represent bone balance.
  • Assessing bone health requires integrated markers to understand net bone changes.

Purpose of the Study:

  • To develop a bone balance index (BBI) by combining collagen type I C-telopeptide (CTX) and procollagen type I propeptide (PINP) markers.
  • To investigate the association between the BBI, CTX, PINP, and changes in bone mineral density (BMD).

Main Methods:

  • Utilized a community-based cohort (Study of Women's Health Across the Nation) of 535 women transitioning through menopause.
  • Employed mixed-effects linear regression to analyze the relationship between BBI, CTX, PINP, and annualized percent change in lumbar spine (LS) and femoral neck (FN) BMD.
  • Adjusted for covariates including age, body mass index, race/ethnicity, and menopause transition stage.

Main Results:

  • A more negative BBI was significantly associated with greater annual BMD loss at both the LS and FN.
  • Each standard deviation decrease in BBI correlated with a 0.26% greater decline in LS BMD and a 0.42% greater decline in FN BMD.
  • Elevated levels of CTX or PINP individually also predicted increased bone loss, with CTX showing a stronger association with LS BMD decline.

Conclusions:

  • The BBI effectively estimates bone balance, with a less favorable BBI predicting accelerated BMD loss.
  • Individual markers CTX and PINP reflect overall bone turnover, and higher levels are linked to greater bone loss.
  • These findings highlight the utility of a combined BBI for assessing bone health and predicting BMD changes, particularly in menopausal women.