Normal bone is dense and strong
	Bone with osteoporosis has thinned out and become more porous, making it more likely to break

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NORMAL BONE REMODELING PROCESS

The bones in your hip, wrist, and spine are most at risk for breaking. Your upper back may curve if the bones in your spine fracture, and you may actually get shorter with age. You are at increased risk for osteoporosis if:

• Your body is no longer producing estrogen
• You have a small, thin frame
• You have a family history of osteoporosis
• You have had an early menopause
• You suffer from anorexia nervosa or bulimia
• You have amenorrhea (abnormal absence of menstrual periods)
• You are advanced in age
• There is not enough calcium in your diet
• You smoke or drink alcohol
• You use certain medicines such as steroids, anticonvulsants, excessive thyroid hormones, or cancer treatments
• You don't exercise much

Children's bones grow quickly and reach their full length in the teenage years. During this time of rapid growth, you can build strong bones by eating calcium-rich foods and getting plenty of exercise.

When you're a young adult, your bones thicken. They reach their peak bone mass between the ages of 25 and 35. Bones are strongest when at their peak bone mass. You can help them reach their peak by staying active and getting enough calcium.

Bone mass declines slightly during these years. Your body makes just enough new bone to maintain peak bone mass. Estrogen also helps to maintain your bone mass. To keep your bones at their peak mass, be sure to exercise and get a lot of calcium.

As you near menopause (stop having your monthly periods), your supply of estrogen decreases. Bone loss increases the most during the menopausal years. As a result, your bones may become thinner and weaker. Hormone replacement therapy (HRT) can help prevent bone loss during this time. Exercise and calcium can also help keep your bones strong.

The rate of bone loss slows. But your body may still be losing bone faster than it can replace it. If too much bone is lost, you may be at risk for fractures. You can lessen bone loss by staying active and increasing your calcium uptake. Continue HRT if you are taking it. If you have osteoporosis, learn to live with it safely.

Your body uses calcium to keep your bones strong. But it also needs calcium for other things. If you don't give your body enough calcium, it will take the calcium from your bones. This is why you need to get enough calcium throughout your life. The best source of calcium is food, but if you can't get enough from food, there are supplements.
Good food sources of calcium include dairy products, fish and beans.
How much daily calcium do you need?

• 11-24 years: 1200 mg
• 25 years - Menopause: 1000 mg
• During the Menopausal Years: 1500 mg
• After Menopause: 1500 mg

Your body needs vitamin D to use calcium. You should be getting 400 IU (International Units) of vitamin D daily. Vitamin D is found in certain foods, including milk. Multivitamins and even 30 to 60 minutes of sunshine a day are other good sources. Too much vitamin D can be harmful, though.

Exercise plays a major role in maintaining bone mass no matter what your age. The amount and type of activity you do also play a part in keeping your bones strong. Weight-bearing and resistance exercises, such as walking, aerobic dancing and bicycling, are just a few of the activities that are good for your bones. You should set aside at least 20 minutes, 3 times a week for exercise.
Always check with your physician before starting any new exercise program, and stop any exercise that causes pain!

A major cause of osteoporosis in women is loss of the hormone estrogen. Estrogen helps maintain bone mass. At menopause, your body stops making this hormone. Bones may become thin and weak. But hormone replacement therapy can help. Besides preventing bone loss, HRT can also help reduce the risk of heart disease, and help in the symptoms of menopause, such as hot flashes, vaginal dryness, moodiness, insomnia and sweating.

Testing is the most practical way to accurately measure your current level of bone density, and having a test now can help your physician predict your risk of broken bones in the future. Your physician may also recommend follow-up tests in later years. Follow-up tests allow your physician to compare your current and future results to find out how fast you are losing bone over time or to measure the effects of treatment.
Dr. Monlezun uses the Osteometer DTX-200 Bone Densitometer in his office to measure bone density of his patients. It estimates the bone mineral content (BMC, in grams) and bone mineral density (BMD, grams/cm²) in the patient's wrist. The forearm is placed in a container during the examination. The x-ray source is located on one side of the forearm and a detector is located on the other side. When more bone mass is present, fewer x-rays are detected. When bone mass is low, more x-rays are detected. From this, bone mass results are automatically calculated.

This is a printout from a 45-year-old female with normal bone mass. Notice the white square is in the green area. Lower bone mass would show the square in the white, yellow, orange and red areas, which indicate progressively lower bone mass density.

Fosamax, pronounced FOSS-ah-max (Alendronate, by Merck), is the most exciting drug released to date for the treatment of osteoporosis in women after menopause.
It works by:

• Reducing the activity of the cells that cause bone loss
• Decreasing the faster rate of bone loss that occurs after menopause
• Increasing the amount of bone in most patients

These effects are seen as soon as 3 months after therapy with Fosamax has begun. These effects continue as long as you keep taking the drug. The density of bone increases and the bone is less likely to fracture. Thus, Fosamax reverses the progression of osteoporosis.

Miacalcin (calcitonin-salmon) nasal spray is indicated for the treatment of postmenopausal osteoporosis in women more than 5 years postmenopause who refuse or cannot tolerate estrogens, or in whom estrogens are contraindicated.
Postmenopausal osteoporosis involves the progressive loss of bone mass, due to an imbalance between the rate of bone resorption and rate of bone formation. An increase in the number and activity of osteoclasts occurs after menopause, resulting in accelerated loss of bone mass. Calcitonin, along with the adequate intake of calcium and vitamin D, is beneficial in helping to prevent such loss.