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©2013 UpToDate ® Print Email BMD and fracture risk by age (A) Bone loss begins in the third decade of life in both sexes. The data are from the Epidemiological Follow-up Study cohort of the First National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of noninstitutionalized civilians who were followed for a maximum of 22 years. A cohort of 2879 Caucasian men (1437 in the bone density subsample) aged 45 to 74 years at baseline (1971-1975) were observed through 1992 [From: Looker AC, et al. Osteoporosis Int 1998; 8:468]. (B) Age is a more critical determinant of fracture risk than bone mass in humans. Data are from a follow-up of 521 Caucasian women over an average of 6.5 yr with repeated bone mass measurements at the radius. A total of 138 nonspinal fractures in 3388 person-years were detected, and the incident fractures were cross-classified by age and bone mass. The incidence of fracture was then fitted to a log-linear model in age and bone mass [From: Hui SL, et al. J Clin Invest 1988; 81:1804]. Reproduced with permission from: Manolagas SC. From estrogen-centric to aging and oxidative stress: A revised perspective of the pathogenesis of osteoporosis. Endocr Rev 2010; 31:266. Copyright © 2010 The Endocrine Society.