The continuous process where old bone is broken down by osteoclasts and replaced with new bone by osteoblasts—the balance between these determines bone strength.Bone remodeling is the coupled process of osteoclastic bone resorption followed by osteoblastic bone formation, occurring continuously in basic multicellular units (BMUs). Normal remodeling maintains skeletal integrity; imbalance causes disease. In osteoporosis, resorption exceeds formation. Antiresorptive agents (calcitonin, bisphosphonates) reduce resorption; anabolic agents (teriparatide, abaloparatide) stimulate formation. The anabolic window—the period where formation exceeds resorption—is time-limited with PTH analogs, explaining the 24-month treatment duration limits.C↑ Top