Which type of bone is most rapidly lost in response to hypogonadism and glucocorticoid therapy?

• A. Trabecular bone
• B. Cortical bone
• C. Compact bone
• D. Woven bone

Answer: (A)

Trabecular (spongy) bone is lost most rapidly because it has a high surface area and undergoes remodeling more quickly than cortical bone. Its lattice of thin plates provides many sites for osteoclast and osteoblast activity, so hormonal and drug-induced changes translate into rapid architectural deterioration there. Hypogonadism lowers estrogen, which normally suppresses osteoclasts, increasing resorption. Glucocorticoids reduce osteoblast formation and promote osteoblast/osteocyte death while increasing RANKL signaling, further tipping the balance toward resorption. This makes trabecular bone—found in vertebral bodies and the ends of long bones—especially vulnerable, while cortical (compact) bone turns over more slowly. Woven bone is immature and not the typical pattern of adult bone loss.