According to the World Health Organization, Osteoporosis is a progressive disease associated with low bone density and deterioration of bones that increases the risk of fractures due to bone fragility (Khan, et al, 2004). Inside the body, bone tissues are renewed through the action of osteoblasts and osteoclasts. During Childhood, the increase in the size of bones results in an increase in bone mass. The peak bone mass is attained in the third decade of individuals' lives. Once individuals reach their fifties, age related bone loss is believed to start because as individuals age, instead of laying down new bone tissue, the resorption of bone tissue is favoured (Parsons, et al, 1996). Since compared to men, women have a lower peak bone mass before the age related bone mass decline begins, they have an increased chance of developing osteoporosis. Therefore, peak bone mass is an important factor that determines individuals' risk of developing osteoporosis. It is believed that genetic factors, in particular collagen type IA 1 gene, are responsible for the various peak bone masses in different individuals (Ralston, 2007).
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In women the reproductive system and its hormones have a great impact on the skeleton. Starting from puberty, the circulating estrogen in the body binds to estrogen receptors in bone cells and reduces bone resorption and promotes bone formation (Lindsay, Gallagher ,Â Kleerekoper ,&Â Pickar, 2002). Therefore, in postmenopausal women the low levels of estrogen are the leading cause of bone loss (Compston, 2010).
In addition, osteoporosis can also develop as a result of using different medications. For instance, this type of osteoporosis known as secondary osteoporosis can develop because of using glucocorticoids. Glucocorticoids are used to treat autoimmune disease and they also increase bone resorption and inhibit bone formation (Canalis, Mazziotti, Giustina,& Bilezikian ,2007). Some reports suggest that even low doses of glucocorticoids have a negative impact on the skeleton and can increase the risk of fractures by five folds. Furthermore, fractures in glucocorticoid- induced osteoporosis can occur at higher bone mineral density(BMD) compared to other types of osteoporosis(Vestergaard, Rejnmark, &Mosekilde, 2008).
Treatments of osteoporosis have different goals, including preventing the progression of the disease and maintaining the existing BMD and preventing fractures. Since bones require a limited amount of mechanical strain by means of exercising to stay healthy, exercise is an important factor in preventing and treating osteoporosis. Specifically, weight-bearing exercises can result in a higher peak bone mass among the young (Brown, Fortier, Frame, 2006). Similarly, in older individuals exercises, such as jogging and walking, can increase mobility and decrease the chance of developing kyphosis and fractures (Sinaki , Wahner , Offord , Hodgson, 1989).
Another factor that is both important in prevention and treatment of osteoporosis is calcium intake. According to one survey, the risk of bone fractures is doubled in women over the age of fifty, who had a low milk intake in their childhood. Calcium increases the peak bone mass and therefore individuals' diet has a direct impact on their bone health (Kalkwarf, Khoury ,& Lanphear, 2003). Also, Vitamin D supplements are used to treat osteoporosis, since calcium absorption depends on the action of this vitamin in the body. In fact, it is believed that without Vitamin D, less than 10% of Calcium is absorbed in the body(Brown et al, 2006).
There are still some questions that remain unanswered about osteoporosis. For instance, a few studies suggest that nutrients in fruits and vegetables also affect bone health, but the complete mechanism is unknown (Tucker, 2009). Also, the specific changes to bones as a result of continuous exercise are still unknown. This is important because in some cases even very small geometrical changes in bones can make them stronger (Daly, 2007).
While the body mechanism and the process of aging often results in a loss of BMD and osteoporosis, it is important to understand the risk factors and take preventive measures to reduce the chance of developing osteoporosis. In this way the complications of this disease along with the financial burden on individuals and economies can be reduced.
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