A number of factors can increase the likelihood that you'll develop osteoporosis, including:

* Your sex. Fractures from osteoporosis are about twice as common in women as they are in men. That's because women start out with lower bone mass and tend to live longer. They also experience a sudden drop in estrogen at menopause that accelerates bone loss. Slender, small-framed women are particularly at risk. Men who have low levels of the male hormone testosterone also are at increased risk. The risk of osteoporosis in men is greatest from age 75 on.

* Age. The older you get, the higher your risk of osteoporosis. Your bones become weaker as you age.

* Race. You're at greatest risk of osteoporosis if you're white or of Southeast Asian descent. Black and Hispanic men and women have a lower, but still significant, risk.

* Family history. Osteoporosis runs in families. For that reason, having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures.

* Frame size. Men and women who are exceptionally thin or have small body frames tend to have higher risk because they may have less bone mass to draw from as they age.

* Tobacco use. The exact role tobacco plays in osteoporosis isn't clearly understood, but researchers do know that tobacco use contributes to weak bones.

* Lifetime exposure to estrogen. The greater a woman's lifetime exposure to estrogen, the lower her risk of osteoporosis. For example, you have a lower risk if you have a late menopause or you began menstruating at an earlier than average age. But your risk of osteoporosis is increased if your lifetime exposure to estrogen has been deficient, such as from infrequent menstrual periods or menopause before age 45.

* Eating disorders. Women and men with anorexia nervosa or bulimia are at higher risk of lower bone density in their lower backs and hips.

* Corticosteroid medications. Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, is damaging to bone. These medications are common treatments for chronic conditions, such as asthma, rheumatoid arthritis and psoriasis. If you need to take a steroid medication for long periods, your doctor should monitor your bone density and recommend other drugs to help prevent bone loss.

* Thyroid hormone. Too much thyroid hormone also can cause bone loss. This can occur either because your thyroid is overactive (hyperthyroidism) or because you take excess amounts of thyroid hormone medication to treat an underactive thyroid (hypothyroidism).

* Selective serotonin reuptake inhibitors (SSRIs). Research published in 2007 showed lower bone mineral density among both men and women currently using SSRIs compared with study participants not taking these antidepressants. However, these results don't necessarily mean that SSRIs cause bone loss or osteoporosis. More research is needed to fully understand the association between SSRI use and low bone density. Evidence does not currently indicate that you should stop using SSRIs because of concerns about bone loss.

* Other medications. Long-term use of the blood-thinning medication heparin, the cancer treatment drug methotrexate, some anti-seizure medications, diuretics and aluminum-containing antacids also can cause bone loss.

* Breast cancer. Postmenopausal women who have had breast cancer are at increased risk of osteoporosis, especially if they were treated with chemotherapy or aromatase inhibitors such as anastrozole and letrozole, which suppress estrogen. This isn't true for women treated with tamoxifen, which may reduce the risk of fractures.

* Low calcium intake. A lifelong lack of calcium plays a major role in the development of osteoporosis. Low calcium intake contributes to poor bone density, early bone loss and an increased risk of fractures.

* Medical conditions and procedures that decrease calcium absorption. Stomach surgery (gastrectomy) can affect your body's ability to absorb calcium. So can conditions such as Crohn's disease, celiac disease, vitamin D deficiency, anorexia nervosa and Cushing's disease - a rare disorder in which your adrenal glands produce excessive corticosteroid hormones.

* Sedentary lifestyle. Bone health begins in childhood. Children who are physically active and consume adequate amounts of calcium-containing foods have the greatest bone density. Any weight-bearing exercise is beneficial, but jumping and hopping seem particularly helpful for creating healthy bones. Exercise throughout life is important, but you can increase your bone density at any age.

* Excess soda consumption. The link between osteoporosis and caffeinated sodas isn't clear, but caffeine may interfere with calcium absorption and its diuretic effect may increase mineral loss. In addition, the phosphoric acid in soda may contribute to bone loss by changing the acid balance in your blood. If you do drink caffeinated soda, be sure to get adequate calcium and vitamin D from other sources in your diet or from supplements.

* Chronic alcoholism. For men, alcoholism is one of the leading risk factors for osteoporosis. Excess consumption of alcohol reduces bone formation and interferes with the body's ability to absorb calcium.

* Depression. People who experience serious depression have increased rates of bone loss.

NOF's Five Steps to Bone Health and Osteoporosis Prevention:

1. Get your daily recommended amounts of calcium and
vitamin D.

2. Engage in regular weight-bearing exercise

3. Avoid smoking and excessive alcohol

4. Talk to your healthcare provider about bone
health.

5. When appropriate, have a bone density test and
take medication.

If you are premenopausal or postmenopausal, but on hormone replacement therapy, you need at least 1,000 milligrams of calcium and 800 units of vitamin D per day. If you are postmenopausal, but not on hormone replacement, or you are over 65, you should be getting 1,500 milligrams of calcium per day.

When it comes to getting more calcium in your diet, most of us automatically think of milk and other dairy products. However, there are many other foods, such as almonds, broccoli, green leafy vegetables, and soy products, such as tofu, which are all rich in calcium.

