Which tests are used to evaluate osteoporosis will depend on your age, symptoms, and current health. In determining a patient’s risk from bone loss, a doctor is likely to use BMD test and FRAX calculator The USPSTF recommends using FRAX to calculate risk with subsequent testing of the following groups: All women 65 and older Women 50-64 with 10-year risk of fracture of 9.3% or more FRAX Fracture Risk Assessment Tool Is a fracture risk assessment tool that allows for calculation of future risk of fracture based on patient characteristics Calculates the 10-year risk for osteoporotic fractures FRAX is a free online tool, invented by the World Health Organization, that accurately predicts a patient’s risk of fracture. Because osteoporosis is so common among people over fifty, FRAX is particularly useful to primary care physicians who can use it with or without a bone density test. Patients can use this tool themselves though they will need to convert height and weight to centimeters to get accurate results. The FRAX is available at no cost through the University of Sheffield at this address: https://www.shef.ac.uk/FRAX/tool.jsp Imaging The most common test for osteoporosis is a non-invasive x-ray of bones. This procedure, known as a bone mineral density (BMD) test, commonly targets the bones most at risk for problematic breaks:

Prevention with proper diet and exercise should be the main focus! Much of osteoporosis bone loss is irreversible. Due to the high incidence of osteoporosis in people over fifty, anyone in that age bracket is advised to adopt healthy preventive measures to avoid developing osteoporosis. Ideally, prevention with proper diet and exercise should begin before puberty, when bones are growing. This is needed lay done a proper foundation of strong bones. Adequate intake of calcium Dairy Products; milk, yogurt, cheese. Spinach, Kale, Okra, Collards, Soybeans, White beans,  Some fish; sardines, salmon, perch, and rainbow trout Foods that are calcium fortified, such as some orange juice, oatmeal, and breakfast cereal 1000mg/d for men and premenopausal women 1200-1500mg/day for postmenopausal (between 4-5 cups of milk) Calcium sources Calcium supplements: calcium carbonate and calcium citrate for those unable to obtain enough calcium from diet alone Adequate vitamin D intake  (Vitamin D insufficiency <32ng/mL) 800-1000IU intake daily Sunlight, 15 minutes a day Beef liver, Cheese, Egg yolks, Fatty fish; tuna, mackerel, and salmon Foods fortified with vitamin D; some dairy products, orange juice, soy milk, and cereals Weight bearing exercise to increase bone density Exercise alone is not effective for post-menopausal women as effects of exercise are estrogen dependent Maintenance of normal body weight   Avoid cigarette smoking and excessive alcohol intake

There is a debate within the medical community as to whether osteoporosis is reversible, but the condition can definitely be stabilized and symptoms reduced with proper treatment. When it is caught early, treatment consists mostly of lifestyle changes consisting of proper exercise, diet, and avoiding substances that weaken the bones. Adequate intake of calcium Dairy products are high in calcium, but if a patient cannot tolerate dairy, many other foods, especially fish, soy products, fortified cereals, and dark leafy vegetables, have natural or added calcium. Calcium can also be taken as a pill supplement. When taking calcium tablets, it is important not to exceed the recommended daily dose of calcium, because calcium overdose can cause a multitude of health issues. For women over fifty, the daily recommended allowance of calcium is 1200 milligrams. Under no circumstances should a woman take in more than 2000 milligrams of calcium a day. For men aged 51-70, the recommended daily allowance of calcium is 1000 milligrams, and the upper safe limit is 2000. When a man turns 71, his recommended allowance increases to 1200  milligrams, but the upper limit remains 2000. Calcium food sources and overview Dairy Products; milk, yogurt, cheese. Spinach, Kale, Okra, Collards, Soy beans, White beans,  Some fish; sardines, salmon, perch, and rainbow trout Foods that are calcium fortified, such as some orange juice, oatmeal, and breakfast cereal 1000mg/d for men and premenopausal women 1200-1500mg/day for postmenopausal (between 4-5 cups of milk) Calcium supplements:

For people who have more advanced osteoporosis, prescription medications, as well as lifestyle modifications, may be necessary to control and mitigate the disease. When to Start Osteoporosis Medications In post-menopausal women and men >50 yrs old with T-score >2.5 and <-1.0 with a FRAX score of >20% for major osteoporotic fracture risk and .3% for hip fracture risk typical fragility fractures T-scores < -2.5, Multiple risk factors; particularly those who already had fracture The prescription drugs Alendronate, Risedronate, Ibandronate, and Zoledronic acid are the most commonly prescribed drugs in the treatment of this disease. They belong to a class of pharmaceuticals known as bisphosphonates. These medications are typically taken orally once a week or once a month or by injection once every year or once every three months. Bisphosphonates : synthetic analogues of pyrophosphates. Reduce bone resorption and bone loss by binding to bone and poisoning active osteoclasts. Medication shows yearly bone density increases of 2-3% at the lumbar spine. Brands Alendronate (Fosamax) 5mg/day for prevention, 10mg/day for treatment Risedronate (Actonel) prevention and treatment dose in the same. 5mg/day, 35mg once a week, 75mg 2x a month, or 150mg once a month Zoledronic Acid (Reclast) 5mg IV once yearly Instructions:

Cautions:  All people with osteoporosis are advised to avoid the risk of falling. People with advanced osteoporosis will be cautioned by their doctor to perform low-impact, low risk exercises such as water aerobics, walking, and swimming.  Many will be advised to avoid extreme sports, skiing, jogging, and climbing where falls are common. Future outlook on the condition:  Some experts estimate that Osteoporosis currently causes 1.3 million bone fractures a year. According to an article published in the American Journal of Medicine , the cost of osteoporosis death and disability in the United States was between seven and ten billion dollars in 1986. As the elderly population in the United States grows, the problem of osteoporosis will grow with it. Beginning in 2013, doctors were examining the relationship of magnesium to osteoporosis. Early analyses suggest that both low magnesium and elevated magnesium aggravate osteoporosis. Further research will be needed to verify these findings. For the most part, however, future research on osteoporosis is likely to focus on the development of new drugs that don’t just inhibit bone loss, but actually stimulate bone tissue formation. Because of the high cost of osteoporosis in the United States, research is needed to suggest ways to prevent and treat the disease