Osteoporosis is a condition that results from progressive loss of bone mass, leading to weakening of bone strength and increased risk of fracture. Osteopenia is when there is less than optimum bone mass or bone density, but the situation is not quite osteoporosis.
Both of these diagnoses can be confirmed by bone density measurement on a piece of equipment called the DXA (pronounced dexa).Bone is living, dynamic tissue whose strength and size is determined by the balance between two types of cells: osteoblasts (which build bone) and osteoclasts (which break down bone).

During childhood growth, osteoblasts take the lead over osteoclasts, resulting in bone growth. After menopause, and with some other medical conditions, osteoclasts overpower osteoblasts, leading to loss of bone.
Medications that help to improve that balance fall into two categories: antiresorptive agents and bone-forming agents.Antiresorptives work by decreasing the effects of osteoclasts on bone breakdown (called bone resorption). These medications include hormone replacement therapy, bisphosphonates (Fosamax, Actonel and Boniva), hormonelike agents (Evista), and a nose spray (Miacalcin, Fortical).

This category of medications can be very effective in preventing bone loss.
There is no clear answer on how long they should be taken, but osteoporosis experts are trying to draw some conclusions about that very question.There is currently only one medication in the bone-forming category, but others are expected in the near future. Forteo is an injectable medication that resembles a hormone made by the body called parathyroid hormone. It is self-injected directly under the skin daily for a total of two years. This medication is quite effective for those with a very high risk of fracture.

Medications alone are not sufficient to prevent and treat osteoporosis. Calcium and vitamin D are critical building blocks for preserving bone health. Important lifestyle measures include weight-bearing exercise and avoidance of smoking and excessive alcohol use.

What is osteoporosis? It’s a disease in which the bones become thinner and weaker and are susceptible to fractures. It can affect any bone, but the hips, vertebral bodies and wrists are of special concern. Estrogen depletion after menopause is the main reason women are more commonly affected than men. Men get osteoporosis too, though not as frequently as women.Women sometimes come to my office complaining of terrible back pain. The cause turns out to be a fracture in the vertebrae of the spine, yet patients have no idea they’re experiencing broken bones.

That’s because it doesn’t always take a fall or impact to cause a break. If the osteoporosis is severe enough, bones can simply collapse.To help prevent the onset of osteoporosis, post-menopause, you need at least 500 milligrams of Calcium three times a day and 400 international units of vitamin D daily for someone who doesn’t get outside much - it helps absorb the Calcium.

If you have no special risk factors, you should start bone density screenings at age 65 - younger if risk factors are indicated.Special risk factors for osteoporosis include smoking, sedentary lifestyle, estrogen depletion through surgery (such as hysterectomy) before age 45, family history of unexplained fractures before 50, and personal unexplained fractures (not from snowboarding, for instance) before age 50.

Several risk factors can contribute to the development of osteoporosis. Here is a list of some key "red flags" for osteoporosis.

Bone breaks: Breaking a bone as an adult could be a warning sign that the body's bones are weak.

Family history: If a person has osteoporosis, a family member may have a 60 to 80 percent chance of getting the condition.

Low dietary calcium and vitamin D: Milk and other dairy products can provide a major source of bone-building calcium to most diets. Leafy green vegetables and soybeans are also high in calcium.

Excessive smoking or drinking alcohol: Smoking reduces the body's ability to absorb calcium, and doubles the risk of an osteoporotic fracture. Drinking too much alcohol on a regular basis can likewise make a person susceptible to bone loss and fractures.

Low body weight: Thinness is an important risk factor for osteoporosis, and raises the possibility of suffering bone fractures. Frequent dieting can contribute to a loss of bone density.

A chronic medical problem: Rheumatoid arthritis, hyperthyroidism (excessive production of thyroid hormones), hyperparathyroidism (a condition caused by excessive amounts of parathyroid hormone), diabetes or liver disease increases the chance of osteoporosis.

Persistent back pain: Pain that does not dissipate could signal a spinal fracture. Spinal fractures occur when bones in the back become so weak that they fracture and collapse.

The bones of the human skeleton contain 99.5% of the total calcium in the body. The calcium within bones is available to the body should the body need it for other purposes (see the chapter on the symptoms of hyperparathyroidism for more on this topic). It is the activity of bone osteoclasts which absorb the calcium in the bone and release it into the blood stream (more about this on our parathyroid and osteoporosis page). Remember, it is the calcium within the bones which makes them strong.

