This increase
in bone formation at the periosteal surface is thought to
partially compensate for losses occurring on the endocortical
surface, to reduce cortical thinning and thereby
improve or maintain bone strength and fracture resistance
[33]. In terms of trabecular bone, the absolute
amount of bone loss from young adulthood to old age is
similar in men and women [34], but there are gender differences
in the pattern of microarchitectural trabecular
bone loss. In men, the loss in trabecular bone appears to
be mainly through trabecular thinning, whereas women
predominantly experience a loss of trabecular connectivity
[34]. These finding are important because a loss of
trabecular elements has a two- to five-fold greater impact
on bone strength compared to trabecular thinning.