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The Evidence that Supplementation with Vitamin D and Calcium

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Starting from infancy and right through adolescence, there is a predominant bone formation activity that goes along with the growth and development of the human body. It is during the adolescent stages that bone development peaks, which is demonstrated through the almost doubling of skeletal mass at the end of adolescence. According to Rauch 2007, the increase in bone mass that occurs by the growing bones comes from changes in the outer dimensions of the bones and from the net addition of tissue that takes place in the inner bone surfaces.

Hence any consideration of an increase in bone mass has to take into account the bone accrual that occurs at the trabecular or inner bone surfaces and the periosteal or inner bone surfaces. Bones get bigger through the addition on the outside surfaces and get denser through additions in the inner surfaces. Two different processes are involved in the growth of bone, one which increases length and the other which increases width. Bones just do not increase in length alone, but in width too. An increase in length occurs through the growth plate, while the periosteum is responsible for the increase in width.

The process of increase in length and the increase in width is a well-coordinated process, for if the bone were to merely increase in length, it would become unstable and prone to breaking. The processes involved in this coordination are still not clear, but an essential factor to the functions of the bone to take up mechanical loads (Rauch, 2007). During the developmental stages, the trabecular bone becomes thicker as a result of bone remodeling with a positive balance.

In the process of remodeling, osteoclasts remove worn-out bone cells, while osteoblasts deposit new bone cells, which is closely linked over time and space. The balance is positive when more new bone is deposited in relation to the removal of old bone. Bone accrual on periosteal surfaces that is responsible for bone size is a critical element in the determination of bone strength during the entire period of life. In what is termed as bone modeling periosteal osteoblasts continue to deposit new bone over an extended period of life, without having to contend with the removal of bone old bone by the osteoclasts.

Subsequent to the growth period of an individual there are limited and slow changes to the size of the bone. It is this factor that makes the bone growth in size during the developmental period and important factor in the determination of bone strength throughout the life of an individual (Rauch, 2007).

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