What Is It?
Osteoporosis can cause bones to become brittle and weak, putting a person a risk of fracture. 
Bones, made up of calcium and other minerals, are constantly being broken down and rebuilt. In people with osteoporosis, bone tissue breaks down faster than it is replaced. The bones become less dense (thinner) and brittle and are more likely to break (fracture) with pressure or after a fall. Bone loss happens without any warning signs. Therefore, osteoporosis is called a “silent disease.” Osteoporosis is different from osteoarthritis, a form of arthritis in which joint cartilage, the rubbery material that covers the ends of bones, wears away. 

During and after menopause, when estrogen (hormone) levels drop, women lose bone mass faster. About five to 10 years after menopause starts, women can lose up to one-third of their bone mass. Men also lose bone mass as they age, but women tend to lose it faster. 

Each year, in the United States, osteoporosis contributes to more than 1.5 million fractures of the back/spine, wrists and hips.
What Are The Causes?
The amount of bone mass a person has as a young adult, and the rate at which it is lost with aging, determines one's risk for osteoporosis. In addition to age, gender, family history, certain medical conditions and procedures, lifestyle habits and medication use also play a role.
Osteoporosis is more common in:

• Women, especially those who are past menopause or who are elderly.

• Women who have had their ovaries removed through a hysterectomy.

• Women who don’t exercise regularly or who exercise so much that menstrual periods stop.

• Men with low levels of testosterone.

• Individuals who are thin or have small body frames.

• Individuals with a family history of osteoporosis, or who are of Caucasian or Asian ancestry.

• Individuals with a history of bone fractures after a minor injury.

• Individuals with an inflammatory form of arthritis, such as rheumatoid arthritis, psoriatic arthritis, lupus, ankylosing spondylitis or reactive arthritis. 

• Individuals who take drugs that reduce bone mineral density such as corticosteroids (cortisone, prednisone or methylprednisolone), anticonvulsants (anti-seizure medications), a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or heparin, a blood thinner.

• Individuals with celiac disease (allergy to gluten), inflammatory bowel disease (IBD), hyperthyroidism, chronic obstructive pulmonary disease (COPD), multiple myeloma (bone marrow cancer), thyroid or parathyroid disease.

• Individuals who have had bariatric surgery

• Individuals who smoke or drink three or more alcoholic beverages a day

• Individuals with a history of anorexia nervosa or other eating disorders

• Individuals who have had long periods of immobility or bed rest

People who have one or more of these risk factors should talk to a doctor about ways to reduce the risk of osteoporosis and whether a bone density test is needed.
 
What Are The Symptoms?
Osteoporosis is a silent disease that causes few outward signs or symptoms. Because osteoporosis develops over the years, a person may not be aware they have it until there is a broken bone, loss of height, or noticeable hump in the upper back. 
Other symptoms of osteoporosis are:

• Tooth loss. This may be a sign that osteoporosis has affected the jawbone.

• Back pain. A fracture or a collapsed vertebra in the spine may mean you have developed spinal osteoporosis.

Diagnosis
Osteoporosis develops slowly over the years. Symptoms such as tooth loss or back pain may be mistakenly attributed to something else. Anyone who has a family history of osteoporosis or risk factors for the disease should discuss their chances of getting it with a doctor
The doctor will make a diagnosis of osteoporosis by considering several factors, including: 

• Health history and physical -- The doctor will perform a physical examination and ask questions about the patient's personal and family medical history, medications, diet and fracture history.

• Blood and urine tests.  These tests help to rule out other diseases that weaken bones.

• Bone density scan -- Bone-density measurement is quick and painless. The most accurate test is called a dual-energy X-ray absorptiometry (DEXA) scan.

 
The United States Preventive Services Task Force recommends an initial bone density test at age 65, or age 60 if you are taking corticosteroids. People with rheumatoid arthritis should have a baseline bone density test when diagnosed with that condition.
Bone-density tests should be also done for:

• Women as early as age 50 if they have a high risk for osteoporosis

• Individuals who are taking, or have taken, long-term corticosteroids or expect to do so

• Individuals with a personal history or family history of fractures

• Individuals who have diseases that affect calcium absorption or bone strength
   

What Are The Treatment Options?
Treatment for osteoporosis involves slowing the rate of bone lose or increasing the rate of bone formation. There are two types of medications for this.  

• Drugs that slow the rate of bone loss are called antiresorptive medications.

• Drugs that increase the rate of bone formation are called anabolic medications.

Until somewhat recently, estrogen hormone replacement therapy (HRT) was the traditional way to prevent osteoporosis as well as treat menopausal symptoms. However, recent evidence suggests estrogen can increase the risk of breast cancer, stroke and heart attack. Because of this, estrogen supplementation after menopause is usually not used to prevent osteoporosis.
Antiresorptive Medications include:
Alendronate (Binosto, Fosamax)
Ibandronate (Boniva)
Risedronate (Actonel)
Zoledronic acid (Reclast)
Denosumab (Prolia)
​
This is a naturally occurring hormone that decreases bone breakdown. It is FDA-approved for osteoporosis treatment but not prevention. Calcitonin controls bone breakdown and may ease pain in people with spine fractures. It’s available as a nasal spray or an injection (Miacalcin, Fortical). 
These drugs work like estrogen, but with fewer side effects. Raloxifene (Evista) is an FDA-approved SERM for the treatment and prevention of postmenopausal osteoporosis. In 2013, the FDA approved Duavee, a combination product containing the SERM bazedoxifene and conjugated estrogens for menopausal symptoms and osteoporosis. 
Anabolic Medications include:
Teriparatide (Forteo)
Abaloparatide (Tymlos)
Romosozumab (Evenity)
 
 
Self Care

• Taking a proactive part in osteoporosis treatment is important.

• Vitamin D level should be in the range 40-100. Talk to you doctor about the right amount of daily supplementation or the need for vitamin D prescription.

• Smoking cessation

• Calcium supplementation in smokers and breast feeding women.

• Exercises or other physical activities that strengthen bones can help maintain bone mass. Weight-bearing and resistance exercises are especially beneficial.