Bone is a living substance in which the tissue is constantly breaking down and being regenerated. An essential mineral element in this bone remodelling is calcium because the bones act as the body's calcium reserve or bank. Calcium is deposited or withdrawn daily, according to the body's needs. Bone strength is increased by weight bearing exercise and measured by bone mineral density.

Maximum or peak bone mass is achieved by the mid 20s. After the mid 30s, bones start to lose more calcium than is deposited and gradually lose strength. With increasing age, more bone is lost than is replaced so the outer shell gradually becomes weaker and the inner material develops larger holes. Eventually a danger level is reached and the risk of fracture increases.

Maximising peak bone mass development during childhood and adolescence means greater protection against fractures in later life. Throughout life we can take action to minimize some risk factors for osteoporosis and fractures.

Prevention of bone loss, starting early but continuing throughout life, is critical to preventing osteoporosis and the potentially deadly fractures associated with the disease. Post-menopausal women, as the highest risk group, should be particularly concerned with minimizing risk and should discuss lifestyle choices to prevent bone loss with their physicians.

A sedentary lifestyle, inadequate calcium and vitamin D consumption, smoking, caffeine and alcohol consumption can all increase an individual's risk for developing osteoporosis. Regular weight bearing activity and daily calcium intake, either through dairy products or supplements, can help

Other risk factors for osteoporosis, which cannot be controlled through life-style choices include: a family history of osteoporosis; gender (women are more susceptible); age (50 or older); menopause, either natural or surgical; prolonged hormonal imbalances; and medications such as cortisone related compounds.

These risk factors may require medical management and are best discussed with your local doctor.

How is Osteoporosis Diagnosed?

Currently, the most accurate way to diagnose osteoporosis is by a DEXA scan. This low radiation scans measures bone mineral density and provides an indicator of fracture risk. If you have concerns because you meet some of the risk factors, or are near menopause, discuss them with you doctor.

Exercise and Osteoporosis

Weight-bearing exercises such as walking, jogging, aerobic dance, climbing stairs, skiing, and weight-lifting can help you build strong bones before you reach menopause. And once you've reached menopause, weight-bearing exercises can help prevent osteoporosis.

Recent studies have shown that the risk of osteoporosis is lower for people who are active, and especially those who do load-bearing, or weight-bearing activities at least three times a week.

Even if you have osteoporosis, it's still important to exercise. By strengthening muscles, improving posture, and improving balance

Calcium and Vitamin D

Calcium and vitamin D supplements are an integral part of all treatments for osteoporosis. Everyone should make sure they get enough of these two nutrients, but especially women and others at risk for osteoporosis. Attention to diet and exercise are important not only for treatment, but also for prevention

Calcium supplements can be beneficial to those people with existing osteoporosis and as a preventative measure to those who do not have a high calcium intake in their diet. Not all calcium tablets contain enough elemental calcium (or calcium that can be used by your body) so speak to your doctor or pharmacist about making the right choice.

Vitamin D plays an important role in controlling the entry and loss of calcium from bones. Older people especially if house bound or institutionalised may not get enough sunlight exposure and may not make enough Vitamin D. Special forms of Vitamin D (such as calcitriol) can improve your calcium absorption from the diet and have been shown to reduce the risk of further fracture if you already have osteoporosis.

Hormone Replacement Therapy (HRT) Oestrogen (the female hormone) has been shown to stop and partially reverse bone loss and can reduce the risk of osteoporosis in women after menopause and in older women who already have been diagnosed with osteoporosis. HRT has also been shown to have other benefits, such as reducing the risk of heart disease and in controlling menopausal symptoms. Your doctor should discuss the potential benefits and any contra-indications

Biphosphates

Bisphosphonates are a non-hormonal type of therapy which stick to the bone surface and make the cells which break down and destroy bone tissue less effective. This allows the bone rebuilding cells to work more efficiently, and has been shown to reduce the risk of further fracture if you already have osteoporosis.

Specific Oestrogen Receptor Modulators (SERMS)

Specific Oestrogen Receptor Modulators (SERMS) have been shown to reduce bone loss and increase bone mineral density in post menopausal women. They also have benefits for the heart and may reduce the risk of breast cancer. They are not HRT and will not relieve menopausal symptoms.

Your doctor will work with you to decide which approaches are best for you. It is important to discuss with your doctor how you should take these medication and any side effects you may experience. Ask lots of questions and remember to read the instructions about these medications.