EVOLUTION OF THE PATHOGENESIS OF POSTMENOPAUSAL BONE LOSS

At a time when the investigation of bone diseases appears to be on the threshold of a new era, it is appropriate to pause and contemplate pa st and present thinking on the etiology of postmenopausal osteoporosis . This brief review traces the evolution of ideas on the nature of the pathogenesis of this disease from Albright's hypoosteoblastic hypothe sis through other hypotheses that include disturbance in osteoclasia, negative calcium balance, disturbance of calcium homeostatic control m echanisms, increased skeletal sensitivity to parathyroid hormone, defi ciency of calcitriol and calcitonin, altered activities of growth fact ors and cytokines, alterations in the local regulation of osteoclastog enesis, and changes in mechanical usage set points.