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Although E is required for the attainment of maximal peak bone mass in both sexes, the additional action of T on stimulating periosteal apposition accounts for the larger size and thicker cortices of the adult male skeleton. Aging women undergo two phases of bone loss, whereas aging men undergo only one. In women, the menopause initiates an accelerated phase of predominantly cancellous bone loss that declines rapidly over 4\u20138 yr to become asymptotic with a subsequent slow phase that continues indefinitely. The accelerated phase results from the loss of the direct restraining effects of E on bone turnover, an action mediated by E receptors in both osteoblasts and osteoclasts. In the ensuing slow phase, the rate of cancellous bone loss is reduced, but the rate of cortical bone loss is unchanged or increased. This phase is mediated largely by secondary hyperparathyroidism that results from the loss of E actions on extraskeletal calcium metabolism. The resultant external calcium losses increase the level of dietary calcium intake that is required to maintain bone balance. Impaired osteoblast function due to E deficiency, aging, or both also contributes to the slow phase of bone loss. Although both serum bioavailable (Bio) E and Bio T decline in aging men, Bio E is the major predictor of their bone loss. Thus, both sex steroids are important for developing peak bone mass, but E deficiency is the major determinant of age-related bone loss in both sexes.<\/jats:p>","DOI":"10.1210\/edrv.23.3.0465","type":"journal-article","created":{"date-parts":[[2014,1,8]],"date-time":"2014-01-08T13:25:50Z","timestamp":1389187550000},"page":"279-302","source":"Crossref","is-referenced-by-count":1727,"title":["Sex Steroids and the Construction and Conservation of the Adult Skeleton"],"prefix":"10.1210","volume":"23","author":[{"given":"B. Lawrence","family":"Riggs","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Metabolism (B.L.R., S.K., L.J.M.), Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sundeep","family":"Khosla","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Metabolism (B.L.R., S.K., L.J.M.), Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"L. Joseph","family":"Melton","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Metabolism (B.L.R., S.K., L.J.M.), Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905"},{"name":"Department of Internal Medicine, and Section of Clinical Epidemiology (L.J.M.), Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2016,11,7]]},"reference":[{"key":"2020071612523294500_R1","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1002\/jbmr.5650070902","article-title":"Perspective. 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