Osteoporosis is a condition that causes bones to become more porous (less solid and less dense), which gradually makes them weaker and more brittle. "Osteo" means bone, and "porosis" means porous.

Bones affected by osteoporosis:

• Do not have enough solid calcium and phosphorus, and steadily lose their supporting protein framework

• Become thinner and more fragile than normal

• Break more easily, particularly the spine, hip, and wrist

To maintain bone density, the body needs enough calcium and other minerals and must produce the proper amounts of several hormones, including estrogen in women and testosterone in men. In addition, an adequate supply of vitamin D is needed to absorb calcium from food and incorporate it into bones.

After age 30, bones slowly decrease in density. If the body cannot regulate the mineral content of bones, they become more fragile. The result is osteoporosis.

The human and economic costs of osteoporosis are significant. As many as 20 percent of the people who break their hip because of osteoporosis die within a year. Over age 70, the mortality within a year may increase to as much as 50 percent, and 30 percent may require help for the activities of daily living. Another 20 percent may be unable to walk for a year afterwards, and up to 50 percent cannot walk as well as they did before the fracture.

That's why preventing, detecting, and treating osteoporosis is so important.

Facts About Osteoporosis Osteoporosis, called "the bone-thinning disease," is a common condition that affects over 25 million people each year. 80 percent of people with osteoporosis are women. 80 percent of women over age 65 have osteoporosis. Osteoporosis is responsible for one and a half million fractures each year and costs $15 billion for fracture care. Fractures do heal with appropriate measures After menopause, women lose about one to two percent of their bone density each year. Although the vast majority of people with osteoporosis are women, 1.5 million men also have osteoporosis, and another 3.5 million men are at high risk. By the age of 80, nearly half of all women show on an X-ray that they have had a fracture of their spine. Yet many cannot recall any injury or incident that would have caused the fracture.

What Causes Osteoporosis?

There is no single cause of osteoporosis.

Our bodies constantly build new bone and remove older bone. In childhood, more bone is built than removed, and so the bones grow in size. After age 30 or 40, however, the cells that build new bone do not keep up with those that remove bone. The total amount of bone then decreases, and osteoporosis may develop as a result.

The average rate of bone loss in men, and in women who have not yet reached menopause, is small. But after menopause, bone loss in women accelerates to an average of one to two percent a year.

This is because after menopause, the level of the female hormone estrogen in a woman's body sharply decreases. Estrogen protects the skeleton by helping the body's bone-forming cells to keep working. After menopause, when the level decreases, some of this protection is lost.

How-To Information: Activity stimulates new bone formation, but immobility (for example, after a bone fracture) can result in bone loss. This is called osteopenia, which means "bone deficiency." People immobilized by bedrest and astronauts on weightless space flights have loss of bone density. Weight-bearing exercise is vitally important to help keep osteoporosis from developing.

Are You At Risk?

Some people are more likely than others to develop osteoporosis.

Are You At Risk?

Some people are more likely than others to develop osteoporosis.

• Risk factors

• Why your teenager should be concerned

• Can men be affected too?

Risk Factors

Certain risk factors greatly increase the chance of someone developing the condition. These risk factors are:

• Menopause in women. The risk of developing osteoporosis is much higher in women after menopause. In fact, the earlier the menopause, the greater the risk. Most women, on average, begin menopause at age 45 to 55. After menopause, the ovaries produce less estrogen, which results in less bone formation and more bone loss.

• Hysterectomythat included removal of the ovaries. Younger women who have had both ovaries removed as part of their hysterectomy are also at higher risk. Younger women who have had a simple hysterectomy, with their ovaries left intact, are not at higher risk.

• Age and gender. After we reach maturity, there is a gradual decrease in the total amount of bone formed, compared to the amount of bone removed. After age 30 or 40, this may lead to a gradual loss of bone, which occurs more rapidly in women than in men. At first, the loss is so gradual it cannot be detected. But people over age 40, and women in particular, are at increased risk.

• Race. Although osteoporosis is common in people of northern European heritage, recent studies show that low bone mass is actually common in many populations, including Caucasian, Hispanic, American Indian and even African-American. It is no longer thought to be simply a problem of older white women.

• Cigarettes. Smoking cigarettes may double the risk of developing osteoporosis. This is most likely because smoking lowers the estrogen level in the blood.

• Family members with osteoporosis. The risk of developing osteoporosis seems to be higher if other blood relatives have the condition. This is particularly the case for women whose mothers have osteoporosis.

• Women who are underweight. Women who are underweight for their height often develop osteoporosis more rapidly. Women who are overweight actually have less chance of developing osteoporosis. This may be caused by a difference in the production of estrogen in overweight women.

• Lack of regular exercise. Regular exercise helps to delay osteoporosis and can even reverse its progression. On the other hand, lack of exercise can make people much more vulnerable to osteoporosis. Exercise, especially weight-bearing activity such as walking, stimulates the bone cells to be more active and to produce stronger bone. Without weight-bearing activity, bones may become less dense and weaker.

