Throughout one’s lifetime, old bone is removed (resorption) and new bone is added to the skeleton (formation). During childhood and teenage years, new bone is added faster than old bone is removed. As a result, bones become larger, heavier, and denser. Bone formation outpaces resorption until peak bone mass (maximum bone density and strength) is reached around age 30. After that time, bone resorption slowly begins to exceed bone formation.

For women, bone loss is fastest in the first few years after menopause, and it continues into the postmenopausal years.

Risk factors:

Certain factors make a particular person prone to  osteoporosis . We can divide them into non modifiable and modifiable risk factors.

Non modifiable risk factors:

• Age:          Old age is the major risk factor for osteoporosis. The older you are the greater the risk for osteoporosis.
• Sex:            Females are at more risk for osteoporosis . The thin bone structure and wearing off of safe hormone estrogen effect in post menopausal women makes them more prone to osteoporosis induced fractures.
• Ethnicity :      Caucasian and Asian female are at more risk , that too who have family history of osteoporosis.

• Body frame:   Small , thin boned women are at greater risk .

• Family history:   People with familial history of fractures also prone to have reduced bone mass and may be at risk for fractures.

Modifiable risk factors:

• Hormonal status: Post menopausal women are at particular  risk ( Lack of estrogen safe effect on bone), abnormal absence of menstrual cycles(Amenorrhea) and Low testosterone levels in males put them more prone to osteoporotic fracture.
• Smoking : There is a direct relation between smoking and decrease bone density
• Medication: Long term usage of steroid medication for chronic inflammatory conditions leads to osteoporosis.
• Alcohol: Excessive alcohol consumption contributes to osteoporosis.

• Life style : Sedentary life style and lack of weight bearing exercises put a particular person at more risk for osteoporosis.

• Diet :  Diet which is low in calcium and Vitamin D  can put you ahead for osteoporosis. 

How to prevent:

• Calcium supplementation: Body calcium demand will be high in growth periods like adolescence and pregnancy . Even in old age we have to increase calcium supplementation because of decrease absorption through gut.
• Calcium rich foods:  Buffalo milk, plain low fat yogurt, almonds, cabbage and soya bean and  foods fortified with calcium like orange juice , breads.
• Vitamin D supplementation
• Weight bearing exercises: Like walking, hiking, jogging, climbing stairs, weight training, tennis, and dancing.

• Quit smoking

• Usage of preventive medication.

Symptoms:

• Osteoporosis is often called a silent disease because bone loss occurs without symptoms.
• Back pain

• sudden strain, bump, or fall causes a hip or wrist  to fracture or a vertebra to collapse. (Hip fracture , Wrist fracture and Vertebral fracture)

• Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis (severely stooped posture).

Diagnostic tests:

Bone mineral density test:

Dual-energy x-ray absorptiometry, or DEXA test:

BMD tests can:

• Detect low bone density before a fracture occurs.
• Confirm a diagnosis of osteoporosis if you already have one or more fractures.

• Predict your chances of fracturing in the future.

• Determine your rate of bone loss, and monitor the effects of treatment if the test is conducted at intervals of a year or more.

Treatment:

Nutrition: Calcium rich food products, calcium supplementation and vitamin D intake.

Exercises: Weight bearing exercises like walking , jogging, climbing stairs and dancing.

Therapeutic Medications:

Bisphosphonates:

• Alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva) .
• These bisphosphonates are approved for both prevention and treatment of postmenopausal osteoporosis.
• Alendronate and Risedronate are also approved to treat bone loss that results from glucocorticoid medications such as prednisone or cortisone and is approved for treating osteoporosis in men.
• zoledronic acid (Reclast), is approved for the treatment of postmenopausal osteoporosis, to increase bone mass in men with osteoporosis, for the prevention of fractures in patients who have recently had a low-trauma hip fracture, and for the prevention and treatment of glucocorticoid-osteoporosis in men and women.

• Side effects of oral bisphosphonates include gastrointestinal problems such as difficulty swallowing, inflammation of the esophagus, and gastric ulcer.

• Some bisphosphonates are marketed with calcium and vitamin D supplements. These nutrients are important for everyone, and people should include adequate amounts of them in their diets.

Raloxifene:

• Raloxifene (Evista) is approved for the prevention and treatment of postmenopausal osteoporosis. It is from a class of drugs called selective estrogen receptor modulators (SERMs).

• Side effects are not common with raloxifene, those reported include hot flashes and blood clots in the veins.

Calcitonin:

• Calcitonin (Miacalcin, Fortical) is a naturally occurring hormone involved in calcium regulation and bone metabolism.
• It is approved for the treatment of osteoporosis in women who are at least 5 years past menopause.
• Although it does not affect other organs or systems in the body, injectable calcitonin may cause an allergic reaction.
• The only side effect reported with nasal calcitonin is nasal irritation.

 Teriparatide:

• This is an injectable form of human parathyroid hormone.
• It is approved for postmenopausal women and men with osteoporosis who are at high risk for having a fracture.

• Unlike the other drugs used in osteoporosis, it acts by stimulating new bone formation.

• Side effects include nausea, dizziness, and leg cramps.

Estrogen/hormone therapy:

• Estrogen/hormone therapy (ET/HT) is approved for preventing postmenopausal osteoporosis .
• Most commonly administered in the form of a pill or skin patch.
• When estrogen therapy or ET—is taken alone, it can increase a woman’s risk of developing cancer of the uterine lining (endometrial cancer).
• To eliminate this risk, doctors prescribe the hormone progestin—also known as hormone therapy or HT—in combination with estrogen for those women who have not had a hysterectomy.
• Side effects of ET/HT include vaginal bleeding, breast tenderness, mood disturbances, blood clots in the veins, and gallbladder disease.