The daily recommended dietary calcium intake varies by age, sex, and menopausal status. Recent studies have shown that many American girls do not get enough calcium in their diet after the age of 11. Much of this is blamed upon the substitution of sodas in the diet for milk, yet the problem does not seem to be the same for males (for a number of subtle reasons). It is important to know that many women of all ages in the US do not get enough calcium in their diet either. The vast majority of endocrinologists encourage their female patients to take supplemental calcium daily. One of the easiest and most effective methods of increasing your calcium intake is to take an oral calcium supplement daily. There are several forms of oral calcium readily available over the counter (without a perscription) such as Citracal which can help maintain healthy bones and prevent osteoporosis. The following list shows the recommended calcium intake according to age, sex and hormone status.

Will Fixing the Overactive Parathyroid Gland Help the Osteoporosis ?

YES! It has been known for many years that removing the bad parathyroid gland (or glands) (and the excess parathyroid hormone it produces) will stop the rapid and continuous loss of bone density. What was not known was whether the body would try to restore the calcium levels in the bones. Several recent studies have shown that the body will restore bone density after the excess hormone is removed. Researchers at the University of Northern Sweden studied the bone density of 12 postmenopausal women (average age 63) with primary hyperparathyroidism before and one year after parathyroidectomy

They found a significant increase in bone density in the hip and lower back one year later. This is a very slow process, and the bones will take many years to repair themselves, it does not happen overnight. In fact, depending on how much bone density has been lost, they may never regain their "normal" calcium levels and overall density. But at least we know that parathyroidectomy doesn't just stop the rapid loss of bone density, it allows the body to begin healing itself.

Osteoporosis is a condition that leads to the loss of bone mass. As a result of this condition, you are more prone to fractures even during routine activities. This animation illustrates what is going on inside the body when someone has osteoporosis. It also briefly discusses preventative measures.

$10 billion in hip fractures!

DIGESTIVE SYSTEM - Calcium may also play a role in colon health but further studies are necessary to confirm the link. Researchers have found that people who eat a lot of calcium containing foods are less likely to develop colon problems than those who eat small amounts. Calcium may exert its protective effects by binding to certain colon irritants. Calcium may also normalize the growth of cells in the intestinal wall thus protecting the colon.

BLOOD PRESSURE - Calcium deficiency can lead to high blood pressure. Increasing intake has been shown to lower blood pressure in cases where there are deficiencies. Whether calcium can lower blood pressure in cases where there are no apparent deficiencies is controversial.

MUSCLES - When calcium levels drop below normal, muscle cramps can occur as low levels of calcium in the blood can increase the sensitivity of the nerves and cause muscles to go into spasm. Pregnant women whose diets are deficient in calcium are at greatest risk of muscle cramps.

TEETH - Calcium's role in tooth development and health are well documented.Those at risk of calcium deficiency include the elderly, people who don’t eat dairy products, those on high protein or high fiber diets and those who drink a lot of alcohol. People on weight reducing diets are also at risk as calcium containing foods are often high in calories. Athletes and premenopausal women whose menstrual periods have stopped may also be at increased risk of deficiency which can lead to stress fractures, shin splints, weak bones, poor bone healing and eventually osteoporosis. Studies have shown that calcium is deficient in the diets of may women with around 35% of women suffering from osteoporosis after menopause. The average daily intake in the US is 600mg and in many countries calcium is the mineral we are most likely to be deficient in. Hip fractures cost $10 billion in the US and $175 million per year in Australia.

important, important!

SUNDAY, Feb. 11 (HealthDay News) -- In the life of a human bone, it's all downhill after 30.
That's the typical cut-off point for bone-building, so experts say it's crucial that younger people take in enough calcium and another nutrient, vitamin D, to maximize the skeleton's potential.
After age 30, those same two nutrients are key to slowing the gradual bone loss that comes with age.
Calcium isn't just important to bones, though.
"It's also important to help prevent colon cancer and for good muscle contraction, including heart muscle," said Katharine Tallmadge, a Washington, D.C., dietitian and a spokeswoman for the American Dietetic Association. "It might even be important for lowering blood pressure and helping to burn off fat."
In fact, calcium is so important to so many aspects of health that "if we don't get enough in our diet, our body pulls it from the bones," Tallmadge said. "It's a critical mineral."
The U.S. Department of Agriculture's recommended daily allowance of calcium amounts to about 1,000 milligrams a day for adults ages 19 to 50 years of age and 1,200 milligrams a day for adults over 50. While many people turn to supplements for their calcium, Tallmadge said food is always a better bet.
"I encourage people to get three high-dairy foods per day, each containing about a third of the daily requirement" she said. "That could be a cup of milk, fortified soy milk, fortified orange juice, a cup of yogurt, one-and-a-half ounces of hard cheese." Lactose-intolerant individuals should still be able to consume skim or lactate-free varieties of milk, or they can turn to fortified non-dairy products.
There are also calcium-laden food sources besides dairy products -- such as grains and vegetables -- but it's tougher for the body to get enough of the nutrient from these foods, Tallmadge said.

