How does estrogen deficiency contribute to osteoporosis?

• A. Accelerates bone resorption after menopause
• B. Increases bone formation
• C. Has no effect
• D. Only affects calcium absorption

Answer: (A)

Estrogen’s job in bone is to keep the remodeling process balanced by limiting osteoclast activity that resorbs bone. After menopause, estrogen drops, removing this restraint. The result is more osteoclast formation and activity, driven in part by increased RANKL signaling and lower osteoprotegerin, along with a rise in inflammatory cytokines like IL-1, IL-6, and TNF. This shifts remodeling toward resorption, so bone is broken down faster than it’s formed, leading to a net loss of bone mass and a higher risk of osteoporosis. It’s not that bone formation ramps up or that calcium absorption is the primary issue here—resorption outpaces formation after estrogen deficiency.