• Use of certain medications. Certain medications may increase the risk of developing osteoporosis. They seem to increase bone loss and decrease bone formation. The most common are cortisone-like drugs (used for asthma, lung disease, arthritis, and allergies). This is especially true if these drugs are used in high doses or are taken for three months or more. Using these drugs for a few days, or even a few weeks, usually will not increase your risk of developing osteoporosis. Thyroid medications may also contribute to osteoporosis if taken in high doses.

• Medical problems. Certain medical conditions are likely to increase the risk of developing osteoporosis. These conditions include rheumatoid arthritis, chronic bronchitis and emphysema, hyperthyroidism (overactivity of the thyroid gland), malnutrition (especially when associated with heavy alcohol use), chronic liver disease, and some forms of intestinal disease.

• Low calcium or vitamin D in your diet. If your diet is consistently low in calcium over the years, especially during the growth years, your risk of developing osteoporosis is increased. Calcium deficiency leads to less bone formation. Vitamin D is needed to help the body absorb calcium and maintain bone.

How-To Information: Here are the risk factors you are able to change: Smoking cigarettes Being underweight Lack of exercise Use of certain medications Low calcium or vitamin D in your diet Here are the risk factors that cannot be changed: Menopause Having had a hysterectomy with ovary removal Age and gender Race Family member with osteoporosis Medical problems

Why Your Teenager Should Be Concerned

Teenage girls in particular need to be aware that osteoporosis in future years can be prevented.

During the teenage years, the bones are developing rapidly. Recent research has found that bone mass in women may peak as early as their early 20s. If teens get enough calcium, chance are good that their bones will have maximum development and strength.

But the foods that are the best sources of calcium - such as milk and cheese - also contain high calories. As a result, some calorie-conscious teens will eliminate these foods from their diet and may pay the price in later years. If calcium in their diet is consistently low, teens may need a calcium supplement to compensate.

In addition, high levels of phosphates, often found in soft drinks, can cause calcium loss from the bones. For this reason, experts recommend that teens limit their intake of soda.

Can Men Be Affected Too?

Yes. Twenty percent of the people who have osteoporosis are men. A leading medical researcher says that 1.5 million men have osteoporosis and another 3.5 million are at high risk. Experts believe that a decrease in the production of the male hormone testosterone, which happens as a natural part of aging, can accelerate osteoporosis.

Unfortunately, in a recent Gallup survey, a majority of men questioned believed they could not get osteoporosis. The lack of knowledge about osteoporosis and its complications are particularly dangerous because osteoporosis has no early warning.

Therefore, the same prevention advice for women is important for men, too.

Nice To Know: Q: I'm an older man who has emphysema and has smoked most of my life, though I recently stopped. Do men really have to worry about getting osteoporosis? A: So much attention has been given to women that osteoporosis may be overlooked in men. Hip fractures are just as limiting and dangerous in men as in women. Risk factors that are common in men who develop osteoporosis are chronic lung disease such as emphysema and chronic bronchitis, as well as the medications often used to treat it. You can help by consuming proper amounts of calcium, exercising as allowed by your physician, and removing any other risk factors.

What Problems Can Osteoporosis Cause?

Osteoporosis alone does not produce any symptoms. Most people with this condition are unaware that their bones are thinning until they experience a fracture.

The good news is that a simple imaging procedure, called a bone mineral density (BMD) test, can detect osteoporosis before a fracture occurs.

Osteoporosis And Fractures

If the bones become thin enough, fractures may occur from a minor fall, after lifting something heavy, and even just from walking. The fracture usually heals with treatment. But if osteoporosis progresses, more fractures may occur.

When fractures occur in the spine, the bones in the spine may become shorter. These are called "compression fractures," and people with severe osteoporosis may sustain two, three, or even more. This is a common way older people lose height.

Spine fractures can also change the square-shaped bones of the spine to wedge-shaped. This can result in a stooped posture.

By the age of 80, nearly half of all women show a spinal fracture on an X-ray. Yet many cannot recall any injury or incident that would have caused the fracture.

Unfortunately, the joint surface alignment in the spine may become distorted, and the joints may therefore wear down. This can cause arthritis in the spine and pain.

Surgery to deal with a fracture may be more difficult on osteoporotic bones, because thinner bones might be unable to firmly hold devices such as rods and screws, which may be necessary to repair the fracture.

How Can You Tell If You Are Developing Osteoporosis?

If your health care provider thinks that you may have or may be at risk for osteoporosis, you may need a bone mineral density (BMD) test (also referred to as a bone density test), which can detect osteoporosis and allow effective treatment to start.

