context: Osteoporosis is a disease that weakens bones, increasing the risk of sudden and unexpected fractures. Literally meaning "porous bone," osteoporosis results in an increased loss of bone mass and strength. The disease often progresses without any symptoms or pain. Many times, osteoporosis is not discovered until weakened bones cause painful fractures usually in the back or hips. Unfortunately, once you have a broken bone due to osteoporosis, you are at high risk of having another. And these fractures can be debilitating. Fortunately, there are steps you can take to help prevent osteoporosis from ever occurring. And treatments can slow the rate of bone loss if you already have osteoporosis. Though we do not know the exact cause of osteoporosis, we do know how the disease develops. Your bones are made of living, growing tissue. An outer shell of cortical or dense bone encases trabecular bone, a sponge-like bone. When a bone is weakened by osteoporosis, the "holes" in the "sponge" grow larger and more numerous, weakening the internal structure of the bone. Until about age 30, a person normally builds more bone than he or she loses. During the aging process, bone breakdown begins to outpace bone buildup, resulting in a gradual loss of bone mass. Once this loss of bone reaches a certain point, a person has osteoporosis. There is a direct relationship between the lack of estrogen during perimenopause and menopause and the development of osteoporosis. Early menopause (before age 45) and any prolonged periods in which hormone levels are low and menstrual periods are absent or infrequent can cause loss of bone mass. Osteoporosis is often called a "silent disease" because initially bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a fracture or a vertebra to collapse. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as stooped posture. Important risk factors for osteoporosis include: Age. After maximum bone density and strength is reached (generally around age 30), bone mass begins to naturally decline with age. Gender. Women over the age of 50 have the greatest risk of developing osteoporosis. In fact, women are four times more likely than men to develop osteoporosis. Women's lighter, thinner bones and longer life spans account for some of the reasons why they are at a higher risk for osteoporosis. Ethnicity. Research has shown that Caucasian and Asian women are more likely to develop osteoporosis. Additionally, hip fractures are twice as likely to occur in Caucasian women as in African- American women. However, women of color who fracture their hips have a higher mortality. Bone structure and body weight. Petite and thin women have a greater risk of developing osteoporosis in part because they have less bone to lose than women with more body weight and larger frames. Similarly, small-boned, thin men are at greater risk than men with larger frames and more body weight. Family history. Heredity is one of the most important risk factors for osteoporosis. If your parents or grandparents have had any signs of osteoporosis, such as a fractured hip after a minor fall, you may be at greater risk of developing the disease. Prior history of fracture/bone breakage. Certain medications. The use of some medications, such as the long term use of steroids (like prednisone) can also increase your risk of developing osteoporosis. Some medical conditions: Some diseases including cancer and stroke may increase your risk for osteoporosis. A painless and accurate test can provide information about bone health and osteoporosis before problems begin. Bone mineral density ( BMD) tests, or bone measurements, are X-rays that use very small amounts of radiation to determine bone strength. A bone mineral density test is indicated for: Women age 65 and older. Women with numerous risk factors. Menopausal women who have had fractures Treatments for established osteoporosis (meaning, you already have osteoporosis) include: Medications such as alendronate ( Binosto, Fosamax), ibandronate ( Boniva), raloxifene ( Evista), risedronate ( Actonel, Atevia), and zoledronic acid ( Reclast, Zometa) Calcium and vitamin D supplements. Weight-bearing exercises (which make your muscles work against gravity) Injectable abaloparatide ( Tymlos), teriparatide ( Forteo) or PTH to rebuild bone Injectable denosumab ( Prolia, Xgeva) for women at high risk of fracture when other drugs don't work Hormone therapy Hormone therapy [estrogen] isbelieved to be useful in preventing or alleviating the increased rate of bone loss that leads to osteoporosis. However, using hormone replacement therapy for prevention of osteoporosis alone -- not to treat menopausal symptoms -- is not recommended by the FDA. If you are using hormone therapy only for osteoporosis prevention, be sure to talk to your doctor so you can weigh the benefits of hormone therapy against your personal risk and consider other medications for your bones. If needed, your doctor can prescribe different treatments to help prevent osteoporosis. Alternatives to hormone therapy include: Bisphosphonates. This group of medications includes the drugs alendronate ( Binosto, Fosamax), risedronate ( Actonel, Atelvia), ibandronate ( Boniva) and zoledronic acid ( Reclast, Zometa). Bisphosphonates are used to prevent and/or treat osteoporosis. All can help prevent spine fractures. Binosto, Fosamax, Actonel, Atelvia, Reclast and Zometa can also reduce the risk of hip and other non-spine fractures. Raloxifene ( Evista). This drug is a selective estrogen receptor modulator ( SERM) that has many estrogen-like properties. It is approved for prevention and treatment of osteoporosis and can prevent bone