2.  Osteoporosis means "porous bones," causes bones to become weak and brittle – so brittle that even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture.  In most cases, bones weaken when low levels of calcium, phosphorus and other minerals in the bones and results as low bone density.  A common result of osteoporosis is fractures of the spine, hip or wrist.  Although it's often thought of as a women's disease, osteoporosis also affects many men.

3. SYMPTOMS  Back pain, which can be severe if fractured or collapsed vertebra  Loss of height over time, with an accompanying stooped posture  Fracture of the vertebrae, wrists, hips or other bones

4. Normal bone has the appearance of a honeycomb matrix (left). Under a microscope, osteoporotic bone (right) looks more porous.

5. CAUSES  The strength of the bones depends on their size and density; bone density depends in part on the amount of calcium, phosphorus and other minerals bones contain.  When the bones contain fewer minerals than normal, they're less strong and eventually lose their internal supporting structure.

6. The process of bone remodeling  Scientists have yet to learn all the reasons why this occurs, but the process involves how bone is made. Bone is continuously changing — new bone is made and old bone is broken down — a process called remodeling, or bone turnover.  A full cycle of bone remodeling takes about 2- 3 months.  In young – the body makes new bone faster than it breaks down old bone, and the bone mass increases.

7.  Reaches the peak bone mass in mid-30s.  After that, bone remodeling continues, but loses slightly more than gain.  At menopause, when estrogen levels drop, bone loss increases dramatically.  Many factors contribute to bone loss, the leading cause in women is decreased estrogen production during menopause.

8.  Risk of developing osteoporosis depends on how much bone mass attained between ages 25 and 35 (peak bone mass) and how rapidly loses it later. The higher peak bone mass, the more bones "in the bank" and less likely to develop osteoporosis as ages.  Not getting enough vitamin D and calcium in the diet may lead to a lower peak bone mass and accelerated bone loss later.

9. What keeps bones healthy  Regular exercise  Adequate amounts of calcium  Adequate amounts of vitamin D, which is very essential for absorbing calcium

11. RISK FACTORS  Sex – Fractures from osteoporosis are about twice more in women than in men. Risk in women at menopause (45 yrs) that accelerates bone loss. Risk in men is greater than age 75.  Age. The older, the higher risk of osteoporosis. Bones become weaker as ages.  Race. Greatest risk – white or of Southeast Asian descent. Black and Hispanic men and women have a lower, but still significant, risk.

12.  Family history.  Frame size. Men and women who are exceptionally thin or have small body frames tend to have higher risk because they may have less bone mass to draw from as they age.  Lifetime exposure to estrogen. The greater a woman's lifetime exposure to estrogen, the lower her risk of osteoporosis.  Excess soda consumption.  Chronic alcoholism.  Depression.

13.  Eating disorders. Women and men with anorexia nervosa or bulimia are at higher risk of lower bone density in their lower backs and hips.  Corticosteroid medications. Long-term use like prednisone, cortisone, prednisolone and dexamethasone, is damaging to bone.  Thyroid hormone. Too much thyroid hormone can cause bone loss.

14.  Other medications. Long-term use of the blood-thinning medication heparin, the cancer treatment drug methotrexate, some anti- seizure medications, diuretics and aluminum- containing antacids also can cause bone loss.  Breast cancer. Postmenopausal women who have had breast cancer are at increased risk of osteoporosis, especially if they were treated with chemotherapy or aromatase inhibitors such as anastrozole and letrozole, which suppress estrogen.

15.  Low calcium intake. A lifelong lack of calcium plays a major role in the development of osteoporosis.  Medical conditions and procedures that decrease calcium absorption. Stomach surgery (gastrectomy) can affect the body's ability to absorb calcium.  Sedentary lifestyle. Bone health begins in childhood. Children who are physically active and consume adequate amounts of calcium- containing foods have the greatest bone density. Exercise throughout life is important, but can increase bone density at any age.

16. TREATMENTS AND DRUGS  Hormone therapy (HT)  Prescription medications – Bisphosphonates, Raloxifene (Evista) / selective estrogen receptor modulators (SERMs), Calcitonin, Teriparatide (Forteo), Tamoxifen.  Emerging therapies – New physical therapy 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 afternoon.

17. ESTROGEN AND BONE PROTECTION Estrogen is essential for healthy bone, and that when the production of estrogen is reduced,

18. PREVENTION  Do exercise.  Add soy in diet.  Avoid smoking  Avoid excessive alcohol.  Avoid caffeine, which is very harmful.  Consider hormone therapy.  Maintain good posture –  Prevent falls.  Manage pain. Don't ignore chronic pain.