[Mechanisms of bone loss in osteoporosis]

Aging and menopause are the two main determinants of osteoporosis, a rarifying osteopathy due to bone loss. Type I osteoporosis observed in post-menopausal women is characterized mainly by trabecular bone loss results from an unbalanced coupling between resorption and formation inducing a thinning of trabeculae and from an increased osteoclast activation resulting in irreversible trabecular perforation. Anti-osteoclastic drugs prevent trabecular and cortical bone loss. Drugs that stimulate osteoblastic proliferation thicken trabecular plates but do not restore the normal trabecular microarchitecture after complete destruction of a large number of trabeculae. In type II osteoporosis, cortical bone loss is favoured by secondary hyperparathyroidism and is responsible for hip fracture. Calcium and vitamin D supplementations decrease the risk of hip fractures by reducing the secondary hyperparathyroidism.