Osteoporosis is a disease that causes low bone mass and loss of bone tissue that may lead to weak and fragile bones. While osteoporosis is often thought of as an older person's disease, it can strike at any age. Eighty percent of those affected by osteoporosis are women. Any bone can be affected, but mostly hip and spine are the affected areas.
There are two classes of osteoporosis :

• Primary osteoporosis : This is primarily linked with natural changes in the body. There are two types :

a) Post-menopausal osteoporosis: It usually occurs between the ages of 50 to 70, largely because of estrogen loss at menopause. It mainly affects trabecular bone that is the spongy looking bone on the inside of the vertebrae.

b) Age-related osteoporosis : It is related directly to the aging process. It usually occurs in people older than 70 years. It affects both trabecular and cortical bone. Twenty percent of bone is trabecular bone and 80 percent is cortical bone. Eighty percent of bone turnover occurs in the smaller amount of trabecular bone.

• Secondary osteoporosis - It is caused by factors which are not directly responsible but are likely to cause bone degeneration. They are also the side effects of certain habits and diseases like Alcoholism  and liver disease. In secondary osteoporosis age is no criteria.

Alternative Names of Osteoporosis: Thin bones

Complications of Osteoporosis

Spine fractures: Thes are also called spine 'wedge' or 'crush' fractures. They can occur spontaneously or as a result of a minor trauma, such as coughing, hugging, or lifting. Repeated fractures may cause:

a) Acute and chronic back pain.
b) A significant loss of height.
c) Gastrointestinal or digestive problems.
d) Respiratory or breathing problems, because of the ribcage abutting or pushing on the pelvis.

Wrist fracture: It is also called Colles' fracture. Wrist fractures are painful, and need to stay immobile in a plaster cast for four to six weeks.

Causes of Osteoporosis
Osteoporosis is caused due to these factors:

• Aging: Bone loss will occur naturally as you get older.
• Heredity : Osteoporosis may be passed along through the family.
• Endocrinal diseases:  Diseases that affect the endocrine system, such as hyperparathyroidism or hyperthyroidism.
• Digestive tract diseases: Due to Poor gut absorption of calcium and vitamin D bone loss occurs.
• Alcoholism: Drinking too much alcohol also leads to this disease.
• Premature menopause: Estrogen level changes in women.
• Amenorrhea: Loss of periods due to an eating disorder.
• Lack of execrcise : Time spent in bed because of illness etc.
• Poor nutrition: Not eating foods rich in calcium, vitamin D and phosphorous can also cause bone loss.
• Medicinal effects : Some medicines used to treat other health problems can prevent our body from absorbing calcium. For example:  Phenytoin (e.g. Dilantin - used for treatment of epilepsy), corticosteroids (e.g. Prednisone, inhaled steroids for asthma) and certain drugs like Heparin, cyclosporin given to transplant patients.
• Caffeine: Coffee, tea and some sodas contain caffeine which can cause bone loss.

Signs & Symptoms of Osteoporosis

Early in the course of the disease, osteoporosis may cause no symptoms.
But later on the indicative signs of osteoporosis are :

• An unexpected quick pain in the back without any cause.
• A sharp pain in the back, ribs, hip or wrist after a fall or accident that does not go away. This could be sign of a fracture even though you might think that the accident was not serious enough to cause a break.
• Dull pain in the bones or muscles, particularly low back pain or neck pain.
• Tenderness and pain made worse by activity that puts weight on the affected area which may subside in a week.
• Stooped posture due to collapsing of vertebrae also known as dowager's hump.

Diagnosis of Osteoporosis

• Medical history and examination: The doctor will study your lifestyle, other conditions that you have and family history to see if you have osteoporosis or if you may be at risk for the disease.
• Bone mineral density test - It can measure bone density in various sites of the body. This test can detect osteoporosis before a fracture occurs, and can predict future fractures. It can also monitor the effects of treatment if the tests are performed a year or more apart and may help determine the rate of bone loss. Various BMD tests are :

a) DXA absorptiometry : Dual-energy X-ray absorptiometry measures the bone density of the spine, hip, or total body. With your clothes on, you simply lie on your back with your legs on a large block.
b) SXA absorptiometry : Single-energy X-ray absorptiometry is performed with a smaller x-ray machine that measure bone density at the heel, shin bone, and kneecap.
c) Ultrasound test : Ultrasound waves pulsing through water are used to measure the bone density in your heel. You place your bare foot in a waterbath and your heel fits into a footrest as sound waves pass through your ankle. Bone loss at the heel may mean bone loss in the spine, hip, or elsewhere in the body. If bone loss is found in this test, you might be asked to have the DXA to confirm the results.

Treatments of Osteoporosis
The main focus of treatment is on slowing down or stopping the mineral loss, increasing bone density, preventing bone fractures, and controlling the pain associated with the disease.

• HRT :  It stands for Hormone Replacement Therapy. It replaces oestrogen and so reduces the rate of bone loss. HRT is most beneficial for preventing osteoporosis if it is started early in menopause and is taken for at least five years. However long-term use increases the risk of side effects.
• Medicines : Drugs like alendronate, risedronate, and etidronate slow down bone loss and in some cases actually increase bone mineral density.
• Supplements: Calcium and vitamin D are needed to increase bone mass.
• Aquatic therapy : Physical therapy in a swimming pool provides a safe place for you to exercise without putting yourself at risk for falls or broken bones.Aquatic therapy increases muscle strength, decreases pain by reducing weight-bearing forces to joints and bones, improves balance, speeds the rate of recovery, and increases proprioception (your body's ability to sense muscle and joint positioning).
• A regular exercise routine: Weight-bearing activities, such as walking or jogging, and resistance exercise, build muscle strength as well as improve your balance and body awareness, thereby reducing your risk of falls.
• Surgery : In advanced stages of osteoporosis, major fractures are commonand surgery may be required to repair the fracture. One of the most common procedures is hip replacement surgery. Hip replacement surgery is used to repair a broken hip. The original hip is removed and replaced with an artificial metal and/or plastic hip.

Prevention of Osteoporosis

• The best defense against developing osteoporosis is building strong bones during childhood and adolescence so as to reduce the risks at a mature age.
• Well balanced diet rich in calcium and vitamin D.
• Various forms of exercise like weight-bearing exercises,walking, dancing, jogging, stair-climbing, racquet sports and hiking in consulation with your physician.
• Maintaining a healthy lifestyle with no smoking or excessive alcohol intake.
• Medication to improve bone density whenever adviced by the doctor.

When to seek Medical Advice

• If you are past menopause and have constant pain in areas such as neck or lower back, consult your doctor for a medical assessment and bone density screening.
• Severe pain in muscles or bones that limits your ability to function.
• If you have sustained serious injuries or suspect fractures of your spine, hip, or wrist.