Aging involves change and adaptation to change. The normal or usual changes of aging often have significantly greater impact on an individual whose disability has limited his or her physical or socioeconomic reserves. The aging process itself may be accelerated by overuse and compensatory mechanisms. The changes of aging have unique features in damaged body systems that exhibit physiologic adaptations. The changes of aging therefore often result in secondary impairments, leading to secondary disability. New adaptations or repeated rehabilitation are needed to regain the equilibrium among biologic, psychosocial, and environmental influences. Disabled women do not seem to have a significantly different experience of menopause from other women, but postmenopausal changes-accelerated bone loss and increased risk of heart disease-do appear to carry greater risk in those with mobility impairment. Hormone replacement therapy has both greater potential benefit and greater potential risks. Review of these issues makes evident the great need for research in the area of aging with disability, improvement in physician and consumer education, and future health care planning.