Peak Bone Mass and its Relationship with Osteoporosis
DNB Orthopaedics • June 2014 • Paper I • 10 Marks
Introduction
Bone mass changes continuously throughout life. Bone mineral is accumulated rapidly during childhood and adolescence, reaches a maximum in early adult life, remains relatively stable for a period, and subsequently declines with advancing age.
The amount of bone accumulated before age-related bone loss begins is an important determinant of skeletal strength and of the individual's future risk of developing osteoporosis and fragility fractures.
Core concept
Osteoporosis in later life depends not only on how rapidly bone is lost, but also on how much bone was accumulated during growth.
Definition of Peak Bone Mass
Peak bone mass (PBM) is the maximum amount of bone tissue or bone mineral accumulated by an individual at skeletal maturity, before age-related bone loss begins.
It represents the culmination of skeletal growth and mineralisation and reflects both:
- Bone size and geometry, and
- Bone mineral density and microarchitecture.
Most skeletal mineral acquisition occurs during childhood and adolescence, particularly around the pubertal growth spurt. Peak bone mass is generally achieved by the late second to third decade of life, although the exact age varies…