This report on osteoporosis is in four parts. Part one is an introduction to osteoporosis; part two, "By the numbers," is a collection of statistics which demonstrate the extent and severity of this disease in America; part three concerns prevention and treatment, and part four describes the medications used to combat osteoporosis.

It would take the combined populations of New York City, Chicago and Philadelphia to equal the number of Americans already living with osteoporosis. If these people were lined up shoulder to shoulder, they would stretch from New York City to Los Angeles--more than three times! And many more people are at risk for developing osteoporosis in the near future.

Known as “the silent disease” because patients usually don’t know they have it until the suffer a fracture, the human toll of osteoporosis is staggering. The effects of osteoporosis range from simple fractures and loss of mobility, to disfigurement, loss of self-esteem, decreased independence and even death.

The National Osteoporosis Foundation defines this ubiquitous condition as “a symptomless disease characterized by bone loss and deterioration of the skeleton, leading to bone fragility and increased risk of fractures. It is defined as about 25% bone loss compared to a healthy young adult or, on a bone density test, 2.5 standard deviations below normal.” Although some bone loss is common with age, patients usually discover they have a serious condition only after their bones become weak enough that a simple bump or fall causes a bone fracture or a vertebra to collapse.

Monetary expenditures for hospital treatment and long term nursing home care directly associated with bone fractures surpasses $13.8 billion per year, ($38 million every day), and the cost is steadily increasing. Over half the patients responding to an international survey on pemphigus reported developing osteoporosis as a result of long term use of Prednisone. No one taking steroids for more than six months should take the risks of osteoporosis lightly.

Osteoporosis is more than just brittle bones. It is a disorder caused by a malfunction of the endocrine system, the glands and tissues that produce hormones. Hormones, such as estrogen, enable calcium absorption from the blood, reduce calcium depletion facilitate bone rebuilding and lessen the breakdown of the skeletal material. The specialists who treat diseases relating to hormone producing glands are Endocrinologists.

The American Association of Clinical Endocrinologists (AACE) released the “2001 AACE Medical Guidelines for Clinical Practice for the Prevention and Management of Postmenopausal Osteoporosis.” These guidelines were developed to improve diagnosis and treatment, and reduce the number and severity of fractures related to osteoporosis.

An Endocrinologist should be consulted when osteoporosis is severe or has unusual features, occurs at a young age (premenopausal for women), very low bone density, fractures even at near normal bone density, an endocrine disorder such as hyperthyroidism, hyperparathyroidism, Cushing's syndrome or hypogonadism. Specialists should be utilized also whenever a patient fails to respond to initial treatment. Other conditions which deserve a specialists attention include, abnormal ovarian function or cessation of ovarian function due to menopause, excessive exercise, dieting or surgical removal of the ovaries; or testosterone or androgen deficiency in men; excess thyroid hormone or overactive thyroid, Type 1 diabetes and eating disorders such as anorexia nervosa or bulimia.