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Osteoporosis makes your bones weak and more likely to break. Anyone can develop osteoporosis, but it is common in older women. As many as half of all women and a quarter of men older than 50 will break a bone due to osteoporosis.

Risk factors include

• Getting older
• Being small and thin
• Having a family history of osteoporosis
• Taking certain medicines
• Being a white or Asian woman
• Having osteopenia, which is low bone mass

Osteoporosis is a silent disease. You might not know you have it until you break a bone. A bone mineral density test is the best way to check your bone health. To keep bones strong, eat a diet rich in calcium and vitamin D, exercise and do not smoke. If needed, medicines can also help.

source: nlm.nih .gov

Hormone therapy (HT) was once the mainstay of treatment for osteoporosis. But because of concerns about its safety and because other treatments are available, the role of hormone therapy in managing osteoporosis is changing. Most problems have been linked to certain oral types of HT, either taken in combination with progestin or alone. If you're interested in hormone therapy, other forms are available, including patches, creams and the vaginal ring.

Discuss the various options with your doctor to determine which might be best for you.

If HT isn't for you, and lifestyle changes don't help control your osteoporosis, prescription drugs can help slow bone loss and may even increase bone density over time. They include:

• Bisphosphonates. Much like estrogen, this group of drugs can inhibit bone breakdown, preserve bone mass, and even increase bone density in your spine and hip, reducing the risk of fractures.

  Bisphosphonates may be especially beneficial for men, young adults and people with steroid-induced osteoporosis. They're also used to prevent osteoporosis in people who require long-term steroid treatment for a disease such as asthma or arthritis.

  Side effects, which can be severe, include nausea, abdominal pain, and the risk of an inflamed esophagus or esophageal ulcers, especially if you've had acid reflux or ulcers in the past. Bisphosphonates that can be taken once a week or once a month may cause fewer stomach problems. If you can't tolerate oral bisphosphonates, your doctor may recommend periodic intravenous infusions of bisphosphonate preparations.

  A small number of cases of osteonecrosis of the jaw have been reported in people taking oral bisphosphonates — such as Fosamax — for osteoporosis. These cases have been primarily associated with active dental disease or a recent dental procedure, such as a tooth extraction. If your doctor recommends a bisphosphonate for osteoporosis, consider getting any needed dental work done before starting this medication. If you currently take an oral bisphosphonate and need a dental procedure, discuss this with your doctor and dentist.

• Raloxifene. This medication belongs to a class of drugs called selective estrogen receptor modulators (SERMs). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine and, possibly, breast cancers. Hot flashes are a common side effect of raloxifene, and you shouldn't use this drug if you have a history of blood clots. This drug is approved only for women with osteoporosis and is not currently approved for use in men.
• Calcitonin. A hormone produced by your thyroid gland, calcitonin reduces bone resorption and may slow bone loss. It may also prevent spine fractures, and may even provide some pain relief from compression fractures. It's usually administered as a nasal spray and causes nasal irritation in some people who use it, but it's also available as an injection. Because calcitonin isn't as potent as bisphosphonates, it's normally reserved for people who can't take other drugs.
• Teriparatide. This powerful drug, an analog of parathyroid hormone, treats osteoporosis in postmenopausal women who are at high risk of fractures. Unlike other available therapies for osteoporosis, it works by stimulating new bone growth, as opposed to preventing further bone loss. Teriparatide is given once a day by injection under the skin on the thigh or abdomen. Long-term effects are still being studied, so the Food and Drug Administration recommends restricting therapy to two years or less.
• Tamoxifen. This synthetic hormone is used to treat breast cancer and is given to certain high-risk women to help reduce their chances of developing breast cancer. Although tamoxifen blocks estrogen's effect on breast tissue, it has an estrogen-like effect on other cells in your body, including your bone cells. As a result, tamoxifen appears to reduce the risk of fractures, especially in women over age 50. Possible side effects of tamoxifen include hot flashes, stomach upset and vaginal dryness or discharge.

Emerging therapies
A new physical therapy program has been shown to significantly reduce back pain, improve posture and reduce the risk of falls in women with osteoporosis who also have curvature of the spine. The program combines the use of a device called a spinal weighted kypho-orthosis (WKO) — a harness with a light weight attached — and specific back extension exercises. The WKO is worn daily for 30 minutes in the morning and 30 minutes in the afternoon and while performing 10 repetitions of back extension exercises.

