• Overall decrease in skeletal mass, generally diffuse
  • Skeletal fragility and increased risk of fracture
  • Trabecular bone (especially vertebrae and femur) affected more commonly and earlier
  • Disease begins in adolescence, but fractures do not usually manifest until age ≥50
  • Females affected much more commonly than males, especially after menopause; thought related to estrogen deficiency or age


  • Overall increase in resorption over formation of new bone
  • Advanced age is the most important risk factor
  • Inadequate dietary calcium an important factor, especially early in life
  • Sedentary lifestyle is a risk factor (weight bearing on bone favors new bone formation)
  • Decrease in estrogen with menopause key factor in women
  • Other risk factors include long-term steroid use, alcoholism, methotrexate, tobacco use, low body weight
  • Familial or hereditary factor may coexist

Pediatric Considerations
Although disease appears to start in adolescence, pediatric patients are asymptomatic

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