A BMD test can help your physician confirm a diagnosis of osteoporosis even before broken bones happen. The test can help in several ways:

• BMD testing can is one of the most accurate ways to assess your bone health

• When repeated over time, it can be used to monitor your rate of bone loss

• It can detect osteoporosis at its earliest stage, before the first fracture so that easy and effective treatment can begin sooner

• If you are being treated for osteoporosis, BMD testing can help your physician monitor your response to the treatment

DXA or DEXA (dual energy x-ray absorptiometry) (hyperlink glossary) is the gold standard for bone density measurement. DEXA delivers only about one-tenth the radiation dose of a chest X-ray. It is performed while you are lying in on a cushioned table, while a scanner passes over your body. In most cases you won't even need to undress. Other tests can measure bone density at the heel or the wrist. These are often used as a screening test because they are easy, quick, and inexpensive. If one of these is abnormal, then you should have the standart DEXA of the hip and lumbar spine, which can be used to follow treatment and improvement.

Regular bone density testing can be important in combating osteoporosis in certain people. It is recommended that those who are at higher risk should have a bone density test.

Many insurance companies today will pay for bone density testing under certain circumstances. Most experts agree that allwomen over age 65 are at risk and should have bone density tests. Other women who should have the test include those who have had any fracture, especially after menopause. Men who have had a spine or hip fracture should have the test, as well as women and men who take prednisone for more than three months.

Is All Bone Density Testing The Same?

Some care providers now offer simple bone scans as part of health fairs or screenings. One such scan measures your heel bone density to check for signs of osteoporosis. Health care professionals caution that these tests don't always produce results that are as accurate as the DEXA bone density test, but can be a good first step screening to decide if a DEXA test of the hip and spine is needed.

Nice To Know: Q: In order to keep track of the progression of my osteoporosis, my doctor wants me to have regular bone density exams. But aren't X-rays risky? A: The methods involved in osteoporosis screening tests used today are very safe. The exposure to radiation is very low and considered by most experts to be quite acceptable. And bone mineral density exams have high value in monitoring the progression of osteoporosis and the effectiveness of treatment.

How You Can Prevent Osteoporosis

Preventive measures may reduce or stop bone loss.

The earlier these measures are begun, the more effective the results. If you suspect you're at risk for osteoporosis, it's wise to address it now, before a bone fracture occurs.

Preventing osteoporosis involves making a few changes in your diet, getting enough exercise, and considering whether the available medication is right for you.

• Calcium

• Vitamin D

• Exercise

• Hormone replacement therapy

• Medication (Fosamas, Evista)

Calcium

One of the most important ways to help prevent osteoporosis is to get enough calcium in your diet. Here is the recommended daily dietary allowance of calcium for various age groups:

• Children, age 1-10- 800 mg daily

• Teenagers, age 11-18- 1,200 mg daily

• Pregnant teens - 1,600 mg daily

• Pregnant women, age 19 and older - 1,200 mg daily

• Breast-feeding women - 1,200 mg daily

• Adults, male, up to age 65 - 1,000 mg daily

• Adults, male, over age 65 - 1,500 mg daily

• Adults, women, before menopause - 1,200 mg daily

• Adults, women, after menopause - 1,500 mg daily

Nice To Know:
Here are some examples of calcium content in foods:
Food	Amount	Calcium
Orange juice with added calcium	6 oz	200-300 mg
Dry cereal with ½ cup milk	1 oz	150-350 mg
Flour, self-rising	1 cup	300 mg
Cheese lasagna	8 oz	220 mg
Macaroni baked with cheese	1 cup	360 mg
Oatmeal with milk	1 oz	160-170 mg
Pizza, cheese	10" diameter	620 mg
Cheese, sliced American	1 oz	150-200 mg
Cheese, cheddar	1 oz	210 mg
Cheese, swiss	1 oz	270-300 mg
Cottage cheese, 1% milkfat	8 oz	140 mg
Milk, calcium fortified	8 oz	500 mg
Milk, skim, whole, 1%, or 2%	8 oz	300 mg
Milkshake, average	8 oz	450 mg
Yogurt, frozen, high-calcium	8 oz	500 mg
Yogurt, frozen (most flavors)	6 oz	150 mg
Yogurt, soft frozen	6 oz	120 mg
Yogurt, 1% milkfat	8 oz	400 mg
Puddings, instant or cooked, average	8 oz	150-250 mg
Sardines, canned with bones	8 medium	350-450 mg
Oyster stew made with milk	1 cup	280 mg

Manufacturers sometimes add extra calcium to foods such as orange juice and breakfast cereals. The Nutrition Facts label on the package will tell you how much calcium is contained in the foods you eat.

In addition, calcium supplement tablets are available over-the-counter. Products to help acid indigestion, such as Tums and Di-Gel, now have added calcium ranging from about 100 to 300 mg per tablet.