loss at the spine, hip, and other areas of the body. Studies have shown that it can decrease the rate of vertebral fractures by 30%-50%. It may increase the risk of blood clots. Teriparatide ( Forteo) and abaloparatide ( Tymlos), are a type of hormone used to treat osteoporosis. They help rebuild bone and increase bone mineral density. They are given by injection and are used as a treatment for osteoporosis. Denosumab ( Prolia, Xgeva) is a so-called monoclonal antibody -- a fully human, lab-produced antibody that inactivates the body's bone-breakdown mechanism. It is used to treat women at high risk of fracture when other osteoporosis drugs have not worked. There are multiple ways you can help protect yourself against osteoporosis, including: Exercise. Establish a regular exercise program. Exercise makes bones and muscles stronger and helps prevent bone loss. It also helps you stay active and mobile. Weight-bearing exercises, done at least three to four times a week, are best for preventing osteoporosis. Walking, jogging, playing tennis, and dancing are all good weight-bearing exercises. In addition, strength and balance exercises may help you avoid falls, decreasing your chance of breaking a bone. Eat foods high in calcium. Getting enough calcium throughout your life helps to build and keep strong bones. The U. S. recommended daily allowance ( RDA) of calcium for adults with a low-to-average risk of developing osteoporosis is 1,000 mg (milligrams) each day. For those at high risk of developing osteoporosis, such as postmenopausal women and men, the RDA increases up to 1,200 mg each day. Excellent sources of calcium are milk and dairy products (low-fat versions are recommended), canned fish with bones like salmon and sardines, dark green leafy vegetables, such as kale, collards and broccoli, calcium-fortified orange juice, and breads made with calcium-fortified flour. Supplements. If you think you need to take a supplement to get enough calcium, check with your doctor first. Calcium carbonate and calcium citrate are good forms of calcium supplements. Be careful not to get more than 2,000 mg of calcium a day if you are 51 or older. Younger adults may be able to tolerate up to 2500 mg a day but check with your doctor. Too much can increase the chance of developing kidney stones. Vitamin D. Your body uses vitamin D to absorb calcium. Being out in the sun for a total of 20 minutes every day helps most people's bodies make enough vitamin D. You can also get vitamin D from eggs, fatty fish like salmon, cereal and milk fortified with vitamin D, as well as from supplements. People aged 51 to 70 should have 600 IU daily. More than 4,000 IU of vitamin D each day is not recommended. Talk to your doctor to see how much is right for you because it may harm your kidneys and even lower bone mass. Medications. Most of the bisphosphonates that are taken by mouth as well as raloxifene ( Evista) can be given to help prevent osteoporosis in people who are at high risk for fractures. Estrogen. Estrogen, a hormone produced by the ovaries, helps protect against bone loss. It can be used as treatment for the prevention of osteoporosis. Replacing estrogen lost after menopause (when the ovaries stop most of their production of estrogen) slows bone loss and improves the body's absorption and retention of calcium. But, because estrogen therapy carries risks, it is only recommended for women at high risk for osteoporosis and/or severe menopausal symptoms. To learn more, talk to your doctor about the pros and cons of estrogen therapy. Know the high risk medications. Steroids, some breast cancer treatments (such as aromatase inhibitors), drugs used to treat seizures (anticonvulsants), blood thinners (anticoagulants), and thyroid medications can increase the rate of bone loss. If you are taking any of these drugs, speak with your doctor about how to reduce your risk of bone loss through diet, lifestyle changes and, possibly, additional medication. Other preventive steps. Limit alcohol consumption and do not smoke. Smoking causes your body to make less estrogen, which protects the bones. Too much alcohol can damage your bones and increase the risk of falling and breaking a bone. If you are lactose intolerant or have difficulty digesting milk, you may not be getting enough calcium in your diet. Although most dairy products may be intolerable, some yogurt and hard cheeses might be digestible. You can also eat lactose-containing food by first treating it with commercial preparations of lactase (which can be added as drops or taken as pills). There are also lactose-free dairy products you can buy. You can also eat lactose-free foods high in calcium, such as leafy green vegetables, salmon (with bones), and broccoli. There are many foods that are fortified with calcium too, such a some orange juices and breads Weight-bearing exercises are activities that make your muscles work against gravity. Walking, hiking, stair-climbing, or jogging are all weight-bearing exercises that help build strong bones. Thirty minutes of regular exercise (at least 3 to 4 days a week or every other day) along with a healthy diet may increase peak bone mass in younger people. Older women and men who engage in regular exercise may experience decreased bone loss or even increased bone mass. If you have osteoporosis, it is important to protect yourself against accidental falls, which may result in fractures. Take the following precautions to make your home safe: Remove loose household items, keeping your home free of clutter. Install grab bars on tub and shower walls and beside toilets. Install proper lighting. Apply treads to floors and remove throw rugs.