Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture, according to the current definition. Bone strength reflects the integration of two main features: bone density and bone quality.

A dramatic increase in bone mineral density (BMD) occurs in adolescence, and an inappropriate diet at that time is a setup for future BMD diminution as peek bone mass is achieved in the teens or early adolescence. There is then an age-related bone loss of 0.5-1 percent per year which accelerates to 1-2 percent per year with menopause. This acceleration may last between five and 10 years.

The National Osteoporosis Foundation (NOF) states that over 10 million people in the U.S. have osteoporosis (8 million women and 2 million men) and over 34 million have low bone mass. Projections are for 14 million cases by 2020 with a projected cost by 2025 of over $25 billion annually. One third of woman by age 90 will have a hip fracture and one third of women by age 65 will have a fracture of the spine. The consequences of these vertebral fractures include loss of height, protuberant abdomen, diminished lung capacity, loss of self esteem, back pain, and deformities such as kyphosis, or dowager's hump.

The presence or history of a fragility fracture or low trauma fracture will make a diagnosis but other risk factors include loss of height, low body weight, advanced age, menopause, smoking, alcohol, medications and inflammatory conditions.

BMD should be done in these patients as well as on all women aged 65 and over. The BMD is a non-invasive painless test which identifies osteoporosis, and determines risk .

The new buzzword is FRAX, or fracture risk assessment tool, which is now being utilized to assess the 10-year probability of hip fracture alone and the 10-year probability of a major osteoporotic fracture of either the hip, wrist, shoulder or vertebral area.

The best way to deal with osteoporosis is to prevent it-focus on building and keeping bone mass.

So what type of program should you establish for total bone health? I would suggest a five- program:

1. Vitamins and minerals should include:

Magnesium 600-800 mg/day Vitamin B and antioxidant vitamins

Calcium 1200-1500 mg/day Vitamin C 1000-2000mg/ day

Trace minerals (Boron 2-12 (Vitamin C complex w/bioflavinoids)

mg/day, Strontium, Zinc, Silicon, Vitamin D 400 IU twice a day

Copper) Vitamin K 100mcg/day

Vitamin a 2,300IU/day or 700mcg Folic Acid 2.mg /day

The above may be purchased at any pharmacy or health food store. The problem is that you may walk out with a shopping bag full of products which may be quite expensive. Also, only 59 percent of patients remained adherent to the regime. A prescription medication called Folgard Os contains all of the above medications and may be a cost effective option.

From the teens to the mid-20s, about 1200mg per day of calcium are needed, for women 1200mg per day, before menopause about 800mg per day, and after menopause about 1500 mg per day to prevent osteoporosis.

• Reduce caffeine intake-caffeine may make the GI tract less amenable to vitamin and mineral absorption thus, unless reduced, you may be wasting your money on these supplements.

• Weight bearing exercise program-mandatory for good bone strength. The program should be designed to build bone in sites with increased fracture risk through exercise, specifically designed to be effective and safe for elderly patients.

• Vitamin D, the Sunshine Vitamin; a normal level is required for any treatment for diminished bone density or osteoporosis to be effective. Vitamin D is necessary for the adequate growth and mineralization of bone. It should be noted that over 90 percent of patients with hip fractures have diminished Vitamin D levels. Fifteen minutes a day in the sun helps in the production of Vitamin D.

• Medication: All patients will continue to lose 1-2.5 percent of bone density each year. The above regimen will certainly be helpful but probably not enough in already compromised patients. Thus, additional therapy may be indicated. Estrogen replacement is approved for postmenopausal osteoporosis but this therapy should only be considered for women at significant risk of osteoporosis and non-estrogen medications should be carefully considered. The bisphophanates, as a second line of defense, are a better choice. The three most common, Fosomax, Actonel and Boniva will prevent further demineralization and even lay down new bone. All three are similar in their anti-catabolic action and have slightly different statistics in their effect on the spine and hip BMD and in the reduction in total hip, spine and non-vertebral fractures. All three must be taken before eating or drinking in the morning with a large glass of water and you must not eat and remain upright for at least 30 minutes afterward.

Another choice for therapy is Evista, which has a breast protective effect and reduces spine and non-vertebral fractures. Vertebral data are comparable but its bone enhancing effects are not quite as good as the bisphosphanates. If one has a family history of breast cancer. Evista would be a good choice. Remember, 80 percent of US women diagnosed with breast cancer have no family history and advancing age is the most important of all risk factors.

There are other regimes which include a once a year treatment with Reclast, a 15-minute IV injection which bypasses the digestive system and offers protection for one year. It is given in a doctor's office or in an infusion center. The vitamin and mineral program must also be used. IV Boniva given quarterly is good if one finds oral bisphosphonates intolerable or one has severe dyspepsia. Finally, Forteo is approved for use in post-menopausal women with osteoporosis who have a fracture history or are at high risk of fracture.. It should not be used just for osteoporosis prevention. It increases the body's ability to form new bone.

Any program must include counseling.

• Discuss risk of osteoporosis and related fracture risk.
• Vitamin and mineral discussion
• Exercise discussion
• Lifestyle discussion including cessation of smoking and excess alcohol