Bone is living, growing tissue. It is made mostly of collagen, a protein that provides a soft framework, and calcium phosphate, a mineral that adds strength and hardens the framework.This combination of collagen and calcium makes bone both flexible and strong, which in turn helps bone to withstand stress. More than 99 percent of the body’s calcium is contained in the bones and teeth. The remaining 1 percent is found in the blood. Throughout one’s lifetime, old bone is removed (resorption) and new bone is added to the skeleton (formation). During childhood and teenage years, new bone is added faster than old bone is removed. As a result, bones become larger, heavier, and denser. Bone formation outpaces resorption until peak bone mass (maximum bone density and strength) is reached around age 30. After that time, bone resorption slowly begins to exceed bone formation. For women, bone loss is fastest in the first few years after menopause, and it continues into the postmenopausal years. Osteoporosis—which mainly affects women but may also affect men—will develop when bone resorption occurs too quickly or when replacement occurs too slowly. Certain risk factors are linked to the development of osteoporosis and contribute to an individual’s likelihood of developing the disease. Some risk factors cannot be changed, but you can change others. v  Gender. Your chances of developing osteoporosis are greater if you are a woman. Women have less bone tissue and lose bone faster than men because of the changes that happen with menopause. v  Age. The older you are, the greater your risk of osteoporosis. Your bones become thinner and weaker as you age. v  Body size. Small, thin-boned women are at greater risk. v  Ethnicity. Caucasian and Asian women are at highest risk. African American and Hispanic women have a lower but significant risk. v  Family history. Fracture risk may be due, in part, to heredity. People whose parents have a history of fractures also seem to have reduced bone mass and may be at risk for fractures. v  Sex hormones. Abnormal absence of menstrual periods (amenorrhea), low estrogen level (menopause), and low testosterone level in men can bring on osteoporosis. v  Anorexia nervosa. Characterized by an irrational fear of weight gain, this eating disorder increases your risk for osteoporosis. v  Calcium and vitamin D intake. A lifetime diet low in calcium and vitamin D makes you more prone to bone loss. v  Medication use. Long-term use of certain medications, such as glucocorticoids and some anticonvulsants can lead to loss of bone density and fractures. v  Lifestyle. An inactive lifestyle or extended bed rest tends to weaken bones. v  Cigarette smoking. Smoking is bad for bones as well as the heart and lungs. v  Alcohol intake. Excessive consumption of alcohol increases the risk of bone loss and fractures.   Osteoporosis is often called a silent disease because 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 hip to fracture or a vertebra to collapse. This may be very debilitating and cause serious problem especially in the old age. STEP ONE MUST TAKE TO PREVENT OSTEOPOROSIS  To prevent Osteoporosis and fracture maintain a proper bone health evaluation is must and the following steps are recommend. A ) Comprehensive medical assessment, your doctor may recommend that you have your bone mass measured. B) A bone mineral density (BMD) test is the best way to determine your bone health. BMD tests can identify osteoporosis, determine your risk for fractures (broken bones), and measure your response to osteoporosis treatment. The most widely recognized BMD test is a dual-energy x-ray absorptiometry, or DXA test. It is painless—a bit like having an x-ray, but with much less exposure to radiation. It can measure bone density at your hip and spine. BMD tests can: v  Detect low bone density before a fracture occurs. v  Confirm a diagnosis of osteoporosis if you already have one or more fractures. v  Predict your chances of fracturing in the future. v  Determine your rate of bone loss, and monitor the effects of treatment if the test is conducted at intervals of a year or more. C) Biochemical markers v  Calcium v  Phosphorous v  Alkaline Phosphates v  Vitamin D 3 v  Beta cross laps v  Osteocalcin v  PTH v  These biochemical markers can give an estimate of bone breakdown or reabsorbtion and bone formation. v  These values can also help in the subsequent assessment of therapy. Treatment A comprehensive osteoporosis treatment program includes a focus on  Nutrition: The foods we eat contain a variety of vitamins, minerals, and other important nutrients that help keep our bodies healthy. All of these nutrients are needed in balanced proportion. In particular, calcium and vitamin D are needed for strong bones and for your heart, muscles, and nerves to function properly. (See “Prevention” section for recommended amounts of calcium.) Calcium needs change during one’s lifetime. The body’s demand for calcium is greater during childhood and adolescence, when the skeleton is growing rapidly, and during pregnancy and breastfeeding. Postmenopausal women and older men also need to consume more calcium. Also, as you age, your body becomes less efficient at absorbing calcium and other nutrients. Older adults also are more likely to have chronic medical problems and to use medications that may impair calcium absorption. Vitamin D deﬁciency is characterized by inadequate mineralization, or demineralization, of the skeleton.There is a considerable body of evidence that vitamin D deﬁciency is an important contributor to osteoporosis through less efﬁcient intestinal absorption of calcium, increased bone loss, muscle weakness, and a weakened bone microstructure (26). Increasing vitamin D intake can signiﬁcantly reduce risk of bone fracture in older people (26 Exercise: Exercise is an important component of an osteoporosis prevention and treatment program. Exercise not only improves your bone health, but it increases muscle strength, coordination, and balance, and leads to better overall health. Although exercise is good for someone with osteoporosis, it should not put any sudden or excessive strain on your bones. As extra insurance against fractures, your doctor can recommend specific exercises to strengthen and support your back. Therapeutic medications: Several medications are available for the prevention and/or treatment of osteoporosis, including: bisphosphonates; estrogen agonists/antagonists (also called selective estrogen receptor modulators or SERMS); calcitonin; parathyroid hormone; estrogen therapy; hormone therapy; and a recently approved RANK ligand (RANKL) inhibitor. These medications are only advised by a specialist after proper assessment and should be taken under supervision.