Skeletal remodelling is a continuous process during life and is still active also in extreme senescence. In the elderly,
bone resorption often prevails over bone formation, causing bone loss and fragility. Elderly subjects are exposed to the risk of fractures, and loss of self-sufficiency, if considering that the proximal femur is the most frequently involved site. Bone remodelling can maintain circulating
calcium within physiological ranges, at the expense of a substantial loss of this ion from the skeleton, particularly during senescence.
Calcium metabolism is regulated at cellular/molecular level by a network of
cytokines,
growth factors, systemic
hormones that act on bone in paracrine/autocrine/systemic fashion. Among the molecules involved in bone metabolism,
parathyroid hormone (PTH) and
vitamin D present some peculiar aspects during senescence. The osteometabolic features in a consistent group of centenarians have been evaluated. It results that a severe hypovitaminosis D was present in 99 out of 104 centenarians (25-
OH vitamin D below 5 nmol/L), and that it plays an important role as
a factor inducing a vicious circle involving
hypocalcemia,
secondary hyperparathyroidism, together with biochemical features indicating a consistent bone loss. Serum C-terminal cross-linking telopeptide, a specific marker of
bone resorption was elevated in 92% of these subjects. Moreover, it has been found that several
femoral fractures had occurred after 90 years of age. These data offer a rational for the possible prevention of elevated bone turnover, bone loss and consequently the reduction of
osteoporotic fractures and fractures-induced disability, in the oldest olds, through the simple supplementation with
calcium and
vitamin D.