Throughout life, bone mass changes, with a maximum (peak bone mass) achieved by age 25-30 years and bone loss occurring after the fourth decade. Higher calcium intakes in childhood and early adulthood result in a 3-8% greater bone mass later in life, thereby improving the key factor in the osteoporotic process and the age-associated risk of fractures. In women, there is a perimenopausal increase in the rate of bone loss that persists after menopause following a decline in oestrogen production (Figure 3).
Factors other than age and sex that are associated with low bone mass include low body weight, smoking, alcohol consumption, reduced physical activity, low calcium absorption, and secondary risk factors such as the use of steroids. Although there is still uncertainty about the quantitative role of nutritional factors in the pathogenesis of osteoporosis, preventive measures include adequate calcium intakes (probably even in old age) and exposure to sunlight to ensure vitamin D adequacy and/or dietary supplementation with vitamin D. Restricted sunlight exposure, reduced capacity of the skin to produce vitamin D, and low vitamin D intake make elderly people prone to vitamin D deficiency.
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