Osteoporosis has recently received increased attention in both the medical and lay literature. It is estimated that there are more than one million osteoporosis-related fractures yearly in the United States, which are responsible for between three and four billion dollars in health care expenditures. A discussion of osteoporosis requires consideration of both the physiology and pathophysiology of bone tissue. In a structural sense, bone exists in two forms, the outer compact cortex accounting for 80 percent of total bone volume, and the more porous inner trabecular bone. Bone-forming osteoblasts and bone-resorbing osteoclasts are responsible for the ongoing, life-long process of formation and resorption of bone. Sex hormone deficiency, as well as chronic illness, malnutrition, and childhood immobilization, has deleterious effects on growth and modeling, ultimately reducing peak bone mass and setting the stage for osteoporosis in later life. Estrogen is known to have a protective effect on the female skeleton. The mechanisms of this effect are unknown, although estrogen may protect against parathyroid hormone-mediated bone loss. There may be a particular subset of postmenopausal women who are particularly susceptible to estrogen deficiency. Calcitonin levels, which decrease postmenopausally, return to normal with estrogen; other hormones may also play important roles. Osteoporosis is not the result of a single hormonal deficiency or excess; it must be considered in relation to other pathogenetic and risk factors.