Osteoporosis is a disease characterized by low bone mass and loss of bone tissue that may lead to weak and fragile bones. The World Health Organization (WHO) in women defines osteoporosis as bone mineral density 2.5 standard deviations below peak bone mass (20-year-old healthy female average) as measured by DXA
Osteoporosis literally leads to abnormally porous bone that is compressible, like a sponge. This disorder of the skeleton weakens the bone and results in frequent fractures (breaks) in the bones.
The fracture can be either in the form of cracking (as in a hip fracture) or collapsing (as in a compression fracture of the vertebrae of the spine). The spine, hips, ribs, and wrists are common areas of bone fractures from osteoporosis although osteoporosis-related fractures can occur in almost any skeletal bone. Osteoporosis is most common in women after menopause, when it is called postmenopausal osteoporosis, but may also develop in men, and may occur in anyone in the presence of particular hormonal disorders and other chronic diseases or as a result of medications. Given its influence in the risk of fragility fracture, osteoporosis may significantly affect life expectancy and quality of life.

Osteoporosis occurs when there is an imbalance between new bone formation and old bone restoration. The body may fail to form enough new bone, or too much old bone may be reabsorbed, or both. Usually, the loss of bone occurs over an extended period of years. Often, a person will sustain a fracture before becoming aware that the disease is present. By then, the disease may be in its advanced stages and damage may be serious. The leading causes of osteoporosis are;

• Hormonal: Lack of certain hormones can lead to osteoporosis estrogen in women and androgens in males
• Diet: Inadequate intake of Calcium and vit D
• Sedentary life-style: Lack of weight bearing exercise
• Age: Women especially more than 60 years of age are effected
• Drugs: Overuse of corticosteroids (Cushing’s Syndrome)
• Diseases: Thyroid
• Personal history of fracture as an adult

The risk factors of osteoporosis can be divided into two types Non-Modifiable and Potentially Modifiable:
Non-Modifiable:

• Age: As the age increases the chances of having osteoporosis increases in both men and women especially females after menopause in males testosterone deficiency can also cause osteoporosis but is less pronounced.
• Gender: Females are more at risk than males especially during menopause when they have estrogen deficiency
• Genetic: In people who have family history of osteoporosis have double the chance of having osteoporosis.
• Race: Europeans and Asians are more at risk
• Diseases:Certain diseases increases ones chances for having osteoporosis
  • Chronic inflammation, due to rheumatoid arthritis or liver diseases
  • Immobility, such as after a stroke, or from any condition that interferes with walking
  • Hyperthyroidism,
  • Hyperparathyroidism
  • Vitamin D deficiency can result from lack of intestinal absorption of the vitamin such as occurs in celiac sprue and primary biliary cirrhosis.
  • Malabsorption (nutrients are not properly absorbed from the gastrointestinal system) from conditions such as celiac sprue
• Drugs:Certain medications can cause osteoporosis.
  • Heparin
  • Antiseizure medications such as phenytoin (Dilantin) and phenobarbital,
  • Oral corticosteroids (such as prednisone).

Potentially modifiable:

• Thin and small body frame
• Cigarette smoking
• Excessive alcohol consumption
• Lack of exercise
• Diet low in calcium
• Poor nutrition and poor general health
• High protein diet

Early in the course of the disease, osteoporosis may cause no symptoms.
Pain:

• Later in the disease it may cause dull pain in the bones or muscles, particularly low back pain or neck pain.
• As the disease progresses sharp pains may come on suddenly the pain may radiate (spread to other areas). The pains may be associated with tenderness of the affected area.It specially becomes worse by activities that tend to put weight on the affected area

Fractures:

• These are usually the first sign of the disease commonly involving the hip or bones of the wrist resulting from a fall.Spinal compression fractures may result in loss of height with a stooped posture (called a dowager's hump).

The doctor will usually begin with a careful history to determine if you have osteoporosis or if you may be at risk for the disease.
X-Ray: A routine X-ray can reveal osteoporosis of the bone because the bones appear much thinner and lighter than normal bones.
DXA (Dexa scan)
It measures bone density in the hip and the spine.The bone density of the patient is compared to the average peak bone density of young adults of the same sex and race. This score is called the "T score," and it expresses the bone density in terms of the number of standard deviations (SD) below peak young adult bone mass.

• Osteoporosis is defined as a bone density T score of -2.5 or below.
• Osteopenia (between normal and osteoporosis) is defined as bone density T score between -1 and -2.5.