Osteoporosis is a major public health threat. An estimated 61 million Indians suffer from this problem. According to National Osteoporosis Foundation, USA 2 out of every 3 women and 1 out of every 8 men beyond 50 years of age run a risk of osteoporosis. While osteoporosis is often thought of as an older person's disease, it can strike at any age.  

FEATURES

A Life-Altering Consequence of Osteoporosis
All bones suffer from this disease. But the majority of fractures occur in the vertebrae (spine), hip, and wrist.

It has been labeled a "silent disease" because it typically progresses without symptoms until fractures occur. Bone loss is progressive, and by the time fractures occur the disease is advanced and the likelihood of further hip, spine or other fractures is great. Vertebral fractures may lead to stooped posture, loss of height, chronic pain and disability, and may cause compression of the lungs and stomach. Hip fractures are not only disabling, but can be life-threatening.  A woman's risk of having a hip fracture is equal to the risk of breast, uterine, and ovarian cancer combined. Approximately 30% of woman having a hip fracture die within six months.  

Misperceptions About Osteoporosis
Many believe that osteoporosis is an unavoidable part of aging for women. Contrary to what many people think, osteoporosis is not an inevitable part of aging, but is preventable for most people, if they take steps throughout their lives. To prevent osteoporosis all of us need a diet rich in calcium and vitamin D, weight-bearing exercise, a healthy lifestyle with no smoking or excessive alcohol intake, and, for those at high risk, bone density testing and preventive medication if necessary.

Bone development and loss
Bone mass increases during childhood and adolescence and peaks between the ages of 20 and 30 years. Peak bone mass is influenced by age, sex, genetic factors, hormonal status, exercise, and calcium intake. Adolescents with average nutritional calcium intake below 1,000 mg/day for boys and 850 mg/day for girls will probably not reach optimal bone mass. The National Osteoporosis Foundation describes bone mass as analogous to bank account into which, during a person’s childhood, adolescence, and early adulthood, new bone "deposits" are made to the skeleton faster than old bone is "withdrawn". After age 30, the rate of withdrawal exceeds the rate of deposit; therefore, establishing healthy bone mass in childhood and early adulthood is crucial.

Even when optimum peak bone mass has been attained, the rate of loss later in life strongly affects fracture risk. In the first 5 years after menopause, women lose bone mass at an annual rate of 1% to 5%. Typically, men lose mass at a rate of about 0.2% to 0.5% per year.

Risk Factors
Certain people are more likely to develop osteoporosis than others. Factors that increase the likelihood of developing osteoporosis are called "risk factors." The following risk factors have been identified:

	Age; most factures occur after age 75.
	Gender; women are at greater risk than men.
	Race; white and Asian women are at special risk.
	A family history of osteoporosis
	Postmenopause, including early or surgically induced menopause
	Abnormal absence of menstrual periods (amenorrhea)
	Anorexia nervosa or bulimia
	A diet low in calcium
	Low testosterone levels in men
	An inactive lifestyle
	Cigarette smoking
	Excessive use of alcohol
	Physical inactivity.
	Use of certain bone-robbing medications (such as steroids and anti-seizure drugs).
	Prolonged immobilization.

80% of those affected by osteoporosis are women. Women can lose up to 20% of their bone mass in the 5-7 years following menopause, making them more susceptible to osteoporosis.  

Symptoms
Osteoporosis is often called the "silent disease" because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a fracture or a vertebra to collapse. One clue is prolonged and severe pain in the middlepart of the back or height loss. Other clues involve change in shape of the spine. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities kyphosis or stooped posture.  

Detection
Specialized tests called bone density tests can measure bone density in various sites of the body. A bone density test can:

• Detect osteoporosis before a fracture occurs

• Predict your chances of fracturing in the future

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

There are several ways to measure bone mineral density; all are painless, noninvasive and safe and are becoming more readily available. In many testing centers you don't even have to change into an examination robe.

The tests measure bone density in your spine, hip and/or wrist, the most common sites of fractures due to osteoporosis. Recently, bone density tests have been approved by the FDA that measure bone density in the middle finger and the heel or shinbone. Your bone density is compared to two standards, or norms, known as "age matched" and "young normal." The age-matched reading compares your bone density to what is expected in someone of your age, sex and size. The young normal reading compares your density to the optimal peak bone density of a healthy young adult of the same sex.

The information from a bone density test enables your doctor to identify where you stand within ranges of normal and to determine whether you are at risk for fracture. In general, the lower your bone density, the higher your risk for fracture. Test results will help you and your doctor decide the best course of action for your bone health.  

The most practical, cost-effective and beneficial method of detecting osteoporosis at the present time appears to be by population screening using peripheral BMD measurement together with risk assessment.  

Types of BMD Tests
There are several different machines (Dual Energy X-ray Absorptiometry, single Energy X-ray Absorptiometry, Peripheral Dual Energy X-ray Absorptiometry, Computed Tomography, ultrasound etc) that measure bone density. Central machines measure density in the hip, spine and total body. Peripheral machines measure density in the finger, wrist, kneecap, shin bone and heel.

Medications
Hormone replacement therapy (HRT) has been proven effective in treating the disease in women. The bisphosphonate family of drugs is another approach. Within this family, alendronate is known to inhibit bone breakdown, increase spine and hip bone mass, and decrease spinal and hip fractures. Alendronate is best reserved for treatment when estrogen is not appropriate and in men with osteoporosis it can also cause irritation of the stomach and esophagus. Other options for osteoporosis treatment include calcitonin - available as injections - and nasal spray. All drugs effective in treating osteoporosis need adequate calcium to work effectively. Not every drug is right for every women. Each women's decision to begin treatment must be made after a complete discussion with her health care provider of each drugs benefits and risk as well as her own circumstances.

PREVENTION
By about age 20, the average woman has acquired 98% of her skeletal mass. Building strong bones during childhood and adolescence can be the best defence against developing osteoporosis later. A comprehensive program that can help prevent osteoporosis includes:

	A balanced diet rich in calcium and vitamin D
	Weight-bearing exercises
	A healthy lifestyle with no smoking or excessive alcohol use
	Bone density testing and medication when appropriate