Osteoporosis means "Porous bones." This is a silent disease that affects nearly 68 percent of American women, with white Caucasian and small-boned Asian (including East Indian women) being most susceptible. One out of two women and one out of four men over 50 years of age will sustain a hip, spine or wrist fracture related to osteoporosis.

Bone is a living tissue constantly broken down by resorption with the help of cells called 'osteoclasts' and replaced by new bone formation called remodeling with the help of cells called "osteoblasts."  The rate of bone loss accelerates as women enter menopause with loss of estrogen and the reduction of testosterone in older men. Often, the first symptom is back pain and the development of the typical hunchback from loss of height due to loss of bone density.

The major consequences of osteoporosis are fragility fractures that increase the rate of mortality from complications. There are two kinds of risk factors: modifiable and non-modifiable.

A major modifiable risk factor is diet-eating calcium rich foods and getting enough vitamin D are important for good bone health. The recommended allowance is 1,500 mg of calcium and 2,000 mu of vitamin D for post-menopausal women not taking estrogen therapy and adults 65 years and older. The body can absorb only 500 mg of calcium at a time, so it is important to spread your intake through the day.

Weight-bearing exercise, such as walking and weight lifting, is important to build bone-water exercises do not help you in this regard. Lifestyle factors, such as smoking or excessive alcohol intake, contribute to loss of bone density. The recommendations are not to exceed one drink per day for women and two drinks per day for men.

Non-modifiable factors are heredity, ethnicity, gender and age and family history. Being female, 50 years old and older, Caucasian or Asian puts one at a higher risk for osteoporosis. Increased age and a small-boned frame are also contributing factors to a higher risk for osteoporosis.

It's important to get a baseline bone density test done with a DXA or dual X-ray absorptiometry if one is in the high-risk category-this could be an age as early as middle 40s. Otherwise, the recommended age for a screening is 65 years old.  A bone density score of -2.5 puts one in the osteoporosis range, between -1 and -2.5 puts one in the range of osteopenia and a score of -1.0 puts one in the normal range, as per the guidelines from the World Health Organization.

Physical therapists should make sure their patients reside in a save indoor and outdoor environment. Eating a calcium-rich diet and getting enough exercise will improve balance and reduce one's risk for falls and possible fractures.

Medications available today include the SERM's (Evista); Biphosphonates: Fosamax, Actonel, Boniva; Calcitonin (a nasal spray) and Forteo, which requires a daily injection. The SERM's mimic estrogen receptors, but are not hormone based. The biphosphonates reduce the breakdown of bone, whereas Forteo helps with building the bone cells. With the exception of Forteo, all of these medications have an effect on the osteoclast activity; Parathyroid hormone injection (Forteo) is the first to affect osteoblast activity. This is a relatively new medication and fairly expensive with no long term information available yet, regarding any potential side-effects.

The University of Arizona developed a physical therapy treatment that includes the following exercise called the BEST regimen: leg press; one-arm military press, seated rows, wall squat, back extension and lat pull down.

This protocol, with the addition of calcium citrate supplementation, was studied and found to have beneficial effects on the bone density of post-menopausal women.

Bone healthy practices need to start in the teenage years with emphasis on calcium-rich foods, and an active lifestyle filled with sporting activities, such as running, strength building and walking activities. Prevention via early screening at menopause for high-risk individuals followed by adequate supplementation and exercise, safety indoors and outdoors will help to reduce the incidence of fractures and the serious consequences later in life.