Vitamin D

One of the uses of vitamin D by the body is to help absorb calcium from the intestine. Some people with osteoporosis have a lower level of vitamin D and a less effective absorption of calcium as a result. Vitamin D is either made in the body from exposure to sunlight or is taken through foods.

The recommended daily allowance for vitamin D is 400 IU. You can increase that to 800 IU, especially if you don't get enough in your diet and don't get much sun exposure. Don't take any more than that per day, unless your physician has recommended a higher dose.

Exercise

One of the best ways to forestall osteoporosis is to do regular weight-bearing exercises.

Begin a regular exercise program and stay with it. Start light and gradually build up to 30 to 40 minutes of exercise several times a week. Of course, consult your physician before you begin any exercise program and if you feel pain after you've begun.

Although swimming is not a weight-bearing exercise, it can be excellent for strengthening the muscles in your back. The stronger the back muscles, the stronger and more dense the bones of the spine. Exercising in the water is also a good option for individuals with arthritis or others who experience pain with weight-bearing exercise.

Keep in mind that it is possible to get too much exercise. Some women athletes who train excessively and exercise strenuously may alter their hormone production so severely that their menstrual periods stop, a condition called amenorrhea. This can lead to osteoporosis and fractures.

Here are some of the many benefits of exercise:

• Maintaining bone condition. The pull on the bones from exercising muscles helps to maintain bone density and strength.

• Improving your posture. Exercising the back muscles helps the whole body become more upright. This can help avoid the "bent-forward position" that can develop with osteoporosis.

• For general fitness. This is important for everybody, but especially for individuals with osteoporosis.

How-To Information: Here are some good weight-bearing exercises you may want to consider: Walking Hiking Jogging Running Jumping rope Aerobic dancing Ballroom dancing Gymnastics Tennis Racquetball Squash Handball Rowing Weight training Basketball Volleyball Cross-country skiing Bicycling, to some extent

Hormone Replacement Therapy

Menopause, as well as surgical removal of the ovaries, causes estrogen production to decrease. Low estrogen levels make women more vulnerable to osteoporosis. Women can protect themselves by taking estrogen to replace what their ovaries no longer produce naturally. This is called hormone replacement therapy.

Studies have shown that osteoporosis can be prevented or delayed if estrogen treatment is begun within the first few years of menopause. Hormone replacement therapy is considered both an effective treatment and a preventive measure for osteoporosis.

Hormone replacement therapy has been shown to entirely restore the rate of post-menopause bone loss to the pre-menopausal rate. It may even replace a small amount of bone already lost.

It also controls hot flashes, vaginal dryness and other symptoms which can happen around the time of menopause.

For many years, hormone replacement therapy has been routinely given to women at menopause. In addition to osteoporosis prevention, it was thought to lower the risk of coronary heart disease and heart attack. Recent evidence shows that hormone replacement therapy may not prevent coronary heart disease or stroke and that it may increase the risk of breast cancer or ovarian cancer. The possible side effects of hypertension and the increase in risk of blood clots in some women have been known for years.

Estrogens are given either as tablets or as a skin patch that is replaced periodically. Hormone replacement therapy often includes a combination of estrogen and progesterone. Estrogen given alone is associated with an increased risk of uterine cancer, but that risk is eliminated when progesterone is added. Progesterone is not necessary for women who have had a hysterectomy(removal of the uterus).

Although hormone replacement therapy (HRT) has obvious and proven benefits, they must be weighed against possible long-term effects. It remains effective for prevention and treatment of osteoporosis and for relief of menopause symptoms. However, whether to begin hormone replacement therapy is a decision every woman must make for herself. Try to learn all you can about the facts, benefits, and risks. Your health care provider can help you determine what is right for you.

For more information about hormone replacement therapy, go to Hormone Replacement Therapy.

Medication

New medications have been approved by the U.S. Food and Drug Administration (FDA) for the prevention of osteoporosis: Fosamax (alondronate), Actonel (residronate), Evista (raloxifene) and Miacalcin (nasal calcitonin).

• Alendronate (Fosamax) - This is the first in a new class of drugs approved by the FDA for both preventing and treating osteoporosis. It has been shown to increase healthy bone and reduce the risk of spinal fractures by 70 percent and hip fractures by over 50 percent in women with osteoporosis. The bone density increases within a few months in over 90 percent of patients and the risk of fractures improves within the first year.

  Data from clinical trials show that, over three years, Fosamax builds healthy bone at the spine and hip and other sites by as much as 10 percent compared with people not taking Fosamax.

  Fosamax can be taken weekly or daily (most patients prefer weekly). It is recommended that it be taken once you're up for the day, in the morning before breakfast with a glass of water and no other food or drink for 30 minutes. Certain individuals, such as those with digestive problems or severe kidney disease, should not take Fosamax. If you have esophageal narrowing (stricture) then you should not take Fosamax until you talk to your doctor. Fosamax is usually well tolerated, but if indigestion or heartburn occur, then check with your doctor.