Source:mayoclinic.com

What is osteoporosis?
In osteoporosis, the inside of the bones becomes porous from a loss of calcium (see the picture below). This is called losing bone mass. Over time, this weakens the bones and makes them more likely to break.

Osteoporosis is much more common in women than in men. This is because women have less bone mass than men, tend to live longer and take in less calcium, and need the female hormone estrogen to keep their bones strong. If men live long enough, they are also at risk of getting osteoporosis later in life.

Once total bone mass has peaked—around age 35—all adults start to lose it. In women, the rate of bone loss speeds up after menopause, when estrogen levels fall. Since the ovaries make estrogen, faster bone loss may also occur if both ovaries are removed by surgery.
Normal bone versus bone affected by osteoporosis

What are the signs of osteoporosis?
You may not know you have osteoporosis until you have serious signs. Signs include broken bones, low back pain or a hunched back. You may also get shorter over time because osteoporosis can cause your vertebrae (the bones in your spine) to collapse. These problems tend to occur after a lot of bone calcium has already been lost.


Am I at risk for osteoporosis?
See the box to the right for a list of things that put you at risk for osteoporosis. The more of these that apply to you, the higher your risk is. Talk to your family doctor about your risk factors.


Will I need a bone density test?
Check with your doctor. For many women, osteoporosis (or the risk of it) can be diagnosed without testing. When testing is appropriate, doctors use equipment that takes a “picture” of the bones to see if they are becoming porous.


What about hormone replacement therapy?
Hormone replacement therapy (HRT) is one way to prevent osteoporosis or keep it from getting worse.

In HRT, you take hormones (estrogen and progestin together, or estrogen alone) to counteract the drop in estrogen that happens at menopause or when the ovaries are removed by surgery.

Women who take HRT are at an increased risk for breast cancer, heart attack, stroke, serious blood clots and Alzheimer's disease.

Many physicians now recommend that their patients on HRT stop taking it to prevent osteoporosis.

Factors such as your health history and your family’s health history will be important when weighing the risks and benefits of HRT. Talk to your doctor about whether it’s right for you.


What is calcitonin?
Calcitonin (some brand names: Calcimar, Miacalcin) is a hormone that helps prevent further bone loss and reduces the pain that some people have with osteoporosis.

Calcitonin can be taken as a shot or as a nasal spray. Its most common side effect is nausea.


What is ibandronate sodium?
Ibandronate sodium (brand name: Boniva) is a new drug that is taken once a month. It is not a hormone, but it slows bone loss and increases bone density. Some of the possible side effects include upset stomach, heartburn, nausea and diarrhea.


What are alendronate and risedronate?
Alendronate (brand name: Fosamax) and risedronate (brand name: Actonel) are not hormones, but are used to help prevent and treat osteoporosis. These drugs help reduce the risk of fractures by decreasing the rate of bone loss. Their most common side effect is an upset stomach.


What is raloxifene?
Raloxifene (brand name: Evista) is a drug used to prevent and treat osteoporosis by increasing bone density. It is not a hormone, but it mimics some of the effects of estrogen. Side effects may include hot flashes and a risk of blood clots.


What is teriparatide?
Teriparatide (brand name: Forteo) is a new injectable synthetic hormone used once a day for the treatment of osteoporosis. It causes new bone growth. Common side effects may include nausea, dizziness and leg cramps.


How much calcium do I need?
Before menopause, you need about 1,000 mg of calcium per day. After menopause, you need 1,000 mg of calcium per day if you're taking estrogen and 1,500 mg of calcium per day if you're not taking estrogen.

It’s usually best to try to get calcium from food. Nonfat and low-fat dairy products are good sources of calcium. Other sources of calcium include dried beans, sardines and broccoli.

About 300 mg of calcium are in each of the following: 1 cup of milk or yogurt, 2 cups of broccoli, or 6 to 7 sardines.

If you don’t get enough calcium from the food you eat, your doctor may suggest taking a calcium pill. Take it at meal time or with a sip of milk. Vitamin D and lactose (the natural sugar in milk) help your body absorb the calcium.



Tips to keep bones strong

1. Exercise.
2. Eat a well-balanced diet with at least 1,000 mg of calcium a day.
3. Quit smoking. Smoking makes osteoporosis worse.
4. Talk to your doctor about HRT or other medicines to prevent or treat osteoporosis.