Abstract

Skeletal development in average healthy individuals is maximal at age 25 in women and at age 30 to 35 in men. However, there are significant racial differences, skeletal mass being greater in black than in white individuals. This difference appears best accounted for by increased muscle mass in blacks. Bed rest, immobilization, weightlessness (as in space flights), and aging induce a decrease in skeletal mass. The degree of osteopenia in the elderly depends partly on skeletal development during formative years and can be prevented from becoming severe by maintaining good nutritional status (calcium, vitamin D, protein) and physical activity. Maintenance or actual increase in muscle mass is a desired effect of appropriate physical activity, but excessive physical exercise may induce estrogen deficiency and menstrual irregularities in premenopausal women. In addition to diet and exercise, pharmacologic therapy (estrogens, androgens, diphosphonates, or calcitonin) is indicated in patients with significant osteoporosis.