  Fosamax is not a hormone and does not affect menopause symptoms. It is used in women and men with osteoporosis. It can be given along with Evista or hormone replacement therapy. This often gives a larger increase in bone density than using one of the medications alone.

• Risedronate (Actonel) - This medication is also in the new class of drugs used to prevent and treat osteoporosis. It increases healthy bone and bone density in over 90 percent of patients. It lowers the risk of fractures in the spine by 70 percent and lowers fractures in the hip by 60 percent in women with osteoporosis. Bone density increases within a few months and the lower risk of fractures in the spine and hip happen over the first year.

  Actonel can be taken weekly or daily (most patients prefer weekly). It is recommended that Actonel be taken in the morning on arising, with a glass of water and no other food or drink for 30 minutes. If you have had narrowing (stricture) of the esophagus, check with your doctor before you take Actonel.

  Actonel can be combined with Evista or hormone replacement therapy. This treatment usually gives a large increase in bone density than either of the medications alone.

• Raloxifene (EVISTA) - EVISTA has been approved by the FDA for the prevention of osteoporosis in postmenopausal women. Raloxifene is a member of a new class of drugs known as selective estrogen modulators (SERMs). SERMs are designed to mimic the beneficial effects of estrogen on the bone, without negative effects on the uterus and breast.

  Evista lowers the risk of fractures in the spine and has not been shown to lower the risk of hip fractures. It can be given along with Fosamax or Actonel with a greater increase in bone density usually found than with either drug alone.

  Studies have shown raloxifene to be less effective than estrogen in increasing bone mineral density, but it is not associated with increased risk of uterine cancer. Evista lowers the risk of breast cancer by 70 percent. Therefore, it is an alternative for the prevention of osteoporosis for women who are unwilling or unable to take estrogens. Side effects include hot flashes and leg cramps.

• Calcitonin (miacalcin) -is a hormone that slows the removal of bone. It has been shown to reduce the risk of spine fractures but does not lower the risk of hip fractures. An additional advantage of calcitonin is its analgesic properties, which help relieve the bone pain that can occur with established osteoporosis.

  Until recently, calcitonin was available only in injected form, which can be inconvenient. Today, a nasal spray (Miacalcin) has been approved. The most common side effect is rhinitis. Miacalcin is used most commonly when other medications described above are not able to be taken.

How-To Information: HRT or the newer medications? Until recently, the only therapy known to prevent osteoporosis after menopause was to take estrogen, in the form of hormone replacement therapy (HRT). HRT has definite health benefits for women, but it has some risks, too. Benefits and risks vary for each person, however, and must be weighed against each other. The decision to take HRT is a personal one. A woman's physician is the best source of advice on what is right for her. Most women choose to take HRT for relief of menopause symptoms (such as hot flashes and vaginal dryness) and for protection against osteoporosis. Women who choose not to take HRT now have the option of taking a variety of medications, for the prevention of osteoporosis. These medications do not relieve menopause symptoms or protect against heart disease, however. But if a woman is not experiencing unpleasant menopause symptoms and is not at high risk for heart disease, they may be another option for keeping her bones strong.

Nice To Know: The following may afford protection against osteoporosis: Late menopause Moderate exercise Adequate calcium in your diet Adequate amounts of fluoride in your water Normal or increased body weight Use of oral contraceptives before menopause Childbearing Black or Afro-Caribbean ancestry Hormone replacement therapy after menopause Taking alendronate or raloxifene

