Osteoporosis is a condition where the bones of the body have decreased mass and become weak and brittle, making them more prone to breaking than healthy bone. Bone is living tissue that is constantly being broken down and replaced. This process of destruction and creation occurs simultaneously and continuously.
As we grow, our bone mass increases constantly, which is reflected in our changing height. This rate of increase varies with age. Bone mass grows the most, and most quickly, leading up to puberty. After that the growth slows down until we reach adulthood at 25-30 years of age. Bone growth stops at this point and remains constant until approximately 35-40 years. After that bone mass slowly decreases, approximately 0.5-1% each year in both men and women. However, in women, menopause speeds up the rate of bone loss to 3-5% each year.
 

• Not receiving enough calcium, especially in childhood and adolescence, which is when bone mass increases the most.
• Genetics, such as family history of diagnosed osteoporosis. The condition can be hereditary, but diet and exercise also factor in.
• Certain medications can affect bone density, such as steroids for arthritis and asthma and heparin to treat blood clots. Radiation and chemotherapy can also affect bone health, leading to osteoporosis.
• Smoking and/or drinking alcohol on a regular basis can affect the body’s ability to absorb calcium, leading to early deterioration of the bones.
• Excessive caffeine, such as in coffee or carbonated drinks, can make bones more prone to deterioration.
• Decrease of female hormones during menopause and decrease of male hormones in the aging male affect absorption of calcium, which increases the risk of osteoporosis.
• Eating food low in calcium as you get older can increase your risk of osteoporosis.
• Exercise is important in maintaining bone strength, especially as you age. It is important to continue to be active. Sometimes the elderly may be in a wheelchair or in bed and this inactivity can affect bone health.
• Vitamin D deficiency can lead to bone loss since vitamin D is important for the absorption of calcium.

Osteoporosis does not usually present symptoms until there is a fracture so it is important to understand risk factors associated with the disease. There are two types of risk factors: those that you cannot control (non-modifiable) and those that you can (modifiable). Those with many risk factors are at higher risk of developing osteoporosis and having bone fractures due to this condition.


Risk Factors
 

Modifiable Risks	Non-Modifiable Risks
Not eating enough calcium. Not exercising. Smoking regularly. Drinking a lot of alcohol regularly. Drinking a lot of caffeine regularly. Estrogen deficiency before menopause. Body mass index (BMI) less than 19.	Age (over 65 years). Being female. Being Caucasian or Asian. Menopause before 45 years of age. Being petite. Estrogen deficiency before menopause. Oophorectomy or hysterectomy before menopause.

A bone mineral density test can definitively diagnose osteoporosis and getting tested repeatedly in a certain period of time can indicate the rate of bone loss and bone growth.
 

The results may look as follows:

• T-score    0.0        Normal range for adults.
• T-score    -1.0 to +1.0     Normal.
• T-score     -1.0 to -2.5    Abnormal weak bones, but not diagnosed with osteoporosis.
• T-score     less than -2.5    Osteoporosis.

Osteoporosis progresses slowly. If diagnosed early, you can delay progression or prevent it entirely. But since early osteoporosis does not present any symptoms, by the time patients see their doctors, it is when the bones have broken. This means that the disease has progressed significantly.
 

Osteoporosis may not directly lead to death, but it can lead to other conditions, specifically broken bones. Studies have shown that in the Thai people, after a broken hip, one in six of those patients will die within the first year. Following those patients for five years revealed that a broken hip increases the risk of death by 30% in comparison with other patients.

Osteoporosis can cause bones to break and when the hip bone is broken, patients cannot move. This in itself leads to many complications as well as reduced quality of life and burden on caregivers. Thus, patients with clear risk factors for osteoporosis should pay attention to their bone health and do what they can to prevent the disease and its progression.

There are two types of treatment for osteoporosis: with medication and without.

• Currently there are many types of medication used to treat osteoporosis, such as anti-resorptive drugs and bone-forming agents. Some medications prevent bone loss and promotes bone growth as well as includes nutrients. Osteoporosis has to be treated long-term. Patients should talk to their doctors about the right treatment for them and see their doctors regularly to monitor the progression of the disease.
• Without medication the management of osteoporosis is the same as measures to prevent it.

• Exercise regularly and focus on weight-bearing exercises like jogging, aerobics, stair-climbing, weightlifting, volleyball, football, basketball, jumping rope, etc. The elderly should not run or carry out any strenuous exercises, but should still move their bodies. They may prefer fast walking, stair-climbing, Tai Chi, and so on. Exercise at least 30 minutes three times a week.
• Eat foods rich in calcium and meet the recommended dietary intake of the Department of Health. Those 50 or under should get 1,000 milligrams of calcium each day. Those over 50 should receive 1,200 milligrams of calcium each day. If this cannot be achieved with food alone, consider calcium supplements or calcium-fortified products.
• Receive adequate sunlight for the production of vitamin D, which aids the absorption of calcium. Reports have shown that just 30 minutes of sunlight can help the skin make up to 200 units of vitamin D. The best times to be out in the sun is between 8 am to 10 am and 3 pm to 5 pm. Vitamin D supplements may be appropriate for some, depending on your doctor’s recommendations.
• Avoid behaviors that put you at risk for osteoporosis. Live an active life by making certain changes, such as taking the stairs rather than the elevator.
• Manage chronic conditions that put you at risk for osteoporosis.
• Avoid medication that can lead to osteoporosis, such as steroids, herbs, and so on.
• Adjust your environment to avoid falls, such as keep wires tucked away, keep the floors dry, use rubber mats in the bathrooms, attach the lights as needed, and change your glasses if you are having trouble seeing.

• Faculty of Pharmacy, Madihol University. แคลเซียมกับโรคกระดูกพรุน ตอนที่ 1. Available from: https://pharmacy.mahidol.ac.th/en/knowledge/article/217/แคลเซียมกับโรคกระดูกพรุน-ตอนที่1/ [Accessed 4 February 2022].
• American College of Rheumatology. Osteoporosis. Available from: https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteoporosis [Accessed 4 February 2022].
• Healthline. What Do You Want To Know about Osteoporosis? Available from: https://www.healthline.com/health/osteoporosis#risk-factors [Accessed 4 February 2022].