Osteoporosis is a disease in which bones become fragile and more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones occur typically in the hip, spine, and wrist. Of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability or death. Spinal fractures also have serious consequences, including loss of height, severe back pain, and deformity.
There are two main considerations when diagnosing and treating osteoporosis:
1. Bone quantity
2. Bone quality

Both bone quantity and quality need to be optimized in order to halt or reverse the osteoporosis. We also need to address fall avoidance.
· The risk of falling increases with age and is greater for women than for men.
· Two-thirds of those who experience a fall will fall again within six months.
· A decrease in bone density contributes to falls and resultant injuries.
· Failure to exercise regularly results in poor muscle tone, decreased strength, and loss of bone mass and flexibility.
· At least one-third of all falls in the elderly involve environmental hazards in the home.

What are the best methods to detect osteoporosis?
· DEXA scans: DEXA is a type of X-ray exam, and is the most commonly used test for measuring bone mineral density; in other words body quantity. DEXA scans only predict 44% of elderly women and 21% of elderly men who actually progress to an ·osteoporotic fracture, so DEXA is not a very accurate measure of actual fracture risk.
· Blood tests
· N-telopeptide (N-terminal telopeptide of type 1 collagen) – a peptide fragment from the amino terminal end of the protein matrix; it is recommended that the test be performed at baseline before starting osteoporosis therapy and again 6 months later
· P1NP (Procollagen Type 1 N-Terminal Propeptide) – formed by osteoblasts; reflects rate of collagen and bone formation; may be ordered along with bone resorption marker such as C or N-telopeptide; most sensitive marker of bone formation and particularly useful for monitoring bone formation therapies and antiresorptive therapies; it is recommended that the test be performed at baseline before starting osteoporosis therapy and again 6 months later.
· Osteocalcin (bone gla protein) – a protein formed by osteoblasts; part of the non-collagen portion of the new bone structure; some of it also enters the bloodstream; osteocalcin helps to predict the rate of bone loss in postmenopausal women and can serve as an indicator of the rate of bone remodeling; somewhat helpful in choosing most effective treatment for osteoporosis but not as sensitive to change as are the telopeptides

Non-drug treatments
The ideal nutritional supplement should contain:
Vitamin K2 (as MK7 and MK4)
Calcium
Magnesium
Vitamin D3
Boron

Fall prevention
· Wear proper fitting, supportive shoes with low heels or rubber soles.
· Correct your age-related vision diseases and clean your eye glasses on a regular basis
· Check with your doctor regarding the prescription drugs you are taking. Sedatives, anti-depressants, and anti-psychotic drugs can contribute to falls by reducing mental alertness, worsening balance and gait, and causing drops in systolic blood pressure while standing. Additionally, people taking multiple medications are at greater risk of falling.
· Schedule a home visit by an interior designer or occupational therapist might who is trained to identify fall risk factors and recommend appropriate actions.

It is extremely important to prevent falls – here are a few of the better known statistics
· The risk of falling increases with age and is greater for women than men.
· Annually, falls are reported by one-third of all people 65 and older.
· Two-thirds of those who fall will fall again within six months.
· Falls are the leading cause of death from injury among people 65 or over.
· Approximately 9,500 deaths in older Americans are associated with falls each year. The elderly account for seventy-five percent of deaths from falls.
· More than half of all fatal falls involve people 75 or over, only 4 percent of the total population.
· Among people 65 to 69, one out of every 200 falls results in a hip fracture, and among those 85 or over, one fall in 10 results in a hip fracture.
· One-fourth of those who fracture a hip die within six months of the injury.
· The most profound effect of falling is the loss of independent functioning. Twenty-five percent of those who fracture a hip require life-long nursing care. About 50 percent of the elderly who sustain a fall-related injury will be discharged to a nursing home rather than return home.
· Most falls do not result in serious injury. However, there is often a psychological impact. Approximately 25 percent of community-dwelling people 75 or over unnecessarily restrict their activities because of fear of falling.
· The majority of the lifetime cost of injury for people 65 or over can be attributed to falls.