Living With Osteoporosis The good news is that almost everyone with osteoporosis can be treated successfully. The newer medications on the market today (described in How You Can Prevent Osteoporosis) [hyperlink to that section] are considered breakthroughs in the treatment of osteoporosis. But treatment begins after the diagnosis, which is quick and easy with your bone density test -- before the first fracture. Knowledge is the key. The more you know about the prevention and treatment of osteoporosis, the better your chances of staying active and independent. The key to managing osteoporosis is to prevent as much bone loss as possible with a good diet, healthy habits, and proper exercise. If you have been diagnosed with osteoporosis, there are certain things you can do to help yourself stay as active as possible. Helpful Exercises Certain exercises can benefit individuals with osteoporosis (and those who may be at risk). Be sure to discuss these exercises with your health care provider or physical therapist. Back stretching - This is a good exercise to help you limber up for the day even before you get out of bed. It stretches the hips, the lower back, and knees. These exercises can be done on the bed or the floor. Pull one knee (at a time) to your chest. Place your hands under your knee to help pull the leg in further. Now do the same with the other leg. Repeat, alternating legs. Begin with five repetitions, two or three times a day, and gradually build up to 20 repetitions. Now pull both knees to your chest, at the same time, and hold for six seconds. Gently rock side-to-side while holding your knees. Cheek to cheek - This is a fun exercise because you can do it anywhere, anytime, and practically in any position. This exercise strengthens the muscles of the buttocks, which help support the back and legs. If you do it when you are sitting down, you'll find that you rise up out of your chair a little as you contract the muscles. Press your buttocks together, and hold for a six-second count. Relax and repeat. Gradually increase up to 5, then 10, then 20 repetitions. Repeat two times daily. You can do this exercise as often during the day as you'd like. Frequent repetitions will not hurt you. Pelvic tilt - This is one of the best exercises you can do to strengthen your abdominal muscles. This, in turn, will help support your back. You can do this one in bed or on the floor; depending on which is more comfortable. Lie down and bend your knees. Next, relax and raise your arms above your head. Then tighten the muscles of your lower abdomen and your buttocks at the same time, so that you flatten your back against the bed or floor. Hold this flat-back position for a six-second count. Then relax and repeat. Bridging - This exercise strengthens the muscles in the back. It is done lying in bed or on the floor. Lie on your back and bend your knees. Now lift your hips and buttocks off the bed or mat 4 to 6 inches, making sure that you keep the small of your back nice and flat. Tighten your buttock and hip muscles to maintain this position, and hold for a count of six. Then, relax and lower your hips and buttocks to the floor. Repeat this exercise twice daily. Gradually increase your repetitions, per set, to 5, then 10, then 20. Straight leg raises - This exercise strengthens the muscles of the abdomen and improves the flexibility of the legs. Lie on your bed or on the floor, whichever is more comfortable for you. To protect your back during this exercise, hug one leg to your chest, or simply bend your knee, and rest the foot on the bed. Now raise your other leg straight up, slowly, as far as you can, until you feel your back begin to arch. Try to keep your abdomen in. Keep your back firmly against the floor or bed as you did in the pelvic tilt. Hold the position for six seconds. Bend and lower the leg, and repeat the exercise. Now do the same with the other leg. Repeat this exercise, gradually increasing to 5, then 10, then 20 repetitions. Partial sit-up - This exercise strengthens the muscles of the abdomen. You can do this exercise on your bed or the floor. Lie on your back with your knees bent. Raise your head and shoulder blades off the floor, and hold the position for a six-second count. Slowly return to lying on your back with your knees bent. Repeat. Start this exercise with only one or two repetitions, until your body adjusts to it. Gradually increase to 5, then 10 repetitions. Back extension - This exercise for strengthening the back muscles is done lying on your bed or the floor, stomach down. Raise your head, arms, and legs off the floor. Do not bend your knees. Keep your torso straight. Hold for several seconds while you count out loud. Relax and repeat. Gradually increase this exercise up to 5, then 10 repetitions. If you experience discomfort, stop. Get the okay of your doctor or physical therapist before you try it again. Cat camel - This exercise strengthens your back muscles. Skip it if you have painful knees, ankles, or hands, because it places pressure on these areas. Pretend you are going to crawl, and place your hands directly beneath your shoulders. Take a deep breath and arch your back the way a frightened cat does, and lower your head. Hold the position while you count six seconds out loud. Then, exhale, lower your back slowly, and raise your head. Wall push - This exercise helps to stretch your body. Stand spread-eagle against a solid wall. Now arch your back inwards slowly. Repeat this exercise and gradually increase repetitions from 1 to 5 or more. This exercise is fun because you can do it anytime you feel you need a good body stretch. Repeat two times daily. Deep breathing - This exercise improves your posture and gives you better movement through your chest. Lie down on your back and place your hands behind your head. Then, breathe deeply and raise your chest, while you fill your lungs completely. Hold for two seconds. Then exhale by drawing your upper abdomen in (keep your chest extended). Take the next breath against the uplifted chest. Begin this exercise slowly. Gradually increase the repetitions from 5 to 10, then up to 20. Increasing Calcium In Your Diet One of the best ways to help slow the progression of bone loss is to get enough calcium in your diet. Here are some practical ways to increase the calcium your