Vitamin D is needed in order for your body to absorb calcium. Without it, your body will "rob" calcium from the skeleton, resulting in weakened bones, and the prevention of new bone formation.

If you are not getting sufficient calcium from the foods you eat, you should consider taking a calcium supplement, many of which also contain appropriate amounts of vitamin D. Calcium carbonate, calcium phosphate, and calcium citrate are all compounds containing calcium. While calcium carbonate is absorbed best when taken with food, calcium citrate can be taken anytime, an important consideration if you will be taking your supplement on an empty stomach. When choosing a calcium supplement, look for familiar brand names, as well as the USP (United States Pharmacopeia) symbol, to ensure you are getting a quality product.

Be sure to take no more than 500 milligrams of calcium at once, as your body cannot absorb more than that at one time. Also be aware that some people experience gas or constipation when taking calcium. If this happens, you may need to increase your intake of water and high fiber foods to offset the problem. Finally, you should talk with your doctor or pharmacist about any possible interactions between your prescription as well as over-the-counter medications and calcium supplements.

Three important types of exercise for building and maintaining bone density are weight-bearing, resistance, and flexibility exercises. Weight-bearing is any exercise in which your legs and feet are bearing the weight of your body. Walking, jogging, stair climbing, and dancing are all weight-bearing exercises. Walking just three to five miles per week can really help to strengthen your bones.

Weight lifting using free weights or weight machines and water exercises are resistance exercises. Also known as strength training, this type of exercise involves working against the force of another object, and can slow the rate of mineral loss from bone.

Flexibility exercises such as stretching, T'ai chi, and Yoga, help make joints more flexible, and therefore may prevent injury.

Be sure to consult your doctor before beginning any exercise program. This is particularly important if you already have bone loss or osteoporosis.

The DEXA (Dual Energy X-Ray Absorptiometry) scan is the most commonly used test for measuring bone mineral density, and one of the most accurate ways to diagnose osteoporosis. It uses low energy x-rays to measure how dense your bones are, usually at your hip or spine, where fractures are most likely to occur. The DEXA scan is a simple non-invasive procedure which is painless and exposes you to only a minimal amount of radiation - less than what you would receive from a chest x-ray.

All postmenopausal women under age 65 who have one or more additional risk factors for osteoporosis (in addition to being postmenopausal and female)

All women age 65 and older regardless of additional risk factors

Postmenopausal women who sustain a fracture

Women who are considering therapy for osteoporosis if bone density testing would facilitate the decision

Women who have been on hormone replacement therapy (HRT/ERT) for prolonged periods

*Guidelines from the National Osteoporosis Foundation

Several medications are available for osteoporosis treatment:

Bisphosphanates such as Fosamax, Actonel, Boniva, and Reclast help regulate calcium and prevent bone breakdown. Most bisphosphanates are taken by mouth (Reclast is an intravenous medication) on a daily, weekly, or monthly basis. They need to be taken with a full glass of water on an empty stomach, after arising in the morning. You must be able to remain in an upright position, and wait 30 minutes before eating or drinking, or taking any other medications. Your calcium and vitamin D should be taken at least 2 hours before or after taking bisphosphanates.

When taken as directed, side effects are rare, but may include heartburn, abdominal pain and irritation of the esophagus, headache, pain in your muscles and joints, constipation, diarrhea, difficulty swallowing, and increased gas. It could take several months for heartburn to appear.

Calcitonin (brand names Miacalcin and Fortical) is a naturally occurring hormone which helps to regulate calcium and bone metabolism. Available as an injection or nasal spray, it increases bone density in the spine and slows bones loss.

The injectable form of calcitonin may cause an allergic reaction. Possible side effects are flushing of the face and hands, urinary frequency, nausea or skin rash. Side effects for the nasal spray are runny nose, headache, back pain, and nosebleed.

Hormone Replacement Therapy, also known as Estrogen Replacement Therapy, is approved for the treatment of osteoporosis because it has been shown to reduce the incidence of fractures in the hip and spine in postmenopausal women. However, given recent findings that Hormone Replacement Therapy may increase the risk of certain types of cancer, as well as strokes and heart attacks, it is best to consider other osteoporosis medications.

Raloxifene (brand name Evista) was developed to provide the benefits of estrogen without the risks. It is taken once a day in pill form.

Side effects for Evista are mild, and include hot flashes and leg cramps. Although rare, a much more serious side effect is blood clots in the veins. Pain in the calves of the leg, leg swelling, sudden chest pain or shortness of breath, coughing up blood, or visual disturbance should be reported to your physician immediately.

Parathyroid hormone - Teriparatide (brand name Forteo) is the only approved treatment for osteoporosis which actually increases formation of bone instead of slowing its loss. It is taken as a daily injection for up to 24 months.

The FDA warns that in pre-approval studies of Forteo using rats, there was an increase in the occurrence of osteosarcoma, a rare but serious form of bone cancer. It is possible that taking Forteo could increase your own risk of developing osteosarcoma.

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