IntroductionAs a result of the aging process, the bone deteriorates in composition, structure and function, which predisposes to osteoporosis. Osteoporosis is defined as deterioration in bone mass and micro-architecture, with increasing risk to fragility fractures [Raisz and Rodan, 2003]. Owing to the close relationship between the aging process of bone and the pathogenesis of osteoporosis, research on the mechanisms of age-related bone loss has increased significantly in recent years involving a combination of basic, clinical, observational and translational studies.Bone is a dynamic organ that serves mechanical and homeostatic functions. It undergoes a continual self-regeneration process called remodeling. Remodeling removes old bone and replaces it with new bone. This regenerative process occurs in distinct areas of bone known as bone metabolic units (BMUs) [Riggs et al. 2002]. Within each BMU bone formation by osteoblasts and bone resorption by osteoclasts is coupled tightly in a delicate balance to maintain bone mass and strength to resist deformity. With aging this balance shifts in a negative direction, favoring greater bone resorption and less bone formation. This combination of bone mass deficiency and reduction in strength ultimately results in osteoporosis and fractures.Aging in combination with intrinsic and extrinsic factors accelerates the decline in bone mass that predisposes to fractures. Intrinsic factors include genetics, peak bone mass accrual in youth, alterations in cellular components, hormonal, biochemical and vasculature status. Extrinsic factors include nutrition, physical activity, comorbid medical conditions and drugs. In this article we review the mechanisms of age-related bone deterioration and their impact on the pathogenesis of osteoporosis. In addition, current and future therapeutic approaches focused on the correction of mechanisms associated with aging bone will also be outlined. Bone remodeling in aging boneRemodeling is continuous and coordinated cycle of removal of old bone by osteoclasts followed by the deposition of new bone by osteoblasts in response to micro damage and variable mechanical loadings. Bone remodeling is a continuous process throughout life. In the first three decades of life, bone turnover is coupled tightly to maintain a steady state between bone resorption and bone formation. Although there are variances in turnover rates, peak bone mass and size is achieved around the age of 15-20 years in women and later in men [Raisz and Seeman, 2001]. After this, long before sex steroids deficiency occurs, bone loss Aging and bone loss: new insights for the clinicianOddom Demontiero, Christopher Vidal and Gustavo Duque Abstract: It is well known that the underlying mechanisms of osteoporosis in older adults are different than those associated with estrogen deprivation. Age-related bone loss involves a gradual and progressive decline, which is also seen in men. Markedly increased bone resorption leads to the initial fall in bone mineral density. With increasing age, th...

Poor balance is considered a challenging risk factor for falls in older adults. Therefore, innovative interventions for balance improvement in this population are greatly needed. The aim of this study was to evaluate the effect of a new virtual-reality system (the Balance Rehabilitation Unit [BRU]) on balance, falls, and fear of falling in a population of community-dwelling older subjects with a known history of falls. In this study, 60 community-dwelling older subjects were recruited after being diagnosed with poor balance at the Falls and Fractures Clinic, Nepean Hospital (Penrith, NSW, Australia). Subjects were randomly assigned to either the BRU-training or control groups. Both groups received the usual falls prevention care. The BRU-training group attended balance training (two sessions/week for 6 weeks) using an established protocol. Change in balance parameters was assessed in the BRU-training group at the end of their 6-week training program. Both groups were assessed 9 months after their initial assessment (month 0). Adherence to the BRU-training program was 97%. Balance parameters were significantly improved in the BRU-training group (P < 0.01). This effect was also associated with a significant reduction in falls and lower levels of fear of falling (P < 0.01). Some components of balance that were improved by BRU training showed a decline after 9 months post-training. In conclusion, BRU training is an effective and well-accepted intervention to improve balance, increase confidence, and prevent falls in the elderly.

No abstract

No abstract