consume: Include 3 to 4 servings of calcium-rich products daily in your diet. Milk, cheese, and yogurt all contain lactose, which enhances calcium absorption. If you are counting calories, instead of excluding dairy products, choose low-fat or skim milk products. Drink vitamin D-fortified milk and get some exposure to the sun (use a good sunscreen to avoid skin damage). Avoid a diet high in fat and protein, as excessive fat and protein can interfere with calcium absorption in the intestine. Caffeine in coffee has also been implicated in calcium loss, so avoid drinking too much. Preventing Injuries And Falls Hip Protectors If you have osteoporosis and feel unsteady or have problems with falls, you can wear a simple protection to prevent hip fractures. Hip protectors are simple and comfortable - mcuh like a pair of underwear which can be worn under a dress or pants. Tests show that in those who fall, hip fractures may be reduced by as much as 50 percent if hip protectors are worn. They can be purchased at a medical supply store or ask your doctor for help in finding a pair. It's important to take extra care to avoid injury if you have osteoporosis. You can do this by making sure your home is safe. Here are the most common causes of falls: Slippery carpets, poor footwear Fainting brought on by irregularity in heart rhythm or another condition that results in low blood supply to the brain Sleeping pills or other medication that makes you drowsy Excess alcohol Muscle weakness Poor eyesight Impaired nerves in your legs Impaired balance as in Parkinson's disease Nice To Know: Use this checklist to address problems in your home that could cause you to fall and injure yourself. Home Entrance: Walkways should be level, with cracks repaired. Lawn equipment and toys should be put away. Water hoses should be coiled or placed next to house. Doormats should be flat on the ground with no turned-up edges. Any steps leading into the home should be easy to see, and at the proper height. Adequate porch and outside lighting are essential. Living Room: All electrical cords should be placed next to the wall or behind furniture. You should be able to walk through the room without being obstructed by furniture. Rugs should be flat on floor, anchored down, or have nonskid mats under them. Avoid all waxes or floor shines that may cause slippery floors. Bedroom: Keep bedspread or dust ruffle at least one inch off the floor to avoid tripping. Bed should be kept away from the wall for easy access when changing linens. Electrical and telephone cords should be placed behind furniture. Shoes should be organized in a shoebag hanging in the closet. All accessories should be at easy-to-reach level and organized on shelves. The room should be well-lit. Bathroom: Use flat, nonskid rug on the floor to avoid slipping. Use nonskid bathmat in tub or shower. Install an easy-to-reach shelf in tub or shower bath products and soaps. Use liquid soaps to avoid slipping on bars. Keep the bathroom well-lit. Buy a nightlight for the bathroom and keep it on. Store the medicines you use most frequently on the lower shelf in your cabinet. Install grab bars in shower and by toilet. Kitchen: Place a nonskid mat by sink. Smooth any rough edges that could cause you to trip. Avoid floor wax and shine products. Keep rarely-used items on the top shelves. Pots and pans should be stored where you can easily reach them. Stack plastic and glass items on lower shelves. Store items you use daily, such as plates, bowls, glasses, and pans, at waist-to-eye level. This will help you avoid straining when you reach for them. Kitchen table and chairs should be well-balanced. Other Tips for Fall Prevention: Go slow - falls may occur when you hurry. Think before moving - carelessness adds to the risk of injury. Don't hesitate to adjust or fix anything in your environment that you think could lead to a fall. Pain Control When osteoporosis causes fractures, bone pain can range from mild to severe. Pain relievers such as acetaminophen (such as Tylenol), aspirin, ibuprofen (such as Advil or Nuprin) or naproxen (Alleve) can help. Stronger pain relievers require a prescription and may be needed immediately after the fracture for a few days or weeks.. For fractures of the spine, along with pain medication, moist heat applied to the back twice daily for 10 to 15 minutes can greatly relieve pain as the fracture improves. Then, gradually resume activity and exercises as recommended by your doctor. For other fractures, you doctor can guide your activity and exercise. Another method of pain control involves electrical stimulation of the skin overlying the area of discomfort. A pad attached to a portable battery can relieve pain by stimulating nerves in the region. This is called Transcutaneous Electrical Nerve Stimulation (TENS), and it is available in many physical therapy departments. If pain becomes chronic, other methods are available for relieving it to allow you to increase your activity. Medications for pain, physical therapy to guide exercises, TENS, and other methods can change pain from terrible to inconvenient and manageable. Your doctor can guide   Frequently Asked Questions Here are some frequently asked questions related to osteoporosis. Q: I've been allergic to milk since infancy. Do I have any hope of avoiding osteoporosis? A: Milk and dairy products are the main sources of calcium in our diet. If you have a true allergy to milk, you must avoid all milk products. But it is common to have an intolerance to milk without a true allergy. In this case, products are available that can be added to milk to make it digestible. At any rate, you should simply supplement your diet with calcium. Also, you should review your risk factors for osteoporosis and take steps to remove as many as possible. Q: I'm an older man who has emphysema and has smoked most of my life, though I recently stopped. Do men really have to worry about getting osteoporosis? A: So much attention has been given to women that osteoporosis may be overlooked in men. Hip fractures are just as limiting and dangerous in men as in women. Risk factors that are common in men who develop osteoporosis are chronic lung disease such as emphysema and chronic bronchitis, as well as the medications often used to treat it. You can help by consuming proper amounts of