Calcium Interaction

Calcium is regulated by several things: vitamin D, which helps the body absorb calcium and deposit it in the bones, calcitonin, which enhances the ability of the bones to store calcium by transferring calcium from the blood to the bones and inhibiting release, parathyroid hormone, which regulates the transfer of calcium from the bones to the blood, estrogens which help retain calcium in the bones, and thyroid and growth hormones. In the absence of vitamin D less than 10% of dietary calcium may be absorbed.Lead absorption is blocked by calcium in the intestines. Boron supplementation may reduce the excretion of calcium. Aluminum containing antacids can inhibit calcium absorption. Excessive calcium can interfere with the absorption of copper, iron, magnesium, manganese and zinc.Calcium helps in the absorption of vitamin B12.Calcium and magnesium and calcium and potassium are related in that high levels of one can produce low levels of the other. Excessive potassium can lower calcium levels.Calcium and phosphorus work together to form healthy bones and teeth. If your phosphorus intake is too high your body excretes the extra phosphorus and calcium along with it.Large quantities of fat, oxalic acid, (which is found in chocolate,rhubarb and many dark green leafy vegetables) and phytic acid, which is found in grains can prevent calcium absorption. Large quantities of sucrose can enhance calcium excretion.Vitamins A and C enhance the transport of calcium through cell membranes. Vitamin B6 may enhance calcium function. High protein diets can increase calcium excretion.The contraceptive pill, anti-epileptic drugs, diuretic drugs, corticosteroid drugs for rheumatoid arthritis, asthma and IBD and some antidepressants can lead to deficiency as can smoking, malabsorption due to lactose intolerance and absorption disorders such as celiac disease.Calcium decreases the absorption of tetracycline antibiotics, iron and aspirin if taken at the same time.Caffeine and carbonated drinks can lead to calcium losses thus contributing to high blood pressure.

what is Osteoporosis ?

Osteoporosis is a condition that leads to the loss of bone mass. As a result of this condition, you are more prone to fractures even during routine activities. This animation illustrates what is going on inside the body when someone has osteoporosis. It also briefly discusses preventative measures.

Therapeutic Uses

Calcium can be used to control the incidence of leg cramps in pregnant women. It has also been shown to reduce menstrual muscle tension and stress associated with premenstrual syndrome.Use of calcium supplements during pregnancy may support normal blood pressure and normal delivery. During pregnancy, the fetus will take calcium at the expense of maternal bones. Adequate calcium is therefore extremely important during this life event.Calcium may be of benefit in the support of allergies, normal mood and sleep, muscle and joint health. Recent studies have shown that slow release calcium fluoride therapy can reduce bone fractures and increase bone density in postmenopausal women although other researchers have found that fluoride therapy can lead to calcium deficiency despite calcium supplementation.

Calcium in Early life

Getting enough calcium early in life is vital for bones to reach their maximum density so that they are as strong as possible to support the body even when they lose density later in life. Studies show that calcium intake in the 11-24 age group is often below the recommended levels with serious consequences for later life. It is never too late to slow the bone loss seen in osteoporosis and early postmenopausal years are an important time to ensure optimal intake.There may be a genetic component in osteoporosis in addition to behavioral and hormonal factors. Body weight is the factor most frequently linked to bone mineral density and in women, body fat may be at least as important as muscle in maintaining bone mineral content. Bone loss is found to be up to 11% greater during the night. Calcium levels are also lowest during the night and may be affected by the concentration of the hormone cortisol. These findings may offer new hope for the support of osteoporosis.A synthetic calcitonin nasal spray is available in the US and offers and alternative support for osteoporosis for women who cannot tolerate the estrogen therapy that is the conventional support for osteoporosis. Intake of calcium and vitamin D needs also to be adequate.