On new opportunities for absorptiometry

Mechanical loads cause bone strains; and muscle forces, not body weight, cause the largest strains. The strains help to control the effects of bone modeling and remodeling on bone strength and "mass." When strains exceed a threshold range, modeling increases bone strength and "mass." When strains stay below a smaller threshold range, remodeling begins removing bone next to marrow. As a result, increasing muscle strength increases bone strength and "mass," and decreasing muscle strength decreases bone strength and "mass." Estrogen apparently lowers the remodeling threshold, which reduces bone losses. Loss of estrogen raises that threshold to cause losses of bone next to marrow. Such facts help to explain: 1. Bone loss in aging adults. 2. An increase in bone "mass" in girls at menarche. 3. The loss of bone during menopause. 4. The greater bone "mass" in obese than in slender subjects, and in weightlifters than in marathon runners. 5. And the pathogenesis of physiologic osteopenias and true osteoporoses. Thus new standards are needed for the relationships between bone and muscle strengths, and as functions of sex, age, race, disease, endocrine status, nutrition, vitamin and mineral intakes, medications, puberty, and menopause. Obtaining those standards and studying such relationships provide many new opportunities for studies that involve dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) and, perhaps some day, ultrasound and magnetic resonance imaging (MRI) techniques.