calcium, exercising as allowed by your physician, and removing any other risk factors. Q: I'm a 63-year-old woman who recently fractured my wrist playing golf. Should I have further tests to determine if I have osteoporosis? A: A wrist fracture is one of the most common types in osteoporosis (in addition to hip and spine fractures). If your fracture happened with only mild injury, osteoporosis is the most likely problem. Your physician may be able to tell if your bones have osteoporosis from your wrist X-ray, but in many cases this is not possible. It would be wise for you to have a bone mineral density test to check for osteoporosis. Q: My teenage daughter is constantly on the go, and I'm not sure she's getting enough calcium in her diet. How can I be sure that she will be protected in her growing years? A: Try to prepare balanced meals with calcium-rich foods, which will benefit the entire family. If maintaining 1,200 mg of calcium a day is still difficult, consider adding a calcium supplement for teenagers. Also, education of teenagers has been shown to be very effective. Help your teen find ways to be sure of calcium intake that can fit with her desire for weight control. Q: I hate to exercise. The thought of long walks or playing tennis doesn't appeal to me. Is there something else that I can do to help myself? A: Many people do not have an exercise program or do not follow one regularly. But think about your daily activities. You might be able to incorporate a reasonable amount of exercise in your daily routine. For example, do you have stairs at work or at home? Walking and stair-climbing certainly counts as weight-bearing exercise. In parking lots, try parking at a further distance from your destination and walk. Even brief exercise is better than none at all. Q: In order to keep track of the progression of my osteoporosis, my doctor wants me to have regular bone density exams. But aren't X-rays risky? A: The methods involved in osteoporosis screening tests used today are very safe. The exposure to radiation is very low and considered by most experts to be quite acceptable. And bone mineral density exams have high value in monitoring the progression of osteoporosis and the Putting It All Together Here is a summary of the important facts and information related to osteoporosis. Osteoporosis means thinning of the bones. If bones become thin enough, they break more easily. After fractures, activities can be limited and the risk of death may increase, especially after age 65. Osteoporosis may not be outwardly apparent until a fracture occurs, but it can be detected before the first fracture with a bone density test. Osteoporosis occurs in both sexes but is more common in women. Tests to detect the condition at its earliest and most easily treated stage are easy, quick, and safe. There are effective ways to prevent many of the causes of osteoporosis. Some people are at much greater risk of developing osteoporosis, but they can reduce this risk by removing certain risk factors. Osteoporosis can be prevented with some simple lifestyle measures. It is never too early to take preventive action against osteoporosis and never too late to begin treatment to prevent future fractures. Today, therapies exist that not only can reverse osteoporosis, but also lower the chance of fractures in the spine, hip, and wrist. Glossary Here are definitions of medical terms related to osteoporosis. Bone mineral density (BMD) test: A low-dose X-ray examination of the bones, used to assess bone health Calcitonin: A hormone that may decrease the rate of bone removal; sometimes used in the treatment of osteoporosis Calcium: A chemical element important for bone formation Compression fracture of spine: A fracture in one of the spinal vertebral bodies; when this happens, the usual rectangular shape of the bone becomes compressed and distorted Density of bone: The amount of mass present in a certain area of bone; density usually refers to the quantity of something per unit of volume Dowager's hump: A term to describe the upper-back protrusion that is commonly seen in older women Dual Energy X-Ray Absorptionmetry (DEXA): A method that uses low dose X-rays for testing bone density Estrogen: One of the female sex hormones, produced by the ovary and important in bone formation in women Fluoride: A chemical element that is sometimes used to treat or prevent osteoporosis Fracture: A break in a bone Hysterectomy: Removal of the uterus (womb) by surgery Menopause: The time in which the end of menstruation occurs in women, most commonly from age 45 to 55, when estrogen production by the ovaries decreases or stops Osteoporosis: A bone disease in which the density of the bone is decreased because of a decrease in the amount of bone tissue present Ovary: One of the female reproductive organs; it produces ovum (eggs) and the female sex hormones Pelvis: The bones formed by the ring of bones that support the spine Phosphorus: A mineral the body needs for bone and tooth formation, energy production, and other purposes Progesterone: One of the female sex hormones; it helps regulate the menstrual cycle Risk factors: In osteoporosis, it is any of the conditions that increase your chances of developing osteoporosis Uterus: The female organ in which the fetus develops; also called the womb Vertebra: One of the single bones of the spinal column Vitamin D: One of several nutrients needed by the body for the use of calcium in bone formation Weight-bearing exercise: Activity such as walking, running, or climbing, which brings the weight of the body to bear on the skeleton; such exercise helps fortify the bones   Additional Sources of Information Here are some reliable sources that can provide more information on osteoporosis. The National Osteoporosis Foundation offers a free kit for men entitled "Bone Wise Strong Bones for Life." It is available by writing to the National Osteoporosis Foundation, P.O. Box 96616, Dept. MQ, Washington, DC 20077 A wealth of information and patient stories are available on the International Osteoporosis Foundation Web site at http://www.osteofound.org/ The Osteoporosis Society of Canada offers an on-line "Calcium Calculator" (available in both English and French) to help you decide if you need a calcium supplement. It's available at http://www.osteoporosis.ca/