骨はカルシウムの塩などの骨塩(英語版)(bone mineral content)とコラーゲンを主成分とした骨基質(英語版)が、整然と配置される事によって強度を保っている。しかし、だからと言って重量が嵩んでも困るので、それぞれの骨に普段から力がかかる方向に強いように、骨基質が配置されている。さらに、骨芽細胞による骨形成と、破骨細胞による骨吸収によって、常に古い骨基質を、新しく作り直すという、いわゆる骨の更新作業(turn-over)によっても、その強度を保っている。長い期間身体の構造を支えていると微小な骨基質に微小な傷が生ずるし、糖化産物などが溜まってくる事で劣化してくるので、この更新作業が行われる。
エストロゲンは直接破骨細胞による骨吸収を抑制し、NF-κB活性化受容体リガンド(receptor activator of NF-κB ligand、RANML)の発現を抑制し、破骨細胞の分化も抑制する。閉経後の女性の骨粗鬆症ではエストロゲンの分泌低下によって前述の抑制がなくなることや加齢によって骨吸収の増加が起こることで骨量が減少する。しかし、ステロイド骨粗鬆症では骨細胞と骨芽細胞のアポトーシスが主な病態である。骨細胞と骨芽細胞のアポトーシスにより骨形成が抑制され骨量に加え骨質も低下する。ステロイド骨粗鬆症では始めに骨の内部の海綿骨の骨量・骨質が低下し、椎体圧迫骨折を起こす。後に外側の皮質骨にも影響が出て大腿骨頸部骨折や転子部骨折を起こす。
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